Alcohol and cortisol: what the research shows

Does alcohol raise cortisol? The research gives a narrower answer than the headlines. A 2025 meta-analysis found that, compared with placebo, alcohol did not significantly change how high cortisol peaked. It did find that cortisol stayed higher afterward, in other words slower to come back down. The effect was small and uncertain overall, and larger in people with active alcohol use disorder.

The evidence here is limited, so this page is short.

What the research found

A 2025 systematic review with meta-analysis in Translational Psychiatry identified 84 studies of alcohol, stress and cortisol. The abstract counts them as 53 experimental and 31 observational, and the results section as 40 and 44, and only the experiments went into the main analyses. Some of those experiments asked whether stress makes people drink, which is a separate question. The comparison of alcohol with placebo and no stress test covered 15 experiments and 426 people, mostly young and healthy. The samples were grouped by alcohol use disorder (AUD) status: people actively drinking with AUD, people who had AUD in the past, and people without it.

Two results matter here:

• Recovery. Alcohol intake was linked to a delayed fall in cortisol afterward. The effect was small and uncertain overall, and larger in people with active AUD. The authors say it was considerably smaller in people with a family history of AUD.
• Peak response. Compared with placebo, alcohol did not significantly change how high cortisol rose. The authors conclude that alcohol does not regulate cortisol peak responses. Some subgroups went in different directions, and adding a stress test changed the pattern.

The authors also point out limits. The findings differed a lot between studies, the work was done in research settings with mostly young, healthy people, and stress tests in some studies didn’t raise cortisol at all, which can distort the maths. The review looked at acute drinking in research protocols. It did not look at a regular drink with dinner or at what happens to a blood test the next morning (Transl Psychiatry, 2025).

Heavy drinking and tests for Cushing’s syndrome

Two clinical sources describe a different effect, in people who drink heavily over time. MedlinePlus says high cortisol levels can come and go in some people, a pattern called pseudo-Cushing syndrome, and it lists alcohol use disorder among the causes, along with depression, anxiety, poorly controlled diabetes and obesity. NIDDK says the same of people who “drink too much alcohol”.

A 2024 paper in the Journal of the Endocrine Society adds that these conditions really do produce high cortisol, with Cushing-like features. It says the usual screening tests for Cushing’s syndrome (24-hour urine cortisol, a dexamethasone suppression test and bedtime saliva cortisol) can all be positive in them, and that treating the underlying condition usually resolves the extra cortisol (J Endocr Soc, 2024). NIDDK describes a follow-up test, the dexamethasone-CRH test, used to tell Cushing’s syndrome from pseudo-Cushing’s.

For you, this means two things. A high cortisol result doesn’t prove Cushing’s syndrome if alcohol is involved. And a clinician working up high cortisol needs to know how much you drink. Tell them plainly.

Alcohol, sleep and tiredness

Alcohol shows up on other pages in this section for reasons that don’t depend on cortisol. MedlinePlus lists alcohol among the substances that can cause chronic insomnia, and drinking too much alcohol among the lifestyle causes of fatigue. See cortisol and sleep and cortisol and fatigue.

When to see a clinician

Talk to a clinician if alcohol is affecting your health, sleep or daily life, or if you are drinking more than you want to. MedlinePlus says to get help right away if stress is making you use alcohol or drugs more than usual.

If you have signs of too much cortisol, such as easy bruising, wide purple stretch marks, a rounded face and weak muscles, say so, and mention your alcohol use (high cortisol). A single cortisol result can’t diagnose or rule out Cushing’s syndrome or adrenal insufficiency.

If you take a steroid medicine, never stop or change it because of anything on this page. Ask your prescriber.