When Anxiety and Drinking Feed Each Other

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Written by the Coastwise Clinical Team

Someone has two glasses of wine before a family dinner because the dinner is hard, and it works. It works reliably, within about twenty minutes, and it is cheaper and faster than anything else available that evening. Nobody develops a drinking problem because drinking fails them. The pattern takes hold because it succeeds at what it is being asked to do.

Anxiety and drinking reinforce each other in a loop that closes quietly. Alcohol quiets anxiety in the moment and raises it the following day, so the next evening starts from a higher baseline, and the same two glasses do slightly less work. People notice the drinking long before they notice the anxiety underneath it, and by then the two are difficult to separate.

Is it anxiety, or is it drinking?

Usually both, and the order matters less than it seems. The clinical term is co-occurring disorders, sometimes called dual diagnosis, which simply means a substance use condition and a mental health condition present at the same time.

National SAMHSA data puts the overlap at roughly half of people with a substance use disorder. The conditions are rarely independent. The anxiety is often driving the drinking, and the drinking is reliably making the anxiety worse, which is why trying to establish which came first tends to stall the conversation rather than move it.

Which pairings show up most often?

Any mental health condition can sit alongside any substance, but five pairings account for most of what walks through the door. Each one runs in both directions, which is the part that makes it hard to interrupt.

The pairing	What the substance does for it	What it does back
Anxiety and alcohol	Quiets anxiety within about twenty minutes, which makes it the most reliable tool available on a bad evening.	Withdrawal raises baseline anxiety, so each morning starts higher and the same amount does less.
Depression and alcohol or opioids	Blunts the flatness and the heaviness for a few hours.	Both are depressants. The cycle people describe is using to feel less bad, feeling worse after, and using more.
PTSD and substance use	Dampens hyperarousal, intrusive memories, and the sense of being permanently switched on.	Leaves the trauma untreated, and untreated trauma is one of the most consistent predictors of return to use. EMDR usually has to be part of the work.
Bipolar disorder and substance use	Smooths a mood episode in either direction, at least briefly.	Substance use can trigger episodes, and mania drives impulsive use. This pairing needs therapy coordinated with whoever manages the medication.
ADHD and cannabis or stimulants	Slows a loud mind down, or sharpens focus that will not arrive on its own.	Undiagnosed ADHD keeps the pattern running. Treating the ADHD properly often reduces the use that started as self-medication.

Why does treating one side first usually fail?

Because the side left untreated is often the one holding the pattern in place. The older model was sequential: stop the drinking, then deal with whatever is underneath. It produced poor outcomes consistently enough that the field moved away from it.

If someone is drinking to manage anxiety, and they get sober without treating the anxiety, the anxiety comes back full force. The tool that was managing it is gone. The pressure to return to drinking is enormous. This is not a failure of willpower. It is a predictable consequence of leaving the underlying driver untouched.

The same dynamic holds across every pairing in the table above. Untreated depression pulls people back to opioids, untreated trauma pulls them back to alcohol, and untreated ADHD pulls them back to cannabis. When the mental health side is left alone, the substance returns as the familiar way of managing it.

The research on this is clear: integrated treatment, where both conditions are addressed at the same time by the same clinical team, produces better long-term outcomes than treating them separately or in sequence.

What does the work actually look like?

Both sides are handled by the same licensed clinician, in weekly individual therapy, rather than one provider for the anxiety and another for the drinking. That matters more than it sounds. Two providers who do not speak to each other will each treat their half, and the loop between the halves is the thing that needs attention.

In practice the work includes:

• A clinical assessment to identify co-occurring conditions and understand what's driving the substance use
• Individual therapy with a licensed clinician trained in both sides, certified in addiction counseling, never a trainee practising alone
• Work on relapse prevention alongside emotional regulation, distress tolerance, and interpersonal skills
• Specialty modalities: EMDR for trauma-driven substance use, Ketamine-Assisted Psychotherapy for treatment-resistant depression or PTSD, CBT for anxiety and depression, DBT for emotional regulation
• Coordination with your other providers and external supports when that helps your care
• Family involvement where it helps, because the pattern rarely sits with one person alone

Coastwise is an outpatient therapy practice, not a treatment program. There is no detox, no residential, no partial hospitalization or intensive outpatient here, and no psychiatry or medication management. When someone needs one of those, we say so and help find it.

Can this be treated in weekly therapy?

For most people, yes. A common assumption is that anything co-occurring needs a program, and that is not what the evidence supports. There is a real advantage to doing the work in weekly outpatient therapy, because it happens inside the life where the pattern actually plays out. A skill practised on a Tuesday evening at home holds up better than one practised in a facility.

A higher level of care may be indicated in specific situations, including acute psychiatric instability or severe withdrawal risk, and when that's the right fit we'll help you find it. For many people, though, ongoing one-on-one therapy is enough to do the work.

Does insurance cover this?

Coastwise works with insurance, and many clients use their benefits toward therapy here. We can walk you through how your plan applies, though we cannot tell you what a specific plan will pay. Call (424) 536-3002 or see which plans we work with.

If any part of this includes thoughts of harming yourself, call or text 988. It is free, confidential, and available at any hour.

Getting started at Coastwise

If the drinking and the anxiety have been circling each other for a while, that is a reason to call, not a reason to wait until one of them is worse. Start with a free fifteen-minute consultation. We will talk through what has been happening and which of our licensed clinicians fits it, and you decide who to work with through Coastwise Health.

Call (424) 536-3002 or request a consultation online. Monday through Friday, 9:00 AM to 8:00 PM.

Located at 1366 W 7th Street, San Pedro, CA.