Alcoholism and Mental Health

Alcohol use in the United Kingdom has doubled over the past 50 years. Over 90% of adults between the ages of 16 and 64 now drink occasionally. 38% of men and 16% of women now drink over the recommended daily allowance at least once a week. [1] [2].

These are worrying statistics. Heavy drinking has a high social cost, with alcohol linked to higher rates of violent crime, domestic abuse and traffic accidents. It also causes a range of physical health problems, including liver disease and heart disease.

In this article, however, we are going to be discussing another adverse consequence of alcoholism: poor mental health. Alcoholism has been linked to depression, anxiety, OCD, bipolar disorder, suicidal ideation and dementia.

In many cases the link between alcoholism and mental health cuts both ways: for example, someone may drink to self-medicate for their depression, only to find that alcohol makes them depressed.

They then drink more in order to counter the worsened depression. Thus depression leads to alcoholism and alcoholism leads to depression, in a vicious cycle.

The dangers of self-medicating for mental health problems with alcohol

In people with diagnosed mental health problems, and in the general population, alcohol is often used as a coping mechanism. One study found that 12 million adults in the UK drink to relax or overcome feelings of anxiety or depression. [3]

Why do people do this? Well, alcohol causes feelings of relaxation, which are provoked by chemical changes to neurons in the brain. This leads to the ‘first drink effect’, whereby people become less inhibited, more talkative and less anxious.

As the second and third drink go down, other changes occur. Emotional states are heightened, which means that feelings of anger, depression, aggression or happiness are magnified.

This emotional heightening can be pleasurable, or it can be unpleasant. For those using alcohol to self-medicate, a careful balance needs to be struck. They may find that after one drink, they feel more relaxed and more sociable. After two or three, however, their emotional states become heightened, and they enter a much less relaxing state.

This is one of the problems with using alcohol to self-medicate. Whilst alcohol produces a pleasant buzz in small concentrations, it is also a depressant, which means that large quantities can exacerbate feelings of anxiety.

If the person continues to drink in order to overcome this anxiety, their blood alcohol content will only get higher, and there is no guarantee they will get less anxious. They will simply become more inebriated.

Just like with anxiety, self-medicating for depression is not a good solution. In the short-term, drinking may make a depressed person feel happier, but in the long-term, it depletes the body’s levels of serotonin.

Serotonin is a hormone responsible for making us feel happy and stabilizing our moods. With lower levels of serotonin in the body, a depressed person will be even more depressed.

To sum up, it is very difficult to drink just the right amount of alcohol to make you feel less depressed, or less anxious. Often, when people drink, they drink much more than the recommended allowance. This leads to short-term feelings of release and escape.

The morning after, however, brings a return of the same mental health problems that were there the night before – now made worse by depleted serotonin levels and ‘hangxiety’ (feelings of anxiety which often accompany a hangover).

On top of that, self-medication with alcohol can easily become a vicious cycle. With anxiety, for instance, drinking alcohol to reduce anxiety depletes the brain’s neurotransmitters. [5]

These neurotransmitters are responsible for reducing anxiety naturally. With fewer neurotransmitters, the person becomes more reliant on alcohol to reduce their anxiety.

They find themselves drinking more and more in order to feel normal – and, as we have discussed, this brings a raft of other problems, including social problems such as the difficulty of managing responsibilities while drunk or hungover.

The impact of alcohol on your brain

We’ve touched briefly on the way in which alcohol depletes serotonin and neurotransmitters, leading to depression and anxiety. Let’s take a closer look at what alcohol does to the brain.

Alcohol is not only a depressant; it is also a stimulant. This is a rare combination in a drug, as most drugs are either depressants or stimulants.

Alcohol alters the number of neurotransmitters in the brain, as mentioned earlier. There are, however, two different kinds of neurotransmitters in the brain, both of which are responsible for different things.

On the one hand, there are ‘excitatory’ neurotransmitters. An example of an excitatory neurotransmitter would be glutamate. This raises brain activity and energy. Alcohol causes less glutamate to be released, which slows down the activity of the brain.

On the other hand, there are ‘inhibitory’ neurotransmitters. These include GABA, which slows down the activity of the brain. Depressants like Valium raise the levels of GABA production in the brain which leads to feelings of sleepiness and relaxation.

Alcohol’s depressant effect is clear from the way in which it slows down production of excitatory neurotransmitters, and raises the levels of inhibitory neurotransmitters. The net result? Everything is slowed down, including speech and movement.

However, alcohol is also a stimulant. It increases the amount of dopamine in the brain’s reward centre, leading to feelings of wellbeing. This happens soon after the first drink, which leads people to keep drinking.

Another stimulant property of alcohol is that it raises your heart rate. It can also lead to aggression in some individuals.

One interesting point about alcohol and dopamine is that alcohol appears to have a more pronounced effect on dopamine levels in men than it does in women. [6] This could go some way towards explaining the higher rates of alcoholism among men: 60% of people in alcohol treatment in the UK are male. [7]

Alcoholism and anxiety

We have talked about the theory that people with alcohol use disorders self-medicate for mental health problems. We discussed the way in which alcohol seems at first to alleviate anxiety, but, in greater concentrations, its stimulant properties kick in. This leads to an increase in heart rate and, quite possibly, more anxiety.

