Alcohol use and related Anxiety

Anxiety is a feeling of worry, unease, and/or fear which can also be accompanied by physical sensations like nausea and chest tightness. “Hangxiety” (hangover anxiety), is similar except that it typically follows an episode of drinking.

Studies show that alcohol can lead to anxiety, especially when consumed in excess or when used as a response to stress or other negative emotions including anxiety. Understanding what’s happening as well as the physiological and psychological causes of anxiety may help you avoid it in the future.

Physiological Causes

Hangxiety has two primary physiological causes. These include increased cortisol levels and decreases in GABA in the brain.

Increased Cortisol Levels

Cortisol is a stress hormone that is responsible for regulating multiple systems within the body including immune, reward, and cognitive systems. Cortisol levels begin to increase late in the night, peak in the morning, slowly decreasing throughout the day, and hitting their low point during early sleep cycles. Heavy drinking disrupts this cycle by both increasing cortisol levels and not allowing them to naturally decrease. This induces a “stress state” within the body.

A 2019 study published in Addiction Biology compared those who participated in binge and heavy drinking to social drinkers who drank moderately. It found that stress in combination with alcohol cues increased cravings in those who drank heavily or binged on alcohol but not in the moderate drinker group. Those who binged or drank heavily also had a rise in cortisol after drinking which was associated with even more cravings for alcohol.

Decreased GABA in the Brain

The human brain strives to maintain homeostasis between our main excitatory neurotransmitter, glutamate, and our main inhibitory neurotransmitter, gamma-aminobutyric acid (GABA). In their extreme states too much glutamate will result in seizure and too much GABA will result in coma.

Alcohol boosts GABA and slows down brain activity leading to a feeling of relaxation when drinking. As mentioned previously the brain is always striving for homeostasis so in response to increased GABA it reduces GABA receptors AND increases glutamate production. This effect is also partially responsible for alcohol tolerance.

With less GABA receptors, it takes more alcohol to give us the desired calming effect. Plus the additional glutamate creates increased excitability which makes us susceptible to anxiety. When the alcohol leaves your system, the additional GABA it was supplying leaves as well, you are then left with an imbalance favoring glutamate. This state leads to increased levels of anxiety furthering the cycle of wanting more alcohol. In some cases, this additional glutamate can lead to seizures commonly seen in untreated alcohol withdrawal.

Psychological Causes

In addition to the physiological causes, there are psychological causes of anxiety including regret, worry, and expectation.

Regret and Worry

Waking up with a fuzzy memory can lead to spiraling negative thoughts and anxiety related to what you did the night before if you offended anyone if you hurt anyone, and if you will be confronted. Regret and worry are particularly prevalent after blacking out from drinking and trying to piece together the binge-drinking episode.



If you expect to feel relaxed after drinking, you may feel anxious if this doesn’t happen. This can lead to increased levels of worry and fear as you struggle to understand why you’re feeling anxious instead of relaxed. This compounds the physiological causes of anxiety we discussed earlier.

Here at Harbor Wellness and Recovery Center, we offer various levels of care to treat those struggling with their alcohol use. We also treat individuals with co-occurring mental health conditions. If you or someone you care about is struggling with alcohol we can help. We are available 24/7/365 and offer no-cost and totally confidential consultations to discuss options for helping you or your loved one. Call us at 732-847-4555 or email us at to start the journey to recovery today.