Vivian Marlowe
Alcohol use disorder (AUD) and mental health disorders are closely linked. People with depression, anxiety, and other mental health issues often use alcohol to self-medicate and ease their symptoms. While alcohol can initially make people feel more relaxed and less anxious, these positive effects are short-lived. Excessive alcohol consumption can lead to negative feelings, such as anger, depression, and anxiety, and worsen existing mental health problems. Additionally, long-term alcohol misuse increases the risk of developing mental health disorders and can cause permanent brain damage, affecting understanding, memory, and logical thinking. The relationship between alcohol and mental health is complex, with alcohol abuse co-occurring with, contributing to, or resulting from mental health disorders.
| Characteristics | Values |
|---|---|
| Alcohol use disorder (AUD) | AUD frequently occurs with other mental health disorders and vice versa. |
| AUD and mood disorders may exacerbate each other through common neurobiological substrates, shared genetic vulnerability, and shared environmental stressors. | |
| AUD and PTSD may have multiple causal pathways. | |
| AUD can cause sleep disorders and vice versa. | |
| Alcohol is a depressant that can disrupt the balance of neurotransmitters in the brain, affecting feelings, thoughts, and behavior. | |
| Long-term alcohol misuse increases the risk of serious health conditions, including heart disease, stroke, high blood pressure, liver disease, and cancer. | |
| Alcohol problems and mental illness are closely linked. | |
| People with depression who stop drinking often start to feel better within the first few weeks. | |
| Excessive alcohol use can worsen mental health and lead to more problems. | |
| Alcohol can make people more likely to self-harm and commit suicide. | |
| Alcohol dependence can cause social problems such as unemployment, homelessness, and domestic abuse. | |
| People with severe or moderate AUD who suddenly stop drinking may experience delirium tremens (DT), a severe form of alcohol withdrawal that can be life-threatening. |
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What You'll Learn
Alcohol use disorder (AUD) and mood disorders
Alcohol use disorder (AUD) frequently occurs with other mental health disorders, and vice versa. AUD and mood disorders are often comorbid, with evidence suggesting a genetic link between the two. The most common mood disorders that co-occur with AUD are major depressive disorder and bipolar disorder. The prevalence of AUD in people with major depressive disorder is estimated to range from 27% to 40% for lifetime prevalence and up to 22% for 12-month prevalence. Among individuals with bipolar disorder, the prevalence of AUD is even higher, estimated at 42%.
Long-term exposure to alcohol in individuals with depressive or manic symptoms can lead to a more severe clinical course. This includes longer mood episodes, poorer cognitive function, and an increased risk of suicide. AUD and mood disorders appear to exacerbate each other through common neurobiological substrates, shared genetic vulnerability, and environmental stressors. For example, individuals may use alcohol to cope with symptoms of depression, anxiety, or stress, which can provide temporary relief. However, excessive alcohol use can worsen underlying mood disorders and lead to further negative feelings.
The relationship between AUD and mood disorders can be complex and bidirectional. It is important to determine whether mood symptoms are present during periods of alcohol use or abstinence, as this can help differentiate between alcohol-induced and primary mood disorders. Treatment approaches for comorbid AUD and mood disorders may include medication and behavioural therapy, such as behavioural activation therapy or cognitive behavioural therapy.
Additionally, sleep disorders and post-traumatic stress disorder (PTSD) may also play a role in the development of AUD. Alcohol can disrupt sleep patterns, and sleep-related concerns can be risk factors for heavy alcohol use. Regarding PTSD, alcohol may be used to numb memories of traumatic events, and AUD may increase the likelihood of developing PTSD by disrupting an individual's ability to cope with trauma.
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AUD and sleep disorders
Alcohol use disorder (AUD) and sleep disorders are closely related. Sleep disorders can facilitate the development of AUD, and AUD can cause sleep disorders. Even moderate doses of alcohol can alter sleep physiology, for example, by reducing rapid eye movement (REM) sleep duration. Alcohol use may also worsen sleep-disordered breathing and periodic limb movements during sleep, compromising sleep quality. These alterations in sleep may be subacute or chronic, recovering only after 30 or more days of abstinence.
