Searching for anxiety relief in alcohol can be dangerous

November 13, 2000

Most people experience "butterflies" in their stomachs when faced with the prospect of speaking before an audience. People with high anxiety sensitivity (AS) have a fear of anxiety symptoms themselves. Feeling common anxiety symptoms such as "butterflies," rapid breathing, or an increased heart rate in the face of a stressful situation tends to amplify their anxious response. A study in the November issue of Alcoholism: Clinical & Experimental Research investigated if high AS individuals are more soothed by alcohol than low AS individuals after being exposed to a stressful situation.

"People diagnosed with alcohol problems exhibit significantly higher levels of anxiety sensitivity than non-clinical populations," said Alan B. MacDonald, a doctoral candidate in psychology at Dalhousie University and one of two first authors of the study. "Just as everyone experiences some degree of anxiety in their lives, almost everyone has some degree of anxiety sensitivity. However, people who have high anxiety sensitivity are people on the upper end of the continuum." MacDonald estimates that approximately 16 percent of the population, or roughly between one in six or seven people, has high AS.

"Anxiety sensitive individuals are people who have a fear of anxiety, basically," said Robert O. Pihl, professor of psychology and psychiatry at McGill University. "It's kind of an anticipatory type response. This study helps us understand why these individuals are highly likely to become alcohol abusers. Furthermore, the literature tells us that the abuse is not just about alcohol, it can involve anything that reduces that anticipatory anxiety."

Although prior research has clearly demonstrated a link between alcohol problems and high AS, it has not established causality. This is, does high AS contribute to alcohol abuse or is it the other way around? This study examined volunteer undergraduate students with high or low AS who did not have, or were not yet diagnosed with, an alcohol problem. Participants were asked to hyperventilate for three minutes to induce anxiety-like symptoms. Following hyperventilation, participants were asked to report on three aspects of their experience: fearful thoughts, such as losing control; negative feelings, such as nervousness; and body sensations, such as an increased heart rate. Two doses of alcohol (high and low) were then administered.

Following the hyperventilation exercise and while completely sober, high AS participants reported significantly more fearful thoughts and negative feelings than the low AS participants. They also reported experiencing these negative thoughts and feelings more intensely than their low AS counterparts. After ingesting alcohol (both the high and low doses), high AS individuals showed much greater reductions in their fearful thoughts and negative feelings than the low AS participants. The high AS individuals not only found the alcohol more "soothing" (in that they experienced a greater reduction in their worries and concerns) than did their low AS counterparts, but this soothing effect became more pronounced the more they drank. In other words, more alcohol provided more relief for high AS individuals from their anxiety sensations. MacDonald said that "coping" as a reason for drinking is a well-known marker for future alcohol abuse.

"Our findings support the idea that high AS individuals may drink to cope with unpleasant sensations associated with anxiety, which could in turn lead to alcohol abuse," said MacDonald. "Moreover, the more they drink, the greater the benefit they experience in terms of avoiding these unpleasant sensations. This may explain why high AS individuals report drinking to excess more frequently than the regular population."

Although it might be said that people with high AS experience more benefits or positive effects from the stress-response dampening properties of alcohol, developing a dependency on alcohol is a potential downside. High AS individuals could become highly motivated to drink as a means of avoiding or reducing the anxiety sensations that they find so uncomfortable. With such a strong motivation to drink, it should not therefore be surprising that alcohol abuse is likely in this population.

"Our findings have opened a small window into why some people may learn to abuse alcohol," said MacDonald. "Knowing why leads to knowing what to do about it. We know that about one in seven readers of this article may have a high degree of AS. We are not saying that all people with high AS will necessarily go on to abuse alcohol, but it does appear that they are a high-risk group. If a reader recognizes that they may have high AS, perhaps they should think twice about using alcohol to feel better about their anxiety symptoms."

MacDonald believes the study's findings have implications for both prevention and treatment programs. "There is something unique about anxiety sensitivity, rather than anxiety per se, which may lead to future alcohol problems. Also, we need to study how well people are able to stay abstinent with or without treatment of anxiety sensitivity." He suspects that treatment of high AS may enhance this population's ability to stay abstinent from alcohol.

Indeed, Pihl believes it is imperative to be as specific as possible when looking for the different reasons why people abuse alcohol and other drugs. "We can't look at these individuals as one kind of ubiquitous mass," he said. "When someone talks about 'alcoholism,' that doesn't really explain anything. That doesn't tell you 'why.' There are multiple reasons why things happen, and it's important to understand the reasons why before you get into any kind of treatment. Treatment should be specific to the 'why.'"
Jan M. Baker, now at the Department of Psychology at Queens University, shared first co-authorship of the Alcoholism: Clinical & Experimental Research paper. Additional co-authors included: Sherry H. Stewart of the Department of Psychology at Dalhousie University; and Michelle Skinner, now at the University of New Brunswick. The study was funded by the Medical Research Council of Canada, and the Alcoholic Beverage Medical Research Foundation.

Alcoholism: Clinical & Experimental Research

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