The truth about ‘hangxiety’: agony of the midlife hangover
F O O D & D R I N K / W E L L B E I N G & N U T R I T I O N
After a few glasses of wine do you ever suffer with morning-after anxiety?
Taken from an article written by Jane Mulkerrins for the Times
Hangxiety – also known as “the beer fear” or “the booze blues” – is definitely something that I and many of my clients suffer from. The angst that frequently follows a nice Pinot has led to many to significantly reducing their drinking frequency or stopping completely.
Is it just age? Yes, partly. While individual capabilities vary widely, it’s well documented that most of us lose the ability to metabolise alcohol as effectively as we get older. This is down to the depletion over time of antioxidants such as glutathione, which is crucial for the liver to carry out its detoxification tasks.
“Alcohol is still very mysterious. We actually don’t understand a lot about it and the way it works in the body relative to other drugs,” says Dr Carl Erik Fisher, author of The Urge: Our History of Addiction. “It’s a dirty drug – much dirtier than cocaine or heroin – and hits a ton of different receptors scattered throughout the brain, causing a lot of havoc. And,” he adds, “there have been relatively few studies done on hangovers.”
A growing body of scientific research suggests that a large part of what happens in our fevered, anxious brains is actually happening in our bodies. Hangxiety, experts now agree, is a physiological condition rather than a psychological one.
One major player in this is gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter (or chemical messenger) of the central nervous system – the main neurotransmitter that lowers our inhibitions and helps us feel calm. When we drink, alcohol floods the brain with GABA. “And that’s why we like alcohol,” says Dr Ellen Vora, psychiatrist and author of The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response. “Because when we’re feeling wound-up, tense, nervous, anxious, insecure, we drink, we have a rush of GABA, and we feel suddenly at ease and relaxed and show confidence. But, unfortunately, the story doesn’t end there.”
Our brain doesn’t care about us feeling relaxed, she says; it cares about our survival. “It sees all this GABA and worries that should a real threat present itself – should a leopard come round the corner – we would be too buzzed to care and we could be in danger.”
So, the brain attempts to restore balance by converting the GABA to another, very different neurotransmitter: glutamate, one of our primary excitatory neurotransmitters. If GABA is the calming, soothing auntie of the neurotransmitter world, making you a cup of tea and some toast, glutamate is the rowdy, hectic one, screaming obscenities in your face at the bus stop. It’s surging glutamate that wakes you up at 4am with racing thoughts after a night out, and glutamate that stops you getting back to sleep as you toss and turn with a pounding heart, then feel anxious, edgy and irritable as you stand muttering in the shower and scramble to face the day.
Put simply, says Dr Tim Cantopher, psychiatrist and author of books on both alcohol and anxiety, “Alcohol is a drug, and it’s not a very good one, as it reverses its own effect – and increasingly so.”
When we start drinking, says Cantopher, our anxiety decreases (thanks, GABA) and we feel more confident. When that wears off, however, and the glutamate takes hold, “Your anxiety level goes up just a little more than it went down with the drinks. So, if you drink every or most days, you’re going to get this slow ratcheting-up effect. It’s like a saw tooth with a slightly upward gradient.”
In addition, the insulin rush that follows drinking (alcohol being a high-sugar hobby) is followed by a blood sugar crash, which not only further disrupts sleep but fuels stress. “The way the body is designed,” says Vora, “is that it responds to a blood sugar crash by releasing stress hormones such as cortisol and adrenaline. They help create some kind of urgency to forage for food, so we can restore blood sugar to normal levels. But as a side effect, we’re now in an all-out stress response.”
All this takes a sledgehammer to sleep quality (when/if you’ve made it to bed, that is), says Vora, and, “Sleep is its own independent factor in contributing to anxiety the next day, because if we’re not sleeping, none of our brain chemistry functions well.”
“Our brain will tell us a story about content, and it will make meaning of the sensation, but it’s really just trying to justify what is first and foremost a physical sensation,” she says. “So much of what we call mental health really has a basis in our physical body. We think about mental health from the neck up, that it’s just our thoughts and our cognition, but it really has a physical basis. And that’s incredibly helpful and empowering. So much easier than seven years of psychotherapy and repairing all of the stressors in our lives is keeping our physiology a little bit more stable.”
