Alcohol and Depression

Are people with mental illness more likely to abuse drugs? Or does abusing drugs contribute to mental illness? There are no easy answers to these complicated questions, but the high rate of co-occurrence for these problems is prompting experts to advocate for better screening and treatment options for patients who present with both.

In Part Two, we look at the most common co-occurrence—depression and alcohol use disorder (AUD).

Although many people associate alcohol with “good times,” there is also the old adage of drinking to “drown your sorrows.” This can be the case for those who are clinically depressed and turn to alcohol as a form of self-medication. On the other hand, there are people whose depression only manifests after they begin abusing alcohol. Determining which problem came first is often the key to effective treatment for both issues.

As stated in Part One, there is often a “chicken or the egg” problem when discussing co-occurring (or “co-morbid”) substance abuse and mental illness. In the case of alcohol and depression, treatment professionals try to determine whether a person’s drinking precedes his or her depression or whether the depression precedes their drinking.

An ongoing large-scale research study has been conducted since 2001 to assess drinking and co-occurring conditions among the U.S. population. The most recent National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) showed that 13.9 percent of the population met criteria for AUD during the past year; 29.1 percent reported they experienced AUD at some point in their lifetime.  

The NESARC study also found that people with AUD were 3.7 times more likely to experience a major depressive disorder than those without AUD. Other research has shown that when people experience both AUD and depression, both conditions tend to more severe and are more difficult to treat than when they appear alone.

Interestingly, women are more likely to have depression first, then an alcohol use disorder, while the opposite is true for men—they are more likely to experience AUD first and depression subsequently.

There are two primary reasons alcohol misuse can lead to depression. The first is psychosocial—if a person has problems with alcohol, it can lead to further problems in life. For example, relationships can deteriorate, there could be job loss due to poor performance, or even trouble with the law. Any of these undesirable situations can lead to negative emotions that lead to a major depressive disorder.

The second reason is biological. Although drinking alcohol initially can feel stimulating, alcohol is a depressant, which means it lowers the function of neurotransmitters in the central nervous system. The immediate effects include slower movement, lack of coordination and slurred speech. In the long term, alcohol causes lasting effects in the brain. The misfiring of certain neurotransmitters, such as serotonin, is directly related to clinical depression (not to be confused with temporarily “feeling bad” after a bout of heavy drinking, which goes away after a few days).

A study released by the National Institute on Alcohol Abuse and Alcoholism found that people with a history of alcohol dependence, even including people who have quit drinking, were four times more likely to experience major depression in comparison to those without a history of AUD.

For some people, depression precedes AUD. Studies show that nearly a third of people with depression also have problems with alcohol. Many depressed people turn to alcohol or drugs in an attempt to escape or make themselves feel better, but they unfortunately are only exacerbating the problem. As noted above, the misuse of alcohol affects the brain in ways that can make depression worse.

There also is research saying certain genetic risk factors are present in both AUD and major depressive disorder, so there may be a genetic predisposition for certain people with depression to also become dependent on alcohol.

A Yale University study compared rates of AUD in people with and without depression, and found higher current and lifetime rates of AUD in the depressed population.

Due to the complicated nature of co-occurring of AUD and depression, achieving a successful outcome can be challenging. And, in patients who are able to successfully address both problems, there remains a significant danger of relapse, especially if and when they face difficult life circumstances that test their capabilities and resolve. Also, researchers have found that patients with dual diagnosis have a lower rate of completing formal treatment and attending follow-up sessions.

Fortunately, specialized treatment programs for dual diagnosis are more becoming more common and available, as there is growing awareness of the need for closer collaboration between professionals in the mental health and addiction treatment fields. These collaborative efforts provide the best avenue for recovery, and researchers and clinicians alike continue to explore innovative approaches to help people manage and recover from these two disorders.

Epidemiology of DSM-5 Alcohol Use Disorder

The Prevalence and Impact of Alcohol Problems in Major Depression

Comorbid Depression and Alcohol Dependence

Comorbidity of Alcoholism and Psychiatric Disorders

Meta-Analysis of Depression and Substance Use Disorders among Individuals with Alcohol Use Disorders