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Anxiety that comes on when alcohol is consumed may be an indication of alcoholism, depending upon what other problems the use of alcohol causes. It is also seen in people who are not alcoholics however, as part of a new class of disorders that was recognized this past year in the 5th revision of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The widespread recognition that many people had anxiety, sometimes severe and disabling, only when they took medicines or used alcohol or drugs led to the separation from other anxiety states of substance or medication-induced anxiety disorder.

This type of anxiety is characterized by fear or emotional upset, sometimes accompanied by such physical symptoms as shortness of breath, racing heart, breathlessness or trembling (internally or externally, caused by the effects of either a medication or a drug. such as alcohol or marijuana. Emotional upset about dangers or problems that may or may not occur is generally classified as anxiety, while the term fear is applied to the dread of problems or dangers that are already present.

These symptoms may occur after the use of a drug has stopped or as a result of using the drug. Anxiety caused by the drug may persist as long as use continues, while withdrawal-related symptoms may first manifest themselves up to four weeks after stopping the drug. Prolonged anxiety and panic have rarely lasted for months after cessation of alcohol or drug use.

Alcohol, amphetamine and its derivatives, cannabis, cocaine, hallucinogens like LSD and phencyclidine (PCP) and its relatives have been reported to cause the symptoms of anxiety during intoxication. Withdrawal from alcohol, cocaine, opioids and also caffeine and nicotine can also cause anxiety. Many prescription and even over-the-counter drugs can precipitate anxiety, including antibiotics, especially the quinolones, anticonvulsants, antihistamines, blood pressure medications, bronchodilators for asthma (particularly the ones like epinephrine that stimulate the sympathetic nervous system), cough and cold preparations, contraceptives, cortisone, insulin and other diabetic drugs, pain medications, medications for psychiatric disorders (such as antidepressants, antipsychotics or lithium), statin drugs for elevated cholesterol, thyroid hormone and various medications for ulcers and heartburn. Carbon monoxide poisoning can manifest as anxiety, and anxiety can be an effect of various chemicals, fuel, paint and turpentine among them, as well as insecticides.

It is not clear how many people have anxiety triggered by alcohol or other substances.There are concerns, however, that people with anxiety disorder induced by alcohol or other mood-altering drugs have or could develop alcohol and drug problems, and that people who experience anxiety on medications may develop an anxiety disorder. Disorders of alcohol or other substance use are more common in men than in women and among adolescents and young adults. Approximately 20 per cent of the patients in general hospitals may have problems with substance use, and over half of people who have problems with alcohol or drugs also turn out eventually to have problems with anxiety or depression.

Anxiety symptoms induced by substances including alcohol will usually subside when the offending drug is eliminated; alcohol is eliminated from the body within hours, so anxiety due to its use is usually short-lived. If the anxiety recurs frequently or is severe or disabling, the best approach may be to avoid alcohol. An old axiom in the alcohol treatment business is, "if you think you've got a drinking problem, then you've got a drinking problem". It is always appropriate to consider whether alcohol is causing you more problems than it solves, and to listen to friends and family if they are concerned that it is. An anxiety problem is equally likely, and discussion of anxiety with the family doctor or evaluation by a specialist could be very helpful.

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