One point to consider is that there is less of a link between anxiety and alcoholism than there is with depression. One study found that among alcohol dependent individuals, rates of anxiety were about 19.4%, which is only 1.5 times higher than in the general population. [8]

However, the rates of specific anxiety disorders such as panic disorder and social phobia were much more correlated with alcoholism. [9]

The example of social phobia, or social anxiety, is an interesting one. One recent metanalysis found that people with social anxiety deliberately drink alcohol to overcome their anxiety. [10]

This suggests that people with social anxiety may be more at risk of developing an alcohol use disorder, if their brains become wired to cope with their anxiety by using alcohol. In order to combat this, socially anxious individuals need to find other ways to manage their anxiety which are less destructive.

Meditation, mindfulness and breathing exercises are all good ways to deal with social anxiety. [11]

Alcoholism and depression

Although there is still some debate regarding the relationship between alcohol use disorders and depression, there is undoubtedly a correlation between the two. Someone who drinks heavily is more likely to be depressed; someone with depression is more likely to drink heavily.

Why might this be? Again, the self-medication hypothesis may be the best explanation. Alcohol offers a very short-term solution to depression, in that it gives people a sense of wellbeing for a few hours.

Of course, in the long term, it lowers serotonin levels, which can make depression worse. It also leads to social problems, such as issues at work and problems with relationships, which have an indirect effect on depression.

Studies have shown that cutting down on drinking, or even cutting out alcohol altogether, can have a positive impact on depression. [12] For those dealing with co-occurring alcohol use disorders (AUDs) and clinical depression, this is a crucial step to take.

A note on antidepressants: these medications should not be mixed with alcohol. Antidepressants can raise the chances of relapse in someone who has suffered from an AUD and is in recovery. If you suffer from clinical depression and have problems with alcohol, you should exercise caution before taking antidepressants and make sure to speak to your doctor first.

Alcoholism, suicide and self-harm

One of the effects of alcohol which we have yet to mention is its de-inhibitive nature. People who are inebriated tend to become less inhibited, which leads them to do things that they wouldn’t do when sober.

This might amount to nothing serious, and indeed many people use alcohol because of its de-inhibiting nature: this is why alcohol is such a good social lubricant, for example.

However, the way in which alcohol makes people less inhibited can also have serious adverse consequences in those who are mentally unwell. Someone who may be depressed to the point of suicide is much more likely to go through with suicide if they are inebriated. The same goes for someone who is contemplating self-harm.

This is also linked to alcohol’s tendency to amplify extreme emotions. Someone who feels depressed will feel more depressed when they drink, someone who feels suicidal will feel more suicidal, and so on.

Finally, in extreme quantities, alcohol can lead to psychosis. Psychosis is a form of mental illness whereby the person experiencing this phenomenon has hallucinations.

This adds to the risk of people causing harm to themselves, since a depressed person may be more likely to experience a traumatic hallucination which leads them to react in an extreme manner.

Anyone who is going through feelings of this sort should seek help as soon as possible. A good helpline to use is Samaritans. They offer free, confidential advice at all times of the day.

Alcoholism and bipolar disorder

There is a correlation between bipolar disorder and alcoholism. [13] Indeed bipolar disorder is one of the most common mental illnesses to co-occur with alcohol dependence.

Explanations for this include genetics: genetic differences can make people more disposed towards developing bipolar disorder. It may be that the same differences in the brain which increase the chances of developing bipolar disorder also increase the chances of an AUD.

Another reason could be that bipolar disorder causes depression and anxiety, which, as we have seen, often lead people to self-medicate with alcohol.

A third and final reason could relate to the idea of mania, which is the feeling of elation which follows a period of depression. During manic episodes, bipolar people are less inhibited and more likely to engage in risky behaviour. Alcohol use might well occur during these episodes.

If you suffer from a dual diagnosis of bipolar disorder and an AUD, you should seek treatment as soon as possible. You can also find some useful information here.

Final thoughts

The link between alcoholism and mental health problems is often a complex one. In this article we have tried to show some of the ways in which mental health problems can put individuals more at risk of alcoholism, and vice versa.

It is essential that people with co-occurring mental health problems and alcohol use disorders get treatment. These mental illnesses can be dangerous, especially when combined with a drug like alcohol.

References

[1] https://www.drugsandalcohol.ie/15771/1/cheers_report%5B1%5D.pdf

[2] The Royal College of Psychiatrists. Alcohol and Depression – Help is at Hand. 2004. London, The Royal College of Psychiatrists.

[3] Tomasson K, Vaglum P. Psychiatric co-morbidity and aftercare among alcoholics: a prospective study of a nationwide representative sample. Addiction 1998; 93(3):423-431

[4] https://www.drugsandalcohol.ie/15771/1/cheers_report%5B1%5D.pdf

[5] https://www.drugsandalcohol.ie/15771/1/cheers_report%5B1%5D.pdf

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913110/

[7] Public Health England (2018). Adult substance misuse treatment statistics 2018 to 2019: report.

[8] https://pubs.niaaa.nih.gov/publications/arh26-2/90-98.htm

[9] SCHUCKIT, M.A.; TIPP, J.E.; BUCHOLZ, K.K.; et al. The life–time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls. Addiction 92:1289–1304, 1997b.

[10] Carrigan MH, Randall CL. Self-medication in social phobia: a review of the alcohol literature 55. Addict Behav 2003; 28(2):269-284.

[11] https://www.nice.org.uk/guidance/cg159/evidence/full-guideline-189895069

[12] Shaw, G.K., Waller, S., Latham, C.J., Dunn, G. and Thomson, A.D. (1998). The detoxication experience of alcoholic in-patients and predictors of outcome. Alcohol and Alcoholism, 33(3), 291-303.

[13] KESSLER, R.C.; CRUM, R.M.; WARNER, L.A.; et al. Lifetime co–occurence of DSM–III–R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Archives of General Psychiatry 54:313–321, 1997.

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