Some clinical features of AUD may also precipitate sleep disorders, such as a preoccupation with obtaining alcohol and AUD-related psychosocial stressors. Additionally, tolerance to alcohol can increase alcohol intake, exacerbating sleep symptoms. When patients present sleep-related concerns such as insomnia, early morning awakening, or fatigue, screening them for heavy alcohol use is advisable.
There is evidence of a bidirectional causal relationship between insomnia and AUD. Insomnia associated with heavy drinking may increase the risk of psychiatric disorders and suicidal behaviour. Co-occurring insomnia and AUD are linked to impaired quality of life, psychosocial problems, and an increased risk of relapse during early recovery.
Genetic links between AUD and insomnia have been suggested, with a positive association between the genetic risk for insomnia and AUD. However, no causal relationship between insomnia and alcohol consumption has been established.
The mechanisms underlying sleep disruptions in AUD are not yet fully understood. Sleep-related brain regions show significant overlap with areas of reduced grey matter volume in patients with AUD. This suggests that grey matter structure may contribute to sleep disturbances associated with chronic alcohol use.
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AUD and post-traumatic stress disorder (PTSD)
Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are closely linked. Research has shown that individuals with PTSD use alcohol and experience AUD to a greater degree than those without PTSD. This link between PTSD and AUD has been observed in Vietnam veterans and has since been broadened to include veterans of other wars and anyone exposed to trauma.
There are several possible explanations for the relationship between AUD and PTSD. Firstly, heavy alcohol use may increase the likelihood of experiencing traumatic events such as violence and accidents. This could be due to the associations between risky drinking and violent or accidental events. Additionally, externalizing psychopathologies common in AUD, such as attention-deficit/hyperactivity disorder and conduct disorder, can promote impulsive and risk-taking behaviours that may lead to trauma.
Secondly, AUD may undermine an individual's ability to cope with traumatic events. This may be due to the disruptive effects of alcohol on arousal, sleep, and cognition, which can increase the likelihood of developing PTSD. For example, even moderate doses of alcohol can alter sleep physiology, reducing rapid eye movement sleep duration and compromising sleep quality. The preoccupation with obtaining alcohol and the psychosocial stressors associated with AUD may further exacerbate sleep disorders.
Thirdly, AUD and PTSD share risk factors, including prior depressive symptoms and adverse childhood experiences. Individuals with PTSD may use alcohol as a form of self-medication to numb memories of traumatic events or cope with post-traumatic stress symptoms. This can lead to a cycle where alcohol use increases the likelihood of PTSD, and PTSD symptoms drive further alcohol use.
The comorbidity of AUD and PTSD has been well-established, and the two disorders can influence each other in complex ways. The severity of both conditions determines the appropriate level of care, with more severe cases requiring treatment from mental health or addiction specialists.
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AUD and self-harm
Alcohol use disorder (AUD) and self-harm are closely linked. Self-harm is a term that has historically been used to cover a broad range of behaviours, referring to deliberately causing pain or damage to oneself, and it can be suicidal or non-suicidal in intent. Self-harm is often a coping mechanism to deal with strong physical or emotional pain, distress, or difficult feelings.
Research has shown that persons with combined alcohol misuse and self-harm are at an increased long-term risk of repeated self-harm and suicide compared to those who self-harm but do not misuse alcohol. In a study by Haw et al., 27% of persons with an episode of deliberate self-harm were dependent on alcohol or used it harmfully. Additionally, a meta-analysis found that alcohol use was associated with a 94% increase in the risk of death by suicide.
There are several reasons why alcohol misuse and self-harm co-occur. Firstly, alcohol is a depressant that disrupts the balance of neurotransmitters in the brain, affecting feelings, thoughts, and behaviour. It can enhance feelings of depression, anxiety, anger, and negative emotions. Secondly, alcohol can increase impulsivity, which is a common trait among those who self-harm. Thirdly, alcohol misuse can lead to social problems such as relationship issues, unemployment, financial difficulties, and homelessness, which can contribute to emotional distress and increase the risk of self-harm.
Furthermore, there are genetic and environmental links between AUD and self-harm. Genetic factors account for approximately 60% of the risk for AUD, and a history of childhood trauma or adverse events also increases vulnerability to AUD. Additionally, certain psychiatric conditions, such as depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD), are commonly associated with both AUD and self-harm.
