Do you or a loved one struggle with depression and alcoholism?
Depression and alcoholism are two of the most common mental health disorders in America. They often go hand-in-hand, with alcohol serving as an escape for those who struggle with depression. But what many people don’t realize is that there is hope! With the right treatment plan, it’s possible to break this cycle and live a life free of both conditions.
In this article, we’re exploring the close connection between depression and alcoholism.
The Cycle of Depression and Alcoholism
People experiencing symptoms of depression might turn to alcohol as a form of self-medication. Over a short period of time, an individual can develop a dependence on alcohol, ultimately resulting in a substance use disorder. The combination of depression and substance use disorder is known as co-occurring disorders, which requires specialized co-occurring disorders treatment. It’s estimated that about 64 percent of people with alcohol dependence qualify as clinically depressed and alcohol use among depressed people is also very high.
The association between depression and alcohol use is important because a dual diagnosis requires a different treatment approach than depression treatment or substance use disorder treatment on their own.
Understanding how depression can influence alcohol use, and how alcohol can play a role in depressive thinking can help people break the cycle and adjust their treatment plans.
Here’s what you need to know about depression and alcoholism.
The Link Between Depression and Alcoholism
There are two theories on the link between depression and alcoholism, and why they co-occur so often.
The first is that they share a causal effect with each other. In other words, depression often leads to substance use (alcohol in particular), and alcohol addiction can exacerbate or lead to depression.
The second is that both share environmental and genetic factors that are often co-occurring, such as family predisposition, home environment, parental relationships, childhood experiences, and socioeconomic factors.
It’s reasonable to assume that both play a role in most people’s dual diagnosis. Concurrent mental health and substance use disorders occur often enough that there must be some causal effect between them, and most people would agree that there’s a definite “cycle” between feeling anxious or depressed, self-medicating with an addictive substance, exacerbating the symptoms, and repeating the process.
It’s so common, in fact, that research on the topic discovered that being either depressed or alcoholic more than doubled the risk of struggling with the other in most people. And while there is a causal effect that goes both ways, research also shows us that alcohol use disorder affects the onset of major depressive disorder even more than depression can lead to drinking.
Mood Disorders and Self Medication
Among people where their depression did lead to drinking, one of the main causes of a dual diagnosis is the prevalence of self-medication. Alcohol is an addictive drug, mostly because of the effects it has on the dopaminergic reward system.
Drinking alcohol releases feelings of euphoria through chemical mechanisms in your brain, making you feel good. For people struggling with depressive thoughts, one or two drinks can help take the edge off, reduce inhibition, and release a short-term wave of pleasure.
But long-term exposure to alcohol can lead to chemical and physical dependence and a transformative effect on the brain’s reward system. Dependence leads to the emergence of withdrawal symptoms, making quitting physically and psychologically painful.
The body and mind both begin to crave alcohol, to the point that heavy drinking becomes a daily occurrence. Alcohol’s effect on the brain extends past this – it exacerbates depressive and anxious symptoms, making them even stronger.
This leads to an addiction that affects depressed people on a biopsychosocial level. Biologically, alcohol dependence can worsen physical and emotional symptoms, cause organ damage, create nerve pain, and generate horrible withdrawal symptoms.
Psychologically, alcohol’s impact on the brain affects memory and cognition, reduces problem-solving capacities, increases anxiety, and increases depressive thinking.
Socially, alcohol addiction is expensive, can cause legal problems associated with public drinking and excessive risk-taking, and can cause friction between you and your loved ones.
Many people who struggle with depression don’t know how to fight their way out of it. While the existence of depression is common knowledge, not everyone knows how to recognize it in themselves or their loved ones or knows how to access mental healthcare resources. Only about a fifth of people qualifying as depressed get the help they need, and over a third of depressed people get no help at all.
Alcohol is readily available, and its effects are nearly immediate. For people with few resources desperate for a fix, alcohol is very tempting. It’s often only in the long-term that its effects become apparent, at which point it may be too late to just stop.
Depression is very treatable – but a dual diagnosis can be harder to treat.
Treating Co-Occurring Disorders
Alcohol and depression are a dangerous mix. You cannot address an alcohol addiction without concurrently addressing a person’s depression.
Weaning someone off alcohol with professional help without building up their ability to cope with their depressive thoughts, address negative thinking, or deal with their anxieties means setting them up for a relapse.
On the other hand, trying to address depression without also taking the matter of addiction into account will not yield good results.
A multimodal approach that combines inpatient or outpatient addiction treatment with cognitive behavioral therapy, appropriate medication, and group therapy is key.
Inpatient alcoholism treatment, or rehab, takes people out of their environment to detox and overcome lingering withdrawal symptoms under the care of medical professionals. These programs also help patients develop coping skills to combat cravings and relapses and help them navigate locally available resources for recovery.
Cognitive-behavioral therapy centers around addressing negative thoughts (cognitive therapy) and negative actions (behavioral therapy). Combining substance use disorder treatment with one-on-one cognitive behavioral therapy can help alcoholic patients learn to identify and confront irrational and negative thinking, in addition to reducing depressive symptoms through medication, and developing healthy coping mechanisms through experiential therapy and group therapy.
Which Came First?
Whether someone developed depressive symptoms as a result of their addiction or began struggling with addiction after being depressed ultimately ties back into the need for a cohesive approach to treatment. Most of the time, it’s irrelevant which played the role of the chicken or the egg. What’s more important is how much one affects the other.
If a person is more likely to drink or has been drinking much more as a result of their depression, then antidepressants and therapy may also have a significant impact on their drinking. Otherwise, depression treatments may help reduce depressive symptoms but might only have a modest or negligible effect on addiction.
These questions help inform how a person’s treatment plan might be structured, and what modalities might be given greater importance during treatment.