Treating Depression and Alcohol Addiction
Many people who have depression also have an alcohol use disorder and vice versa. These people are at an increased risk of suicide, and the two conditions can exacerbate each other.
What Is Depression?
The information in this article is intended to be used for educational purposes only. If you believe you have some type of psychological disorder such as depression or a substance use disorder, talk to a licensed mental health professional.
Most people feel depressed at one time or another. But occasionally feeling sad is not the same thing as having a depressive disorder. Those who have clinical depression have a severe psychological disorder that interferes with their daily lives for extended periods of time.
Depression can have potentially fatal consequences, including suicide.
To be diagnosed with major depressive disorder, a person must display 5 of 9 of the following symptoms over the same 2-week period. At least one symptom must be either depressed mood or the loss of experiencing pleasure or significantly decreased interests.
The symptoms cannot be better accounted for by another mental health disorder, medical condition or the use of drugs. 1
The symptoms of depression include: 1
- Depressed mood most of the day nearly every day.
- Significantly diminished interests or the loss of the capacity for pleasure in almost all activities nearly every day.
- Significant weight loss when not attempting to diet.
- Sleep difficulties such as insomnia or hypersomnia (increased sleeping nearly all the time) nearly every day.
- Extremely slow physical movements or extremely jittery, irritable, nervous-like movements nearly every day.
- Significant energy loss or fatigue nearly every day.
- Feelings of worthlessness or guilt nearly every day.
- Difficulties concentrating or thinking nearly every day.
- Recurrent thoughts of death or dying nearly every day.
Relationship Between Alcohol Use Disorder and Depression
The term dual diagnosis (or co-occurring diagnosis) is often used to describe a situation where a person has one psychological/psychiatric disorder , such as depression, and a comorbid substance use disorder . 2
The term comorbidity refers to the presence of 2 or more disorders or illnesses that occur in the same person at the same time. 2 The fact that 2 psychiatric/psychological disorders are comorbid does not mean, however, that one is the cause of the other, even if one disorder developed before the other.4
A number of large studies have estimated the comorbidity between alcohol use disorders and major depressive disorder. The National Comorbidity Survey found that the lifetime odds of a serious alcohol use disorder were significantly elevated for both women (slightly greater than 4.0) and men (nearly 3.0) who had major depressive disorder.
This statistic indicates that the odds of women who had been diagnosed with major depressive disorder and later a serious alcohol use disorder were 4 times higher than having only the major depressive disorder alone. The data also indicates that people first diagnosed with an alcohol use disorder are twice as likely to have comorbid major depression in their lifetime as opposed to having just the alcohol use disorder alone. 5
Alcohol Use Disorder Symptoms
The symptoms of an alcohol use disorder include problematic use of alcohol that leads to impairment or distress characterized by at least 2 of the following symptoms over a 12-month period: 1
- Drinking larger amounts of alcohol than intended or drinking alcohol over a longer period of time than intended.
- Unsuccessful efforts to cut down or a persistent desire to cut down one’s drinking.
- Spending a great deal of time using, obtaining or recovering from the effects of alcohol.
- Strong cravings for alcohol.
- A failure to fulfill major obligations at work, school or in relationships due to alcohol use.
- Continuing to use alcohol despite having recurrent problems due to alcohol use.
- Giving up important social, recreational or occupational activities as a result of using alcohol.
- Repeatedly using alcohol in situations where it is physically dangerous, such as driving a car or operating machinery.
- Continuing to use alcohol despite knowing that it is causing either physical or psychological problems.
- Displaying tolerance and/or withdrawal symptoms.
The more symptoms a person has, the more severe the alcohol use disorder.
If a person meets the diagnostic criteria for both depression and alcohol use disorder at the same time, they would receive a dual diagnosis of major depressive disorder and alcohol use disorder. These disorders cannot be self-diagnosed, diagnosed by friends or family (unless they are licensed mental health professionals), or by any other means except through a formal assessment performed by a licensed mental health professional.
Among those in recovery, alcohol was abused at a higher rate than any other substance, according to a Recovery Brands survey in 2017. The survey reports that nearly 70% of respondents went to treatment because of a drinking problem, and 52.87% of people that took the survey reported seeking treatment for a problem with alcohol more than any other substance.
Development of Alcohol Use Disorder and Depression
People with depression might turn to substance abuse to deal with negative emotions.
A person can develop both an alcohol use disorder and comorbid depression in a number of ways: 6
- One disorder develops after the other or by coincidence. The alcohol use disorder and depression could co-occur either in succession or simultaneously by coincidence.
- The effects of alcohol abuse lead to depression. An alcohol use disorder can produce symptoms, especially during withdrawal periods, that increase the severity of depression or even appear as depression. In addition, the consequences of an alcohol use disorder can lead to changes in an individual’s mood that qualify for a diagnosis of major depressive disorder.
- The person uses alcohol to self-medicate depression. People with depression might turn to substance abuse as a way to deal with severe negative emotions and their effects. This behavior is frequently referred to as “self-medication,” yet research has not consistently supported it. 2, 5, 6
- The person has genetic differences that increase vulnerability to psychological disorders. Individuals who develop any type of psychiatric/psychological disorder may have inherent differences in both their genetic makeup and/or neurobiological makeup that make them prone to developing other psychiatric/psychological disorders. For instance, people prone to developing substance use disorders may have similar neurobiological profiles making them vulnerable to developing depression (or vice versa).
Effects of Drinking While Depressed
- Worsening of depression. Alcohol is a central nervous system depressant , which means that it dampens the rate of firing of neurons in the central nervous system. 7 Abusing alcohol when one has depression can make the symptoms of depression worse.
