Alcohol and Depression: The Endless Cycle

While it can feel anything but normal, depression is one of the most common mental health issues in the world today; around a fifth of the population have suffered from anxiety or stress-related issues [1] .

For many people, this is a one-time experience brought on by trauma, loss, or extreme stress. For others, however, it is a recurring disorder that alters their life indelibly.

For those who suffer from the persistent depressive disorder (around 1.5% of American adults), these ongoing feelings of sadness, anhedonia, and hopelessness can last for years.

In these cases, it is common for people to turn to alcohol and narcotics to cope. As a result, there is an indelible link in the popular mind, whether this is justified or not, between depression and alcoholism.

Recognizing Disorders

Sadness and alcohol are both incredibly common in everyday life across the world.

In the first case because it is a natural, human reaction to certain events and occurrences, and in the second because of the rise of social drinking culture.

Of course, while both can be perfectly normal and healthy, there is a point at which these normal experiences and behaviors become ‘abnormal’; at this point, they are considered disorders.

Recognizing that you or someone you love has a disorder such as alcoholism or depression is a key part of recovery, so you should make a point of knowing the red flags.

Signs of Depression

There are many different kinds of depression, and each has a set of symptoms.

Nonetheless, there are a number of shared symptoms that anyone can look out for. Signs that you or someone close to you may be experiencing a depressive episode include [2] ;

• Prolonged periods of sadness
• Loss of interest in hobbies and activities
• Changes in appetite
• Disruption of your sleep schedule
• Restlessness or slowed movements and speech
• Difficulty in concentrating
• Recurring thoughts about death, violence/self-harm, or suicide

If more than one of these symptoms is present for more than two weeks they constitute a depressive episode by medical standards.

Signs of Alcohol Addiction

Addiction, of course, is not limited to alcohol abuse and so there are different signs and symptoms for each disorder.

Furthermore, there is a distinction between an alcohol dependency which is fuelled by psychological factors and an alcohol abuse disorder (which is a physical disorder).

Signs of an alcohol abuse disorder include [3];

• Craving alcohol
• Losing control of levels of consumption
• Experiencing withdrawal symptoms as a result of physical dependence
• A high tolerance for alcohol – needing more alcohol to get the same feeling
• Hiding how much you consume
• Drinking in the morning to ‘steady’ your hand
• Trying and failing to quit

According to the NIAAA (the National Institute of Alcohol Abuse and Alcoholism), the presence of two or more of these symptoms indicates a potential alcohol dependency or disorder.

Linking Alcohol and Depression – A Vicious Cycle?

For those who struggle with alcohol addiction, depression is often a companion; there are generally two models of comorbidity.

Firstly, there is the view that those struggling with depression turn to alcohol as a means of self-medication, and secondly the view that those with alcohol addiction are more susceptible to depression.

In fact, there is some truth to both interpretations, but recent research suggests that the latter is most common because of the way that alcohol abuse affects the brain [4].

Alcohol and the Brain

While most experts agree that moderate, social drinking is not harmful, they are also clear; drinking alters the way our brains work and can cause us to feel depressed [5].

More than this, if you are already depressed, alcohol is just as likely to exacerbate your symptoms as it is to alleviate them.

This has a lot to do with the way that it alters brain chemistry.

Despite being commonly called a depressant (which it is), it acts as a stimulant first and foremost by triggering the brains ‘reward centre’.

The initial high, of course, wears off as the level of alcohol in your blood decreases; at this point the physical changes wrought by drinking start to work against you and enhance feelings of depression and anxiety leading to guilt, shame, nervousness, and sadness.

This short-term side-effect, however, can spiral into major ‘clinical’ depression [6].

Alcohol as a Self-Medication Strategy

There are those for whom it works in reverse; those who struggle with depression are more likely to turn to alcohol or narcotics as a way to relieve their symptoms.

This psychological dependency forms because of the same biological processes which cause depression in the long-term; the initial, stimulating ‘high’ that alcohol gives provides relief from the symptoms of a major depressive episode.

The problem, of course, is that when this recedes the sadness, anxiety, and shame that often follows heavy drinking exacerbates existing symptoms and leads to a cycle of drinking and withdrawal that fuels itself.

A study undertaken in 2012 found that of 869 college students 57% of men and 40 % of respondents stated they had consumed more than 4 drinks in the 2 weeks prior to the study as a result of feeling depressed [7].

The result of this, however, was increased levels of irritability, sadness, fatigue, loss of enjoyment, and lack of concentration and mild to moderate symptoms of depression among both men and women [8].

The Risks: Dependency and Deteriorating Health

Of course, for people who have depression or are struggling with addiction, or, as is so common, are dealing with a dual diagnosis the precise order of disorders (no pun intended) is unimportant.

The truth is that whether you use alcohol to self-medicate or an existing alcohol abuse disorder is causing depressive episodes there are real risks and lasting consequences.

Short-Term Effects

The short-term effects of alcohol abuse, physical and mental, are well-known; the classic ‘hangover’ symptoms which most people feel at some point. [9]

These are not the only side-effects, however. Short-term effects during drinking include: 

• Impaired vision and hearing
• Loss of coordination
• Slurred speech
• Memory loss
• Increased reaction times
• Loss of inhibition

After drinking, side effects can include:

• Headaches
• Dehydration
• Nausea
• Light sensitivity
• Stomach pain
• Exhaustion and fatigue
• Sweating
• Shaking

Long-Term Effects

The most obvious long-term effect of alcohol abuse is the development of alcohol dependency; for those who already have an alcohol addiction, of course, this risk has come to pass.

