Sometimes, consuming alcohol can lead to paranoia. It can happen due to heavy drinking or during withdrawal.
Alcohol-related psychosis (ARP) is a rare condition that’s characterized by a break from reality. In some cases, it can bring on hallucinations, delusions, and paranoia.
If you notice alcohol is making you paranoid, a therapist can help you unpack these feelings and build a healthier relationship with drinking.
Anyone can experience occasional paranoia. For example, you might wonder, “Is that person following me?” or, “Is my partner mad at me?” even if you don’t have evidence that those things are true. Having a paranoid thought once in a while isn’t necessarily cause for concern.
But sometimes, severe paranoia can signal an underlying mental health challenge. Paranoia is a symptom of mental health concerns like schizophrenia. It can also stem from alcohol use disorder.
For some people, consuming large amounts of alcohol for an extended period of time can lead to something called alcohol-related psychosis [1] (ARP). ARP can occur with chronic alcohol use or during initial cessation [2] (when someone quits drinking). It can lead to symptoms like hallucinations, delusions, and paranoia.
We don’t yet know exactly how many people experience paranoia due to ARP. But research suggests that it’s relatively rare, affecting up to 4% of people [1] with alcohol dependence. Learning more about the connection between drinking and paranoia can help you know when to reach out for help.
Symptoms of alcohol-induced paranoia
As a symptom of ARP [3], alcohol-induced paranoia can happen during acute intoxication or when someone with alcohol use disorder experiences withdrawal.
Some examples of what it might feel like:
You’re out in public or in a social setting and think everyone is staring at you or judging you.
Without cause, you become suspicious of people you might usually trust. This might include a friend, partner, or family member.
You feel a sudden, intense fear that you’re in danger. You might have accompanying physical sensations, like a racing heart, trembling, sweating, and more.
In addition to paranoia, ARP can involve a break in reality in the form of hallucinations (seeing or hearing things that aren’t there) or delusions (false or odd beliefs). These can feel very scary and real for the person experiencing them. While these symptoms will usually subside with abstinence [1], recovery often needs additional support including therapy, medication, time, and other lifestyle shifts.
The care you need, when you need it
Learn how Rula can support your mental health journey
Why alcohol might make you paranoid
Alcohol might make you paranoid for a few different reasons.
For example, maybe you drank too much, lowered your inhibitions, and embarrassed yourself. You might feel paranoid about how others will react to your behavior.
Or perhaps you became intoxicated, blacked out, and can’t recall parts of the previous evening. You might worry about what happened if you can’t piece your memories together. Feeling worried or anxious after drinking once in a while doesn’t automatically mean that you have a mental health condition.
However, intense paranoia that happens during acute intoxication or alcohol withdrawal is more than just a feeling of unease or embarrassment. Like other forms of drug-induced psychosis, we aren’t yet completely sure what causes alcohol-induced paranoia. But as a symptom of ARP, it may be rooted in the cognitive impairment [4] brought on by chronic alcohol use.
Coping with paranoia after drinking alcohol
Paranoia is an unsettling feeling that most people would prefer to avoid. So if you’re experiencing it after drinking, you might want to take some time to reflect. You get to decide what type of relationship you’d like to have with alcohol.
If you want to reduce alcohol-induced paranoia, these tips can help:
Identify your triggers. Looking back, can you notice any patterns related to your paranoia? For example, does it tend to happen when you drink a certain amount or in specific circumstances? If so, these insights can help you create a plan to prevent paranoia after drinking.
Practice harm reduction. If you’re not ready to limit your alcohol intake and also experiencing paranoia, you can still take steps to increase safety. For example, if you’re going to drink, try to do so in a familiar setting and with people you trust.
Take a break. If alcohol-induced paranoia is affecting your life, taking a break from drinking might help you gain perspective. A period of sobriety can be good for your mind and body. It may also motivate you to change your drinking habits to reduce paranoia.
Share your experiences. If you’re struggling with paranoia after drinking, it might help to talk to a friend or loved one. Opening up about your experiences might feel uncomfortable at first. But sharing your concerns with someone who has your best interest at heart can be a way to access support and increase accountability.
Ask for help. If you’re experiencing mental health symptoms like paranoia after drinking, help is available. Some therapists and psychiatrists specialize in substance use disorders (SUDs) and can make sure you get the complete care you need for alcohol dependence or other concerns.
When paranoia shows up after drinking, one common but unhelpful response is dismissing the experience as ‘just being dramatic’ or ‘just the alcohol.’ This can increase shame and isolation instead of encouraging reflection, support, and — when needed — professional help.
Ashley Ayala, LMFT
Clinical reviewer
Find care with Rula
Some people may feel paranoid after drinking. They might be afraid they embarrassed themselves or can’t recall what happened when they were intoxicated. On its own, occasional paranoia isn’t a sign of a mental health condition. But if it’s severe and chronic, it could be cause for concern. Therapy can help you evaluate your relationship with alcohol and make changes to protect your mental and physical well-being.
At Rula, we’re here to help you feel better. Rula makes it easy to find a licensed therapist or psychiatric provider who takes your insurance. That way, you don’t have to choose between great care and a price you can afford.
Rula patients pay about $15 per session with insurance, and 93% say they feel better after getting care through Rula. We have 21,000+ providers, and appointments are available as soon as tomorrow. We’re here to help you take the next step — wherever you are in your mental health journey.
References
- Alcohol-Related Psychosis https://www.ncbi.nlm.nih.gov/books/NBK459134/
- Alcoholic Hallucinosis https://www.sciencedirect.com/topics/neuroscience/alcoholic-hallucinosis
- Alcohol Psychosis https://www.sciencedirect.com/topics/neuroscience/alcohol-psychosis
- Substance-induced psychosis and cognitive functioning: A systematic review https://www.sciencedirect.com/science/article/abs/pii/S0165178121006557
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
Ashley Ayala, LMFT
Ashley is a Licensed Marriage and Family Therapist who specializes in generational healing and family dynamics. Ashley has worked in schools, clinics, and in private practice. She believes that people’s relationships, including our relationship with ourselves, greatly shape our experiences in life.
Ashley is committed to empowering others to show up authentically and deepen their self understanding. This passion stems from taking a critical lens on her own life story and doing inner healing. One of her favorite quotes is “Be yourself and the right people will love the real you.”
Rula’s editorial process
Rula’s editorial team is on a mission to make science-backed mental health insights accessible and practical for every person seeking to better understand or improve mental wellness.
Members of Rula’s clinical leadership team and other expert providers contribute to all published content, offering guidance on themes and insights based on their firsthand experience in the field. Every piece of content is thoroughly reviewed by a clinician before publishing.
