Many people who struggle with mental health issues turn to drugs, both prescription and illicit, to self-medicate their symptoms. The truth is that abusing intoxicating substances can trigger mental illness or make mental health problems worse. Alcohol abuse, problem drinking, and even alcohol use disorder (AUD) – formerly referred to as alcoholism or alcohol addiction – can make mental health, including depression, much worse over time, even though the individual may feel as though the substance temporarily alleviates symptoms of the mental condition.
Depression, Alcohol Use Disorder, and Co-Occurring Disorders
Depression, as defined by the American Psychiatric Association (APA), is a common but serious mood disorder affecting how an individual feels, thinks, and acts. About one in 15 adults in the United States is affected by depression in any given year, which is about 6.7 percent of the population.
People who struggle with depression, typically major depressive disorder, can experience symptoms like:
- Low mood
- Low self-esteem
- Less pleasure in activities that were once enjoyable
- Appetite changes, leading to weight loss or gain
- Changes to sleep patterns, either sleeping too much or experiencing insomnia
- Reduced physical energy, or fatigue
- Increased purposeless activity, like handwringing or pacing
- Slowed speech or movements
- Feeling worthless or guilty
- Trouble making decisions, concentrating, or thinking
- Thoughts of death or suicide
A person does not need to experience all of these symptoms, but if more than two occur for two weeks or more without letting up, the person may have clinical depression. However, some medical conditions, including thyroid disorders, vitamin deficiencies, substance abuse, and brain tumors, can mimic depression symptoms.
The American Society of Addiction Medicine (ASAM) defines addiction as a chronic disease of the brain affecting the reward, memory, motivation, and related neuronal pathways. Behavioral changes include compulsive, escalating consumption of substances, like alcohol, to experience relief; reduced inhibitions; or other pleasurable behavioral changes. People who struggle with addiction, including AUD, struggle with abstaining or moderating their consumption of intoxicating substances, which can lead to both acute and chronic physical problems, including triggering mental illnesses like depression. The Centers for Disease Control and Prevention (CDC) reports that alcohol abuse is one of the behaviors consistently associated with depression.
Both alcohol use disorder and depression are influenced by several factors, including:
- Family history
- Environment or surroundings
Medical researchers are working to understand how these factors influence each other to trigger mental illness, substance abuse, or both. There is a clear connection between mood disorders like depression, and substance abuse like alcohol use disorder. People who experience these two conditions together, known as co-occurring disorders, are more likely to develop depression first and then self-medicate the symptoms of the mood disorder with alcohol or other substances. Adolescents who develop depression are more likely to abuse alcohol as young adults, and women with a history of depression are twice as likely to develop problem drinking.
Because alcohol is a depressant – specifically affecting the GABA receptors and glutamate absorption to induce relaxation and even sleepiness – it can induce depression in people who did not have this mood disorder before abusing alcohol. Alcohol changes brain chemistry, and experiencing a hangover or a blackout may change the balance of neurotransmitters enough to lead to depression, which may trigger more drinking. People who abuse alcohol are also more likely to have lowered inhibitions, which could lead to bad decisions, and this may lead to a sense of guilt and a loss of self-worth, which could trigger depression.
The Overlap between Depression and Alcohol Use Disorder
A 2012 study involving 869 first-year college students found a high correlation between alcohol consumption and depression. The study found that self-reported problem drinkers who developed heavy alcohol consumption also received higher scores on the Beck Depression Inventory (BDI) compared to those who did not have problem drinking patterns.
Depression rates have been reported as high as 22 percent among college students, with suicide as the second leading cause of death among these young adults. Among participants in the study, 18 percent reported being minimally depressed, 4.5 percent reported being moderately depressed, and 1.5 percent reported being severely depressed, per the BDI.
Among the respondents, 57 percent of males and 40 percent of females who participated reported binge drinking at least once in the two weeks prior. Many people who abuse alcohol in college develop AUD; as many as two-thirds of individuals with diagnosable alcohol dependence, a sign of a potential AUD, met the criteria for this condition before the age of 25. Men typically reported drinking more than women, but in general, women who struggle with depression are at a greater risk for developing AUD or other forms of problem drinking.
About 15 percent of the study’s participants reported drinking specifically when they felt depressed; among those who reported binge drinking, 25 percent reported experiencing depression after bingeing.
Among all people living in the United States, over 16 million struggle with AUD – that’s 15.1 million adults over the age of 18, and 623,000 adolescents between the ages of 12 and 17. At the same time, a reported 16 million adults in the US reported having a major depressive episode in 2012. Women are more likely to receive a diagnosis for depression while men are more likely to abuse alcohol. Statistics vary, but as much as 33-50 percent of people who struggle with AUD also have depression concurrently. If the college freshmen survey can be applied to much of the US population, these problems begin early in life.
Consuming alcohol while depressed increases the risk of suicide: The Substance Abuse and Mental Health Services Administration (SAMHSA) found that 30 percent of suicide deaths in the United States involved blood alcohol concentrations (BAC) at 0.08 (the legal limit for driving) or higher. At the same time, 50 percent of those individuals who committed suicide experienced major depression at the time of their death. Alcohol lowers inhibitions, which may be a positive experience for some people in some social situations, but the lowered inhibitions also make thoughts of death or suicide easier to convert into actions.
Treating Co-Occurring Depression and Alcohol Use Disorder
Treating co-occurring AUD and depression requires simultaneous care. Abstinence from alcohol improves mood, including in people struggling with depression, so the first step is to get help safely detoxing from alcohol use with oversight from a medical professional. Managing withdrawal symptoms through a safe detox program not only helps people who may experience harmful symptoms like seizures or heart problems, but it also helps to manage depressive symptoms when they occur. This is important since people going through detox may experience depression as a withdrawal symptom.
Once the person has safely detoxed, their depression symptoms can be re-evaluated. If the mood disorder was induced by alcohol consumption, then symptoms may lift; however, if the individual had an underlying depressive disorder, they may benefit from antidepressants. Total abstinence from alcohol is very important, as antidepressants and alcohol do not mix safely. Alcohol’s presence in the body can make antidepressants less effective, leading to drinking more, and stronger antidepressants mixed with alcohol can lead to a dangerous spike in blood pressure.
Therapy through a rehabilitation program after detox is necessary. As the link between mental health and substance abuse is better understood, more evidence-based rehabilitation programs offer treatments for co-occurring disorders. Motivational Interviewing, Cognitive Behavioral Therapy, Contingency Management, and relapse prevention therapy have all proven very effective for individual and group therapy for co-occurring depression and AUD.
Once the person has completed rehabilitation, and they have been diagnosed with clinical depression, they should continue attending therapy to manage the behaviors associated with this mental health issue. Participation in peer support groups to reduce the risk of relapse and receive social support for recovery is also important to remain sober.