Alcohol and Mental Health: How Drinking Affects Mood, Anxiety and Sleep

For many people, a drink is part of how they unwind: a glass of wine after a long day, a beer with friends, a toast at a celebration. If you have ever noticed that you feel jittery, low or "off" the day after drinking, or that a nightcap leaves you more tired rather than less, you have already seen the connection between alcohol and mental health. This article explains what is going on, what signs to watch for and what you can do if you want to change your relationship with alcohol.

Why alcohol feels relaxing at first

Alcohol slows down activity in the brain. In the short term, that can make people feel calmer, more relaxed and more sociable, and sometimes even euphoric.

The catch is that the brain works hard to keep itself in balance. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the brain quickly adjusts to alcohol's pleasant effects, and as the buzz wears off people can end up feeling more restless and anxious than they did before they started drinking. Anxiety and irritability are listed among the typical symptoms of a hangover, alongside fatigue, headache and nausea.

Alcohol and anxiety

This rebound effect can set up a frustrating loop. Someone drinks to take the edge off their nerves, feels better for a few hours, then wakes up feeling more on edge than before. The natural response may be to reach for another drink to get relief, and over time the brain may come to rely on alcohol to feel "normal".

If you live with an anxiety disorder, using alcohol to cope can make symptoms harder to manage and can get in the way of learning other ways to calm your body and mind, such as the techniques described in our guide to mindfulness for beginners.

Alcohol and low mood

Alcohol can also affect mood more broadly. The NIAAA notes that a range of mental health conditions, including depression, post-traumatic stress disorder and ADHD, commonly occur alongside alcohol use disorder and are linked with a higher risk of developing it. The National Institute of Mental Health (NIMH) describes the relationship as complex and two-way: people with mental health conditions are at higher risk of substance use problems, some may use substances to cope, and substance use itself can contribute to brain changes that raise the risk of other mental disorders.

Both deserve attention. Continuing to drink even though it is making you feel depressed or anxious is one of the questions health professionals ask when assessing whether someone has an alcohol problem.

Alcohol and sleep

A nightcap might seem like a good way to drift off, and it is true that people often fall asleep faster after drinking. But the NIAAA explains that sleep after drinking tends to be fragmented, and people often wake up earlier than they meant to. The result is that you can spend a full night in bed and still wake up tired. Our article on how sleep affects mental health explains why rest matters so much.

Alcohol and medications

Alcohol can interact with many medicines, including some used to treat mental health conditions and sleep problems. MedlinePlus, from the US National Library of Medicine, lists people taking medicines that can interact with alcohol among those who should not drink. If you take any prescription medication, it is worth asking your doctor or pharmacist whether alcohol is safe for you, and how much.

How much is "moderate"?

In the United States, a standard drink contains about 14 grams of pure alcohol. That is roughly 12 ounces of regular beer (about 5% alcohol), 5 ounces of wine (about 12%) or 1.5 ounces of distilled spirits (about 40%). According to MedlinePlus, moderate drinking means no more than 1 standard drink a day for most women and no more than 2 for most men, and even moderate drinking carries some health risks. Many drinks poured at home or in restaurants are larger than a standard drink, so it can be easy to drink more than you realise.

Signs your drinking may be affecting your wellbeing

Alcohol use disorder (AUD) is a medical condition in which a person has trouble stopping or controlling their drinking despite the problems it causes. It can be mild, moderate or severe. Questions health professionals may ask include whether, in the past year, you have:

• Ended up drinking more, or for longer, than you intended.
• Wanted to cut down or stop, or tried to, but could not.
• Kept drinking even though it made you feel depressed or anxious.
• Needed to drink more than before to feel the same effect.
• Had trouble sleeping, shakiness, restlessness, sweating or a racing heart as the effects wore off.

Answering yes to one or more of these does not mean you have a diagnosis, but it is a good reason to talk with a health professional.

Practical steps for cutting back

• Notice your patterns. For a couple of weeks, jot down when you drink, how much and how you feel before and the next day. Our guide to journaling for mental health has ideas for getting started.
• Set a clear limit in advance and plan alcohol-free days each week.
• Have an alternative ready. Sparkling water, herbal tea or an alcohol-free drink can fill the same "end of the day" ritual.
• Find other ways to unwind. A walk, some exercise, a call with a friend or time outdoors can ease stress without the rebound.
• Be kind to yourself. Changing a habit takes time, and setbacks are normal. Self-compassion tends to help more than harsh self-criticism.

An important safety note: if you have been drinking heavily or daily for a long time, do not stop suddenly on your own. The NIAAA warns that alcohol withdrawal can be life-threatening for some people, so speak with a doctor first about how to cut back safely.

Getting help

The good news is that alcohol use disorder is treatable, however serious it may seem. Behavioral therapies, mutual-support groups and medications can all help people cut back or stop, and integrated care can treat alcohol problems and mental health conditions such as depression or anxiety together. A primary care doctor is a good first step. In the US, SAMHSA's National Helpline, 1-800-662-HELP (4357), offers free, confidential treatment referrals and information.

If you ever have thoughts of harming yourself or ending your life, please reach out right away. In the US, call or text 988 to reach the Suicide & Crisis Lifeline, any time, day or night. In an emergency, call 911.

Medical disclaimer: This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always consult a qualified health professional about your situation. See our full disclaimer.