For those who self-medicate, however, there is a real risk of a psychological and physical dependence developing.

There are also long-term health risks to consider.

Alcohol is known to contribute towards the risk of developing over 200 diseases including cancers and liver cirrhosis. [10]

These risks include :

• Liver disease
• Pancreatitis
• Heart disease
• Cardiomyopathy
• Peripheral neuropathy
• Stomach ulcers
• Cancer
• Immune system dysfunction
• Osteoporosis
• Brain damage
• Nerve damage
• Anxiety
• Depression

Treatment

For those who are fighting both alcohol addiction and depression, or those who are supporting someone with a dual diagnosis, it can be very hard to see a viable path to recovery.

Mental health issues are some of the most likely issues to cause a relapse for those seeking recovery.

Nonetheless, it is possible to find appropriate treatments and support for both issues in order to find sobriety and joy; it’s just that these options may look different for dual diagnosis individuals than they do for someone who has only an alcohol addiction or mental illness.

1. Cognitive Behavioural Therapy

Cognitive Behavioural Therapy has long been used in treating both addictions and depression as well as anxiety disorders.

The focus upon finding the connection between thoughts, feelings, and actions which CBT promotes is crucial to helping those struggling with addiction break the cycles which inhibit their recovery [11].

To be precise, CBT helps those fighting alcoholism and addiction by helping them to dismiss the insecurities and false beliefs that contributed to their addiction

It also provides them with self-help techniques to better their mood and manage stress, and teaching effective communication techniques.

Using these skills to recognize triggers and manage their reactions to stressful or unpleasant situations gives those fighting addiction more control and makes the road to recovery a little less rocky for many.

Because these techniques are also used to help those with recurring depressive and anxious episodes, the skills are easily transferable and uniquely placed to help those with a dual diagnosis.

2. Support Groups

While support groups run by organizations like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are a staple of recovery and wellness for many fighting addictions, those who are also dealing with depression often find that they don’t quite offer the support needed.

This is because, of course, those with a dual diagnosis are facing a different struggle to those who are dealing with alcoholism as the primary issue.

There are support groups that deal with this issue, of course; the ‘double trouble in recovery’ program (which largely follows the AA system) is a perfect example.

The 12 steps of this program are much the same as the original with some obvious changes.

For example, step one reads “we admitted we were powerless over mental disorders and substance abuse” as opposed to the traditional version[12].

Being surrounded by people who intimately understand the ups and downs of dealing with addiction and depression is, of course, infinitely helpful for those who are just beginning to seek wellness and recovery.

3. Dialectical Behavioural Therapy

Developed to help people with borderline personality disorder and suicidal ideation, DBT aims to help people build the confidence and coping mechanisms required to navigate stressful situations successfully.

The core tenets of DBT are: 

• Improving communication skills
• Developing coping skills
• Improving self-image
• Recognizing and removing triggers from daily life
• Seeking and building positive relationships

Because of this, recovery centres are increasingly offering DBT to patients as a part of the recovery process due to the high success rates experienced, especially when paired with CBT.  [13]

Recovery Tips

If you or someone you love is fighting depression and alcohol addiction it’s only natural to be apprehensive or even scared.

However, you should remember that with the right support and planning you can begin to manage both your recovery and the symptoms which come with depression.

If you, or someone you love, are currently on the path to sobriety and recovery there are five simple steps you can take to make the journey easier.

1. Build a strong, sober, social network: make your closest friends aware of your need for sobriety and try to include people who also suffer from depressive disorders and alcohol addiction, but who are in recovery. A strong, understanding network is key to recovery.

2. Avoid people and places which are triggering: whether they trigger cravings or depressive episodes, you should either avoid these situations or people or bring someone supportive along with you.

3. Remember that you are responsible for your own recovery: the people who love you will do their best to help you, but cannot rearrange their whole lives to support your recovery.

Likewise, you should change your whole life to support someone else; learning strong refusal and communication skills is crucial to maintaining recovery. After all, people as a whole aren’t going to change any times soon.

4. Spend time with sober friends: there will be people in your life who mean well but are hard work for you to be around, especially in early recovery.

Focus on spending time with those who are understanding and helpful to your recovery until you feel able to move back into mixed settings.

5. Keep your doctor in the loop: if you’re taking any medications for anxiety, depression, or alcoholism and you feel that you are experiencing negative side effects, tell your doctor immediately. They’re here to help you, after all.

Above and beyond all of this, however, you should keep in mind that recovery is a process, just as learning to cope with depression and manage its symptoms is a process.

Take each day as it comes and remember to continually refocus on your goal of sobriety and wellness, and if you’re supporting a loved one through recovery remind them of this goal.

With the right support network and techniques recovery is possible,

References

[1] https://www.mentalhealth.org.uk/statistics/mental-health-statistics-depression

[2] https://www.psychiatry.org/patients-families/depression/what-is-depression

[3] https://www.webmd.com/mental-health/addiction/news/20070702/alcohol-abuse-alcoholism-common#1

[4] https://www.sciencedaily.com/releases/2009/03/090302183002.htm

[5] https://www.talkspace.com/blog/is-drinking-making-you-depressed/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658562/

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654787/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654787/

[9] https://www.bupa.co.uk/health-information/alcohol/alcohol-health-risks

[10] https://www.medicalnewstoday.com/articles/305062.php#long-term-effects-

[11] http://www.bhevolution.org/public/dtr_twelve_steps.page

[12] http://www.bhevolution.org/public/dtr_twelve_steps.page

[13] http://www.bhevolution.org/public/dtr_twelve_steps.page

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