A particularly gnarly element of hangxiety, however, is the mystery. You may have no idea whether your fears about your inappropriate behaviour are even true. How could you know what actually went down when you can’t remember anything after the second bar?
This, say the experts (to my eternal relief), is also chemical.
“Glutamate helps us encode memories,” explains psychologist Andrea Bonior, author of Detox Your Thoughts and presenter of the new podcast Baggage Check. “So when glutamate function is artificially disrupted because of alcohol, that’s what makes things hazy.” By the sixth or seventh drink, the glutamate system is almost entirely blocked. In extreme circumstances, that’s what causes a “blackout”, those uncomfortable missing hours of a night where it feels like the tape recorder stopped working. “Memory disruption can add to our anxiety immensely,” says Bonior.
And if it feels like your hangxiety has grown more acute over the past two and a half years of rolling turbulence – the pandemic, the cost-of-living crisis, war, fuel shortages and now the inability to sell your home or afford a mortgage – you are, unsurprisingly, correct.
“If people are starting with higher baseline anxiety when they drink, then there’s going to be a more marked reduction of anxiety by drinking, and a more noticeable difference the next day in terms of hangxiety,” says Bonior.
“Anxiety is the pH scale of the age we are in at the moment,” agrees Vora. “There are plenty of big existential fears, but fear also sells. We’re living in a cesspool of sources of physiological imbalance and our mental health is the collateral damage.”
Bonior’s professional opinion if hangxiety can become more acute during substantial periods of sobriety. It is, she says, most likely that tolerance for alcohol itself has reduced “and alcohol can sort of take you for a ride and hit you over the head a little bit more”.
This dwindling tolerance is unfortunately lethal when combined with our diminished ability to process booze that comes with ageing. “The hangover might last longer or feel worse because it takes your body more time to rid itself of alcohol,” says Bonior. Many of us are also more prone to poor sleep as we age. “When all those things combine, it’s going to be more pronounced.”
In a body blow for equality, Vora also reports “some evidence to support that women tolerate alcohol less well than men.
“And for women of reproductive age, where you are in your cycle is a consideration,” she continues. “We might be better able to tolerate alcohol in our follicular phase [pre-ovulation], when our hormones are flush, and less able to tolerate it in the luteal phase [the second half of the cycle as we get closer to bleeding], given that waning levels of progesterone towards the end of the cycle are already having an impact on sleep quality and mood. This effect seems to be exaggerated through the perimenopausal period,” she says, “so it stands to reason that a perimenopausal woman in her luteal phase might be especially prone to hangxiety.”
According to a study by Drinkaware, 26 per cent of 16 to 24-year-olds are completely teetotal, compared with just 15 per cent of 55 to 74-year-olds. And in a 2022 British Journal of Sociology study targeting young people who did not drink, about 30 per cent of respondents said they enjoyed arts and crafts in place of boozing.
So, what can be done to swerve the horrors of hangxiety? The usual pre-game tactics apply: make sure you are well hydrated, eat something protein-rich before going out and also before going to bed. Intersperse alcoholic drinks with soft drinks or water.
But the context and company in which you face down your hangxiety also matters, says Bonior. “When you’re using alcohol to lubricate connectedness and you’re dancing and talking and hugging, and then you wake up alone, it’s such a stark contrast, and there’s much more room for self-doubt to creep in.”
“Being around people that we trust and processing our experiences helps lower our anxiety and our stress response,” says Bonior. “So when we don’t have that the next morning, and we aren’t able to be reassured, there’s just more room to worry about what we did.
“There are many ways in which modern adult life cuts us off from that sense of community,” she notes.
While much of what I gleaned from the experts about the causes of hangxiety was comforting, none of them seemed to be able to tell me how long it generally lasts and, when you’re in full-blown hair-shirt misery, when you can expect it to pass. It depends on myriad factors, they say, including how anxious you were to start with, what you drank, when you drank and whether or not you’re a regular drinker.
Dr Tim Cantopher will say, however, that after prolonged drinking, “It takes up to six weeks off the booze for your anxiety level gradually to go down to the level that it was before you ever started. It’s a sort of withdrawal.” Six weeks is a very long time to spend hating yourself.
References
Jane Mulkerrins Friday November 04 2022, 12.01am, The Times