How to Treat Alcoholism While Addressing Co-Occurring Disorders

A person who abuses alcohol and cannot stop may struggle with an alcohol use disorder (AUD), sometimes called alcoholism or alcohol addiction. Like other addictions, this person may have a physical dependency on alcohol to feel normal or relaxed, and they may begin abusing the substance as a way to manage stress or intense emotions.

In many cases, people who struggle with AUD also have a co-occurring mental health condition – the combination of a substance abuse disorder and mental illness is called co-occurring disorders. Fifty percent of people with any substance use disorder will also have any psychiatric disorder; yet, less than 9 percent of people who struggle with AUD get the treatment they need, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). People struggling with co-occurring AUD and mental illness are less likely to get treated.

Alcohol Use Disorder and Mental Health Changes

Typically, people who struggle with substance abuse, mental illness, or both have similar causes that may trigger these conditions. Conditions that may trigger mental or behavioral problems include:

Genetic predisposition
Underlying illness, like a thyroid disorder
Family history
Current environment

While the interaction between these factors is not well understood yet, most researchers believe that these conditions increase individual risk for developing substance abuse, mental health conditions, or both.

A pre-existing mental illness is more likely to lead to substance abuse for many people because struggles with symptoms or emotional reactions may lead one to attempt to self-medicate. In some instances, people who struggle with AUD may also trigger a mental illness. Alcohol is a depressant, so people who abuse alcohol may change their brain chemistry, lose self-esteem, and feel guilty due to their problem. They then begin to experience consequences in their lives due to AUD, triggering depression.

Is a loved one struggling with alcohol?

Here's how to help them now.

Mental Illnesses Most Often Associated with Alcohol Abuse

Certain substances of abuse cause different effects and side effects, so people who abuse these substances to self-medicate may seek out specific drugs. Alcohol is a substance that induces a feeling of calmness, so people who abuse this intoxicating drink often seek out those pleasant effects. Additionally, alcohol is legal for people ages 21 and older, so it is easy to acquire. People who abuse multiple drugs may use alcohol as one of the substances to moderate emotional side effects from other substances.

The most common mental health conditions associated with AUD are outlined below.:

Depression: Close to one-third of people who have major depression exhibit signs of problem drinking. Typically, depression appears first; then, the individual will begin drinking to experience pleasure, feel less guilty or sad, or improve their self-esteem. These effects from alcohol may occur for a short time, but they do not last. Since alcohol is a depressant, people who drink too much are more likely to make their depression worse. They also increase their risk of suicide.
Anxiety: Alcohol and some anti-anxiety medications act on the GABA receptors in the brain, calming rapid firing between neurons and allowing the individual to relax. The medications that offer this benefit, like benzodiazepines, are only prescribed for as-needed or short-term use because they can become addictive. When a person who struggles with anxiety disorder begins drinking and experiences this calmness, they may begin abusing alcohol to feel more relaxed. All forms of anxiety disorder, including panic disorder, post-traumatic stress disorder, and social anxiety disorder, increase the likelihood of developing AUD as a reaction to untreated anxiety. Additionally, people who stop drinking may experience panic and insomnia as withdrawal symptoms.
Bipolar disorder: All forms of bipolar disorder involve cycling between depression or very low moods, and mania, hypomania, or extremely up, energetic moods. This experience can be disturbing, and people who have an undiagnosed bipolar disorder may attempt to self-medicate the symptoms. Alcohol, being a depressant, may be abused to moderate manic periods or alleviate depression. Unfortunately, people with co-occurring AUD and bipolar disorder are less likely to seek treatment or adhere to treatment plans.
Schizophrenia: The symptoms of schizophrenia include persistent delusions, both of grandeur and paranoia; hallucinations; disorganized speech, thoughts, and behavior; the absence of emotional expression or experience; and a lack of motivation. People who struggle with these symptoms are more likely to abuse alcohol as well as nicotine. One study found that more than one-third of people with diagnosed schizophrenia had a co-occurring AUD. While it is likely that people with schizophrenia abuse alcohol to self-medicate, some studies show that alcohol abuse precedes schizophrenia. The individual may experience mood and thought disturbances before more intense schizophrenia symptoms appear, leading them to begin self-medicating.

Assessment of Co-Occurring Disorders

People who present with mental health problems should be assessed for substance abuse by medical professionals, including blood work to detect the presence of intoxicants like alcohol. Similarly, people who enter an emergency room or get a physical checkup and have symptoms of substance abuse should be assessed by a medical professional for potential mental illness.

It is important to note that people who struggle with co-occurring disorders, especially those who have never sought treatment, are more likely to believe that the substances they abuse treat their mental health conditions better than prescription medication and therapy. Overcoming this mental hurdle may involve an intervention from a social worker, physician, or other healthcare professional.

Treating Co-Occurring Disorders and Substance Abuse

Alcohol is known to interfere with all kinds of prescription medicine, especially psychiatric medications, so the first step in treating co-occurring AUD and mental conditions involves detox. Working with a doctor to manage withdrawal symptoms, especially life-threatening symptoms like seizures, is of utmost importance.

Once detox is complete, an evidence-based rehabilitation program specializing in co-occurring disorders is crucial. Both individual and group therapy can help the person understand the link between their substance abuse and mental health, and how changes in their emotional state may trigger relapse.

There are effective medications to reduce the risk of relapse, namely naltrexone and acamprosate. However, behavioral therapy is the most effective treatment after detox to manage both mental and behavioral health.

Once the rehabilitation program has been completed, the person will likely need to continue attending therapy and support groups to stay abstinent from alcohol. Ongoing sessions with a therapist who specializes in their specific mental illness will help them focus on sobriety, and continue improving their overall mental and emotional health.

Medications may be prescribed to treat anxiety, depression, schizophrenia, and bipolar disorder, alongside therapy. Medications can be important tools to moderate brain chemistry, but it’s essential to stay abstinent from alcohol and other substances. With the presence of drugs or alcohol in the body, these medications may have dangerous side effects, or they may be ineffective at treating symptoms of the underlying mental condition.

Treating Alcoholism and Co-Occurring Disorders