Alcohol Dependence: A Mental Health Crisis

Alcohol use disorder (AUD) is a medical diagnosis and mental health condition. It refers to alcohol use that feels distressing or beyond one's control. AUD was previously known as alcoholism until 1994 when the American Psychiatric Association (APA) updated the terminology to alcohol abuse and alcohol dependence. In 2013, the APA further refined the term to “alcohol use disorder”, which falls under the umbrella of substance use disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). AUD is characterised by symptoms such as craving the next drink, using alcohol in hazardous situations, and experiencing withdrawal symptoms. It often co-occurs with other mental health disorders, and the treatment approach depends on the severity of AUD and the co-occurring disorder. While quitting drinking can lead to clinical improvement, treatment for psychiatric symptoms alone may not be sufficient to reduce alcohol consumption.

Alcohol Use Disorder (AUD) is a mental illness

The link between alcohol and mental health is well-established. Alcohol use can affect an individual's mental well-being, and those with mental health conditions may be more susceptible to developing AUD. This relationship is complex and bidirectional, with alcohol use and mental health issues influencing each other over time. People may drink to relieve symptoms of mental ill-health or to cope with difficult feelings such as depression, stress, or anxiety. However, relying on alcohol to manage mental well-being can become problematic, leading to a cycle of dependence.

The treatment of AUD often involves addressing both the mental health and emotional aspects of the disorder. This includes providing individuals with the necessary tools and support to reduce or abstain from alcohol consumption. Motivational interviewing, mindfulness training, and cognitive-behavioural therapy (CBT) are some of the commonly used mental health-centred treatments for AUD. Additionally, the severity of AUD and co-occurring mental health disorders determines the level of care required. Mild cases of AUD may be managed through primary care, while more severe cases may necessitate the involvement of mental health or addiction specialists.

It is important to recognise that AUD is not a moral failing but a legitimate mental health condition. Seeking professional help is crucial, and individuals affected by AUD can reach out to their healthcare providers or local support services, such as alcohol addiction support groups. By doing so, individuals can receive the necessary assistance to manage their alcohol consumption and improve their overall mental well-being.

AUD and co-occurring psychiatric disorders

Alcohol use disorder (AUD) is a highly prevalent psychiatric disorder that often co-occurs with other mental health disorders. Over 50% of treated AUD patients also suffer from other psychiatric disorders. The most common mental health conditions that co-occur with AUD are depressive disorders, anxiety disorders, trauma- and stress-related disorders, other substance use disorders, and sleep disorders. Bipolar disorder, attention deficit-hyperactivity disorder, and psychotic disorders such as schizophrenia also frequently co-occur with AUD.

The co-occurrence of AUD and another mental health disorder can complicate diagnoses and negatively impact the clinical course of both conditions. Many clinical features of AUD significantly overlap with other psychiatric disorders, including sleep disturbances and negative emotional states such as worry, dysphoria, sadness, or irritability. These symptoms often occur during cycles of alcohol intoxication, withdrawal, and craving. The presence of psychiatric symptoms during periods of abstinence from alcohol can indicate separate, primary conditions.

The severity of both the AUD and the co-occurring mental health disorder determines the appropriate level of care. Patients with less severe AUD and mental health conditions may receive treatment in primary care, while those with more severe conditions may require care from a mental health or addiction specialist. Treatment priorities depend on factors such as patient needs and clinical resources available. An emphasis may be placed on treating the AUD component first, the co-occurring psychiatric disorder, or both conditions simultaneously.

The relationship between AUD and co-occurring psychiatric disorders is complex and multifaceted. AUD and psychiatric disorders may share genetic risks and environmental vulnerabilities, such as trauma and adverse childhood experiences. Pre-existing psychiatric disorders may predispose individuals to develop AUD, as alcohol is often used to cope with psychiatric symptoms. Additionally, the co-occurrence of AUD and psychiatric disorders can exacerbate each other, leading to poorer outcomes and increased alcohol use.

Alcohol dependence and withdrawal

Alcohol withdrawal refers to the symptoms that occur when a person who has been drinking heavily on a regular basis suddenly stops or significantly reduces their alcohol intake. These symptoms are caused by the way the brain reacts when alcohol intake is reduced. Alcohol is a depressant, and drinking suppresses the 'fight or flight' response in the brain and nervous system. When someone regularly drinks heavily, the central nervous system gets used to the suppressing effect of alcohol. Therefore, when alcohol leaves the system, the brain can go into 'fight or flight' mode, even when there is no danger present. This results in various withdrawal symptoms, including psychological ones such as anxiety and rapid mood changes, as well as physical symptoms like shakes, seizures, and hallucinations.

Withdrawal symptoms can range from mild to severe and typically appear within six to twelve hours after the last drink. Mild symptoms include headache, mild anxiety, and insomnia. More severe symptoms, such as hallucinations, can occur within twenty-four hours of the last drink. For most people with mild to moderate withdrawal, symptoms typically peak and begin to resolve within twenty-four to seventy-two hours. However, for those with severe withdrawal, the risk of seizures is highest within this timeframe. Delirium tremens is a severe form of alcohol withdrawal that can be life-threatening, causing serious medical issues such as seizures and hallucinations that require immediate medical care.