- Increased risk of self-harm or suicide. People who abuse alcohol often have issues with judgment, impulse control and emotional instability when intoxicated. If they also suffer from depression, the combination can increase the potential for self-harm either from accidents or from intentional acts of self-harm (e.g., suicide attempts).
- Downward spiral from negative consequences. Alcohol abuse can lead to a number of negative consequences, including issues with one’s occupation, relationships and personal health. People who are already depressed may suffer even more depression as a result of their alcohol use disorder. This effect can lead to a downward spiral of worsening depression, leading to worsening alcohol abuse, leading to even worse depression, and so on.
Treatment for Alcoholism and Depression
As noted earlier, dual diagnosis occurs when a person has a psychological/psychiatric disorder and a co-occurring substance use disorder. Research has indicated that in cases of dual diagnoses, treating one disorder and ignoring the other is counterproductive, 8 and it can lead to relapse. The two disorders must be treated simultaneously for the treatment to be successful. 8
Depending on the specific case, treatment options can include: 8
- Inpatient treatment, where the person remains in a clinic or a hospital for the duration of treatment . An inpatient or residential program typically includes detox, medication administration, medical care, and individual and group therapy. Inpatient may be an appropriate option for people who have severe alcohol withdrawal issues or who may be actively suicidal.
- Outpatient treatment involves the person attending treatment sessions at a clinic and then returning home. Sessions may consist of individual or group therapy.
- Types of therapy that are considered useful in the treatment of depression and alcohol use disorders include cognitive behavioral therapy (CBT), certain types of interpersonal therapies, and in some cases, certain types of brief dynamic therapy . CBT therapists help people with depression and co-occurring alcohol use disorders understand the thinking patterns that underlie their depression and alcohol use and then help them to develop new, healthier patterns that can lead to improved mood and reduced alcohol use.
- Medication-assisted treatment , which includes the use of medication in combination with behavioral therapy, can be used in the treatment of both depression and alcohol use disorders. The medications need to be strictly supervised by a psychiatrist or an addiction physician to be most effective and to prevent potential abuse (depending on the medications being used).
- 12-step programs such as Alcoholics Anonymous offer peer support and a structured recovery program to people with alcohol use disorder and depression.
- Group therapy , including family therapy, helps people with mental health and substance use disorders share their experiences with other people who are struggling with similar issues.
- Aftercare programs are recommended for people in treatment for dual diagnoses once the initial periods of therapy are completed. Often, aftercare will include support group participation, 12-step group participation and other interventions.
In addition, simple changes in lifestyle such as exercising, learning stress control techniques, eating a balanced diet, developing goals and making friends who are abstinent can also contribute to recovery.
Frequently Asked Questions
Is Alcohol a Stimulant or a Depressant?
Alcohol is a central nervous system depressant. However, it does have some mild stimulating effects at very low intake.
As a person drinks more alcohol, the central nervous system depressant actions of the drug begin to take over. As a result, the excitability of the neurons in the brain and spinal cord is decreased by the use of alcohol.
Alcohol has a number of mechanisms of action, one of which is to increase the action of the neurotransmitter gamma aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the brain, resulting in a decrease in the normal firing rates of the neurons in the brain and spinal cord.
Does Drinking Alcohol Cause Depression?
This is a tricky question. The best answer is that people who chronically abuse alcohol will suffer a number of negative consequences such as health issues, issues with relationships, issues with work and even potential legal issues. These effects of chronic alcohol abuse can certainly contribute to the development of depression in many people.
In addition, withdrawal from alcohol or even a hangover can result in temporary depression.
Long-term use of alcohol may also be associated with damage to the brain, which can make one more susceptible to developing issues with mood, including depression.
Does Alcohol Withdrawal Cause Depression?
Withdrawing from alcohol can cause a number of issues due to both the physiological effects of alcohol withdrawal and reactive issues. Alcohol users would not be diagnosed with major depressive disorder if they displayed depressive symptoms during withdrawal because one of the criteria for major depressive disorder is that the depression cannot be caused by a medical condition or the use of drugs or medications.
One could, however, be diagnosed with a substance-induced depressive disorder if the depression occurred after withdrawal from alcohol. Moreover, the severe distress from alcohol withdrawal can certainly lead to a depressed mood.
Find Treatment Centers for Alcoholism and Depression
Anyone seeking treatment for alcohol abuse and/or depression can call 1-888-319-2606Who Answers? to speak with a treatment support representative to learn about recovery options. A representative can confirm your insurance coverage over the phone.
If you or your loved one does not have health insurance, you can call the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357) for referrals to low-cost treatment centers or support groups in your area.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, Fifth edition. Arlington, VA: American Psychiatric Association.
. Sadock, B. J., & Sadock, V. A. (2014). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry. New York: Lippincott Williams & Wilkins.
. Kubler-Ross, E. (2009). On death and dying: What the dying have to teach doctors, nurses, clergy and their own families. New York: Taylor & Francis.
. Hatfield, R. C. (2013). The everything guide to the human brain. Avon, MA: Adams Publishing.
. Sher, L. (2004). Depression and alcoholism . QJM, 97(4), 237-240.
. Atkins, C. (2014). Co-occurring Disorders: Integrated Assessment and Treatment of Substance Use and Mental Disorders. Eau Claire, WI: PESI Publishing & Media.
. Rose, M. E., & Cherpitel, C. J. (2011). Alcohol: Its history, pharmacology, and treatment. Center City, MN: Hazelden Publishing.
. Westermeyer, J. J., Weiss, R. D., & Ziedonis, D. M. (Eds.). (2003). Integrated treatment for mood and substance use disorders. Baltimore, MD: JHU Press.