08 Mar Link between alcoholism & Depression
The link between alcohol addiction and depression
Drinking and the blues seem to go hand in hand. So common is this pairing that it even gets romanticized or trivialized as merely a dysfunctional coping strategy. Yet when drinking becomes an alcohol abuse disorder, and when the blues become clinical depression, the stakes couldn’t be higher.
Data shows that people diagnosed with a mood or anxiety disorder are twice as likely to also suffer from a drug-use disorder, including alcohol addiction. The Substance Abuse and Mental Health Services Administration found that 7.9 million adults in the United States experience the simultaneous effects of both conditions. Those findings have been reaffirmed in multiple national population surveys since the 1980s.
However, trying to discern which came first – alcohol addiction or depression – is a proverbial chicken-or-the-egg situation. Indeed, attempting to trace a clear pattern of cause and effect between the two – in either direction – is mired in difficulty. Partly because these two disorders can reinforce and exacerbate one another. Much clearer is the frequency with which people present with both depression and alcohol abuse in a classic dual diagnosis.
A dual diagnosis
According to the National Institute on Drug Abuse (NIDA), drug addiction can be classified as a mental illness because it “changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the drug”. The resulting compulsive behaviors are similar to the symptomatology of other mental illnesses. Yet people may use drugs and alcohol as a form of self-medication to alleviate the preexisting symptoms of depression.
Put simply, as Dr. Shelly Greenfield, a professor of psychiatry at Harvard Medical School, told The New York Times, depression makes people more vulnerable to alcoholism and vice versa. Alcohol, for example, has a range of negative physiological and psychosocial impacts. A study published in the Journal of Psychiatry and Neuroscience showed that alcohol even induces depression by lowering the levels of serotonin, the neurotransmitter that helps regulate mood, sleep, and appetite.
Clinical depression alone is a serious mental health condition. According to the DSM-5, a person struggling with depression can experience the following symptoms:
- Depressed mood,
- Diminished pleasure,
- Weight loss or weight gain,
- Decreased or increased appetite,
- Fatigue or loss of energy,
- Feelings of worthlessness,
- Feelings of guilt,
- Inability to think or concentrate,
- Thoughts of death or suicide.
NIDA confirms that a shared vulnerability to drug-use disorders and other mental illnesses is caused by “overlapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma”. The effects of both depression and alcohol addiction pose a unique set of dangers. The risk of suicide under the influence is higher than for those who suffer depression alone. Subjects of a dual diagnosis are also at a higher risk of relapse due to chronic insomnia that can follow abstinence.
Despite the difficulties, untangling the causal pathways to both depression and alcohol addiction is crucial to treatment. The Journal of Psychiatry and Neuroscience study found that determining the chronology of alcoholism and depression – effectively, which condition is primary and which secondary – is a necessary first step. During an initial investigation of the primary and secondary conditions, the Journal insists: “The diagnosis of comorbid depression, and any associated treatment plan, must be withheld during this period, to determine if depressive symptoms are secondary to the alcohol abuse.”
People suffering from alcohol addiction and depression must have both conditions treated as part of a broader rehabilitation plan to prevent relapse. This may include but not be limited to detox, medication, intensive therapy, education, peer support, and prevention strategies. Without treating the depression that underpins the addiction, or the alcoholism that underpins the depression, clients are vulnerable to a recurrence of symptoms at the end of rehabilitation.