If you think you might be experiencing alcohol withdrawal, it is important to seek medical help and talk to a healthcare professional. Treatment for alcohol withdrawal depends on the severity of the symptoms. Most people with mild to moderate withdrawal can be treated as outpatients, while those with severe symptoms may require inpatient medical treatment or residential rehabilitation. Treatment options include behavioral therapy, group psychotherapy, and medications such as naltrexone, acamprosate, and long-acting benzodiazepines. Total and lifelong avoidance of alcohol is the best treatment for those who have gone through alcohol withdrawal.

Alcohol's impact on mental health

Alcohol use disorder (AUD) is a medical diagnosis, a mental health condition, and a form of substance use disorder. It is characterised by a dependence on alcohol and is often accompanied by other mental health disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines the criteria for diagnosing AUD, categorising it as mild, moderate, or severe based on the presence of certain symptoms.

The link between alcohol and mental health is well-established. Alcohol affects the neurotransmitters in our brains, and while a certain level can help ward off anxiety and depression, excessive drinking can lead to a cycle of dependence. People may drink to relieve symptoms of mental ill-health or to change their mood, but the effect is only temporary. As alcohol wears off, withdrawal symptoms can worsen feelings of depression, stress, and anxiety. This can lead to a vicious cycle where individuals drink more to relieve these difficult feelings, resulting in alcohol dependence or AUD.

AUD frequently co-occurs with other mental health disorders, and the presence of one can increase the likelihood of the other. For example, individuals with AUD are three times more likely to experience major depressive disorder (MDD). The cycle of intoxication and withdrawal associated with AUD can also trigger MDD and other mental health concerns. Additionally, those with pre-existing mental health conditions, such as depression, post-traumatic stress disorder (PTSD), or attention-deficit/hyperactivity disorder (ADHD), may be at an increased risk of developing AUD.

The treatment of AUD often involves addressing both the alcohol dependence and any co-occurring mental health disorders. In some cases, the emphasis may be primarily on treating AUD, while in others, the co-occurring psychiatric disorder may take precedence, or both conditions may be treated simultaneously. The severity of AUD and the co-occurring mental health disorder determine the appropriate level of care, which can range from primary care to specialised mental health or addiction treatment services.

Quitting drinking is often an important step in improving co-occurring mental health disorders. However, it is crucial to do so safely, as sudden cessation can lead to severe alcohol withdrawal symptoms such as delirium tremens (DT), which can be life-threatening. Seeking professional help is essential, as treatment for psychiatric symptoms alone may not be sufficient to reduce alcohol consumption or AUD symptoms. Support for AUD can include behavioural treatment, medication, support groups, and talking therapies.

Treatment options for AUD

Alcohol dependence is closely linked to mental health. Alcohol reduces the number of neurotransmitters in our brains, but we need these neurotransmitters to ward off anxiety and depression. This can lead to a cycle of dependence, where one drinks more to relieve these difficult feelings.

Alcohol use disorder (AUD) often occurs with other mental health disorders, and vice versa. Treatment options for AUD include:

Inpatient Medical Treatment or Residential Rehabilitation

For those with severe AUD, inpatient medical treatment or residential rehabilitation may be recommended. This involves staying at a treatment facility and receiving round-the-clock care and support. This type of treatment can provide a structured and intensive approach to recovery, addressing both the physical and psychological aspects of AUD.

Behavioural Treatment

Behavioural treatments focus on changing drinking behaviour through counselling. This may involve working with addiction counsellors or psychologists to identify triggers, develop coping strategies, and learn healthier ways of managing emotions and stress.

Medication

There are currently three medications approved for AUD in the United States:

• Naltrexone (available as a pill or injection) helps reduce the urge to drink.
• Acamprosate (a pill) decreases the negative symptoms associated with alcohol abstinence, making it easier to maintain sobriety.
• Disulfiram (a pill) discourages drinking by causing unpleasant symptoms when alcohol is consumed.

Support Groups and Talking Therapies

Support groups provide a sense of community and connection with others going through similar struggles. Talking therapies, such as individual or group counselling, can help individuals process their feelings, address underlying issues, and develop healthier coping mechanisms.

Dual Diagnosis and Integrated Treatment

For individuals with severe mental health problems and AUD, a "dual diagnosis" may be given. In these cases, mental health services should oversee treatment, addressing both the mental health disorder and AUD simultaneously.

Family Therapy

Family therapy can be beneficial for those in recovery from AUD, as it helps family members understand the disorder, address their own concerns, and provide support for their loved one's recovery.

Treatment Referral Services

Treatment referral services, such as SAMHSA's National Helpline, offer confidential assistance in finding local treatment facilities, support groups, and community-based organisations. These services can provide information and guidance on available treatment options.

It is important to note that there is no one-size-fits-all approach to treating AUD. Treatment should be tailored to the individual's needs and may involve a combination of these treatment options. Seeking help from a healthcare provider or mental health professional is the first step towards finding the right treatment plan.

Frequently asked questions