It is important to note that the relationship between AUD and self-harm is complex and bidirectional. While alcohol misuse can contribute to self-harm, individuals who self-harm may also be more likely to misuse alcohol as a coping mechanism. Therefore, addressing both the AUD and underlying mental health issues is crucial in preventing self-harm and promoting recovery.
If you or someone you know is struggling with self-harm and/or alcohol misuse, seeking professional help is essential. There are various treatment options available, including behavioural therapies, medication, and mutual-support groups. Additionally, reaching out to trusted individuals, such as friends, family, teachers, or healthcare professionals, can provide support and guidance.
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AUD and social problems
Alcohol use disorder (AUD) is closely associated with mental health disorders. People with depression and anxiety may use alcohol to help ease symptoms, but excessive alcohol use can worsen mental health. Alcohol is a depressant that disrupts the balance of neurotransmitters in the brain, affecting feelings, thoughts, and behaviour. While it may initially make one feel relaxed, less anxious, and more confident, these effects are short-lived. The chemical changes in the brain can soon lead to more negative feelings, such as anger, depression, or anxiety.
AUD can lead to social problems, including relationship issues, unemployment, financial troubles, and homelessness. These social issues can further impact one's mental health. For example, dealing with physical health problems, debt, and housing instability can contribute to poor mental well-being. Additionally, alcohol problems and mental illness are bidirectionally linked; those with severe mental illness are more likely to have alcohol problems, possibly due to self-medication.
The relationship between AUD and social problems is complex and multifaceted. Firstly, social support plays a crucial role in the recovery process for individuals with AUD. The breakdown of social functions and social support networks can result from a lack of socioeconomic resources, leading to social isolation and a decline in mental health. Secondly, AUD can impair one's ability to maintain stable employment, leading to financial difficulties and further social disadvantages. This downward spiral can exacerbate existing mental health issues and create new ones.
Furthermore, AUD can contribute to relationship problems, including divorce and domestic abuse. It can interfere with one's ability to maintain healthy relationships, leading to social isolation and loneliness, which can further negatively impact mental health. Additionally, the stigma associated with AUD may lead to social rejection and exclusion, exacerbating feelings of depression and anxiety.
Finally, AUD can create a cycle of social and economic disadvantages. The disorder can lead to unemployment or underemployment, reducing income and access to socioeconomic resources. This can further limit one's ability to access quality treatment and support, perpetuating the cycle of social and economic disadvantages and negatively impacting mental health outcomes.
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Frequently asked questions
Alcohol is a depressant that disrupts the balance of neurotransmitters in the brain, affecting feelings, thoughts and behaviour. It can make people feel relaxed, less anxious and more confident, but these effects are short-lived and can soon lead to more negative feelings. Research shows that people who drink alcohol are more likely to develop mental health problems, and people with severe mental illness are more likely to have alcohol problems.
Alcohol can be used by people with depression and anxiety to help ease symptoms, but excessive alcohol use can also worsen mental health. While drinking can make people feel good temporarily, this effect doesn't last long, and the feelings of bliss can turn into worsened depression symptoms. Regular heavy drinking is linked to symptoms of depression, and people with depression who stop drinking often start to feel better within a few weeks.
Alcohol is commonly used to numb memories of a traumatic event or cope with symptoms of PTSD. However, alcohol use disorder (AUD) may increase the likelihood of PTSD. Heavy alcohol use may increase the risk of suffering further traumatic events, and AUD can disrupt a person's psychological ability to cope with trauma.
Sleep disorders can increase the risk of developing AUD, and AUD can cause sleep disorders. Even moderate amounts of alcohol can alter sleep physiology, for example, by reducing rapid eye movement sleep duration. Alcohol use may also worsen sleep-disordered breathing and periodic limb movement during sleep, compromising sleep quality.
AUD is when someone cannot stop drinking even when it puts their health and safety at risk. People with AUD may crave alcohol, continue drinking despite negative consequences, drink more than intended, spend a lot of time obtaining and drinking alcohol, and give up important activities because of alcohol. Treatment for AUD may include therapy and medication.
