How common is depression in people with alcohol problems? We explore the link between drinking and mental health.
Over 80 per cent of adults in the UK reportedly drink alcohol on occasion and for the majority, this does not interfere with their day-to-day functioning. However, for some, alcohol use can become problematic and lead to misuse and dependency or even Alcohol Use Disorder (AUD). This can have serious psychological consequences as those who are dependent on and/or misuse alcohol are four times more likely to develop clinical depression than those who don’t. Comorbidity between depression and alcohol misuse or dependence is a particularly disabling combination as it can severely impact a person’s work, social and home life.
Qualified CBT therapist Navit Schechter explores some of the main symptoms of depression and AUD, the negative cycle between the two conditions and the treatments that are available:
What is depression?
Depression is a common mental health problem that is believed to affect 1 in 5 people in the UK at any one time. It is a mood disorder that can cause a person to feel sad, hopeless, helpless, empty and numb amongst other emotions. It can exacerbate negative thoughts such as being worthless as well as patterns of self-criticism and rumination about past difficulties.
These thoughts and feelings are often accompanied by physical symptoms such as lethargy, low motivation, difficulty concentrating, difficulty sleeping, changes in appetite, headaches and tension. Sufferers often find that they lose interest and pleasure in previously enjoyed activities, spending less time with friends and family or doing rewarding activities as a result. People experiencing depression may have frequent thoughts of self-harm and suicidal thoughts or, in severe cases, make attempts to act on these.
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What is Alcohol Use Disorder ?
When drinking becomes severe and leads to misuse and/or dependency it may develop into Alcohol Use Disorder (AUD). AUD is a diagnosable condition given if at least 2 of the following 11 criteria are met:
- A person is unable to limit the amount of alcohol they drink, eg there are times when they drank more, or for longer, than intended.
- A person wanted to cut down or stop drinking on more than one occasion but was unable to.
- A lot of time is spent drinking, acquiring alcohol or dealing with the after effects of being drunk.
- Strong cravings or urges to drink alcohol are experienced.
- Drinking or its effects interfere with family, work or school life.
- A person continues to drink even though it was causing problems with work, friends and family.
- Other, previously important, activities have been reduced or given up in order to drink alcohol.
- A person has undertaken activities that were unsafe while drunk, eg driving, unsafe sex.
- A person continues to drink despite the impact on their physical or mental health.
- More alcohol is needed to experience the same effects as previously.
- Symptoms such as trouble sleeping, irritability, anxiety, depression, restlessness and nausea are experienced when the effects of alcohol are wearing off.
AUD can begin in the teen years, although its onset is most common in the 20s or 30s. It is believed that more than 2 million people in the UK experience AUD at some point in their lives and if left untreated, it can become a life-long issue.
Causes of depression and AUD
A number of risk factors have been identified for AUD including regularly drinking large quantities of alcohol or binge-drinking, drinking from a young age, a family history of problematic drinking, depression and other mental health conditions and a history of trauma. There is a high correlation between depression and alcohol misuse and dependency and both are recognised as risk factors for the other.
It may be that a common underlying factor predisposes an individual to both depression and AUD, as research has found that people with a family history of either condition are at a higher risk of developing depression or AUD themselves, as are those who have experienced abuse, trauma and relationship difficulties in their early years.
However, it may also be the case that the conditions have a more causal relationship as the symptoms of depression can lead a person to self-medicate with alcohol or, in other cases, the effect of alcohol-use can cause symptoms of depression.
The cycle of depression and AUD
Many people who experience depression, especially if they are not receiving the right support, may turn to alcohol for temporary relief from their symptoms or, in other words, to ‘self-medicate’. Research has found that alcohol use increases both the duration and severity of depressive episodes in the long-term and estimates suggest that between 30-40 per cent of alcoholics also experience a depressive disorder.
Alcohol activates a system in the brain that promotes feelings of calm and relaxation and can therefore offer temporary relief from symptoms of depression. In an attempt to maintain balance however, the body responds by activating a counter-system which can result in feelings of anxiety and irritability and exacerbate feelings of depression in the long-term.
Alcohol activates a system in the brain that offers temporary relief from symptoms of depression.
As alcohol misuse and dependency impact on a person’s life, it can lead to relationship and work difficulties, memory and sexual problems, self-criticism and feelings of shame and guilt, which can all compound feelings of depression further. In the absence of other coping strategies to manage, a person might drink more to escape these difficult experiences, which can lead to a cycle of depression and alcohol use. This cycle can be exacerbated further as the long-term impact of alcohol on the physiology of the body in itself can lead to symptoms of depression.
Treatment for depression and AUD
If you are continuing to drink despite the impact it’s having on your relationships, work, finances and other important areas of your life or if you are craving alcohol, unable to give up drinking and are concerned that you are experiencing symptoms of depression, AUD or both, your GP should be able to help you find the support you need.
Depending on how these conditions are affecting you, you might benefit from treatment for depression, AUD or a combined approach. Medication, psychological therapy, community-based intervention programmes or support groups that promote abstinence or moderate drinking are usually the recommended treatments of choice. If you prefer not to speak to your GP, details of some of the alcohol support services are given below.
Community-based intervention programs
Many people will find that their symptoms of depression lift within a few weeks of cutting out alcohol. As such, the NICE guidelines recommend treatment for the alcohol misuse first as this can lead to significant improvement in the depression. If depression continues after 3 to 4 weeks of abstinence from alcohol, other treatment options can then be considered.
Stopping drinking abruptly can cause withdrawal symptoms which can be severe.
Support to help you to detox from alcohol is available within the community. If you drink over 15 units of alcohol per day you may be offered an assisted withdrawal program. As a physical dependency on alcohol can develop, stopping abruptly can cause withdrawal symptoms which can be severe and in rare cases, life threatening. It is therefore best to do this with specialist support.
Medication for depression and AUD
You may be offered antidepressants to help relieve the symptoms of depression. As alcohol can impact on the levels of neurotransmitters in the brain, these can re-balance the body’s physiology, helping to improve your mood.
Other medications such as Acamprosate may also be offered. This helps to reduce alcohol cravings and can be used to support relapse prevention. Other medications are also sometimes used to prevent relapse in some people.
Therapy for depression and AUD
Psychological therapy eg Cognitive Behavioural Therapy (CBT) may be recommended to help you to address the cause and symptoms of depression. A course of CBT will help you to understand the patterns and habits that lead to the development and maintenance of your feelings of depression and how this has led to a reliance on alcohol in an attempt to manage them.
A course of CBT will help you to understand the patterns and habits that lead to depression.
As well as understanding how these patterns have developed, during a course of therapy you will be supported to develop healthier responses to difficult situations and given the opportunity to learn coping strategies that will enable you to live a fulfilling life without drinking.
Support groups for depression and AUD
Support groups such as alcoholics anonymous (AA) and local alcohol treatment services commonly offer classes and support group meetings where you can find support from others in your situation who have overcome their problematic drinking and/or addiction.
Although it can be hard to acknowledge and seek help for depression and AUD and the fact that there is no ‘quick fix’, committing to getting support for these conditions can give you the tools that you need to reclaim your mental and physical health and allow you to lead a healthier, happier and more fulfilling life.
Further help and support
For additional support with anything related to depression and alcohol abuse try one of the following resources:
- We are with you: free, confidential support with alcohol or mental health.
- Depression UK: support for people affected by, or at risk of, depression.
- Alcoholics Anonymous: 12 steps program to sobriety.
- Al-Anon: provides support for anyone affected by someone else’s drinking.
- Samaritans: a charity providing support to anyone in emotional distress.