Alcohol & Depression: Connection, Symptoms, & Treatment

How Are Alcohol & Depression Connected?

Major depressive disorder is the most pervasive mental health disorder, impacting 17% of young adults ages 18-25.² Although alcohol releases feel-good hormones, such as dopamine, this pleasure is short-lived. Chronic alcohol use is associated with impaired functioning, poor impulse control, worsened health outcomes, and interpersonal distress. Each of these effects can exacerbate underlying depression.

Can Depression Lead to Alcohol Use?

Many people use mood-altering substances, including alcohol, to cope with depression. This is especially true for adolescents or young adults who may be experiencing the initial onset of depressive symptoms. This age also tends to be when people experiment with alcohol. Alcohol becomes a way to self-medicate distressing symptoms, but the presence of alcoholism and depression together often worsens both mental and physical health.

How Does Alcohol Use Affect Depression?

Alcohol use disorder can exacerbate depression symptoms, especially over the long term. It’s important to note that alcohol is a depressant. Depressants work by inhibiting the central nervous system (CNS), which slows down perception, movement, and judgment.

Depressants offer initial pleasant effects (which is often the case with alcohol), but persistent, heavy use affects physical and emotional functioning. The more someone engages in problematic alcohol use, the more likely they are to experience mood swings, withdraw from loved ones, or encounter work or school problems.

Why Are Drinking & Depression so Frequently Connected?

Depression is a significant risk factor for alcohol problems. Research also shows that the more a person drinks, the more likely they are to develop depression.³ Depression is a complex and chronic condition without a cure. Naturally, many people feel desperate for some sense of relief, which alcohol temporarily provides. However, the consequences of drinking can take a significant toll on someone’s mental health, which may exacerbate or even trigger new depressive symptoms.

What Happens in the Brain When You Drink Alcohol?

Alcohol dulls communication within the brain, impacting your actions, coordination, and ability to think critically. A higher concentration of alcohol in the bloodstream coincides with fewer inhibitions. This also can result in slurred speech, blurred vision, and loss of coordination.⁴

Alcohol also releases surges of specific neurotransmitters, such as serotonin and dopamine. However, over time, this pattern disrupts normal communication between neurons. As someone becomes more tolerant of alcohol, they need to drink more to achieve their desired effect.

What Are the Symptoms of Depression?

Depression is a chronic mental health disorder that can disrupt numerous areas of functioning. More than just a sad mood, depression refers to a chronic pattern of hopelessness, despair, and difficulty engaging in your everyday routine. Depression can make ordinary tasks like showering or going to work feel downright daunting. In more serious cases, depression can coincide with self-harm and suicidal ideation.

Symptoms of depression may include:

• Hopelessness
• Anhedonia (loss of interest in usual activities)
• Irritability
• Sleep problems (sleeping too little or too much)
• Appetite changes
• Excessive feelings of guilt or worthlessness
• Persistent sadness
• Excessive fatigue
• Concentration problems
• Mood swings

What Are the Symptoms of Alcohol Use Disorder?

Alcohol use disorder refers to an addiction to alcohol. This disorder exists on a spectrum, but when someone abuses alcohol, they consistently drink too much and drink in problematic patterns. Without intervention, alcohol use disorder can worsen progressively over time.

Alcohol use disorder symptoms may include:

• Inability to limit alcohol consumption
• Strong and intense alcohol cravings
• Continuing to drink despite a strong desire to cut back or stop
• Experiencing withdrawal symptoms during times of abstinence
• Continuing to drink despite negative interpersonal effects
• Drinking in hazardous situations (i.e. before driving or while taking care of children)
• Lying, downplaying, or trying to hide alcohol consumption

What Are the Signs Someone Is Depressed & Abusing Alcohol?

Alcoholism and depression symptoms often overlap, and both conditions can have similar presentations. It can also be hard to discern someone’s mental state when they are under the influence or actively in a withdrawal state. This explains why mental health professionals use a thorough assessment when diagnosing such conditions.

Signs someone is depressed and abusing alcohol include:

• Struggling to maintain relationships: Both conditions often coincide with isolation, and people struggling may choose to spend most of their time alone to drink.
• Prioritizing alcohol over most all responsibilities: Over time, alcohol use becomes more and more prominent, which can cause people to neglect other essential priorities.
• Exhibiting themes of apathy or hopelessness: People with depression may drink because they feel like life is worthless or that things will never get better.
• Only appearing to be happy/content when under the influence: Some people drink alcohol because it boosts their mood. However, they tend to be depressed whenever they aren’t drinking.
• Polysubstance use: Someone who is depressed might mix alcohol with other drugs, including stimulants, opioids, benzodiazepines, or cannabis.
• Limited or lack of desire for professional treatment: Because depression often impacts motivation, even if someone knows they are struggling, they might not seek the help they need.
• Unemployment/occupational problems: Both depression and alcoholism correlate with problems at work, which can result in getting fired, chronic absences, or other related issues.
• Financial problems: Both depression and alcohol can be costly, especially when paired with other behavioral compulsions like shopping or gambling.
• Chronic lying: Addiction is often reinforced by secrecy and deception. Likewise, people with depression may try to hide their true feelings to avoid feeling like they are burdening others.
• Suicide attempts: Someone with depression may be at a higher risk of attempting suicide when they are under the influence of alcohol.

What Causes Depression & Alcoholism?

It’s very common for people to experience both depression and alcoholism concurrently. Some research suggests the prevalence of both conditions is as high as 68%.¹ Untreated depression tends to increase the likelihood of someone developing alcohol use disorder. Similarly, alcohol misuse may be responsible for causing or exacerbating preexisting mood disorders. In both conditions, trauma, histories of addiction, and having family members with mental illness represent potential risk factors.

How Are Depression & Alcohol Use Disorder Diagnosed?

A qualified healthcare professional can diagnose either condition. Most doctors begin with a physical exam or lab tests to rule out underlying physical health problems. Mental health professionals typically refer to the DSM-5 to match current symptoms to established criteria. The Beck Depression Inventory (BDI) is a well-known screening tool for depression, and the Alcohol Use Disorders Identification Test (AUDIT) may be used for diagnosing alcohol use disorder.⁵

What Are Treatment Options for Depression & Alcohol Use Disorder?

When seeking treatment, it’s important to consider comprehensive, dual-diagnostic care. Only focusing on improving one condition will likely not resolve someone’s overall mental health. In many cases, it can actually lead to a relapse or significant deterioration. Treating both conditions simultaneously is always considered the best standard of care.

12-Step Programs

12-Step programs, such as Alcoholics Anonymous (AA) are popular and available worldwide. These groups focus on peer-led support, personal accountability, and maintaining abstinence from drugs and alcohol. Many people find a sense of camaraderie with other members, which can dramatically improve their emotional well-being.

Support Groups

Support groups are generally led by trained facilitators or mental health professionals. Some of these facilitators may have lived experience with addiction or mental health concerns, but that’s not always the case. These groups vary by type and can be held in person or found through online group therapy options. Group material may focus on support rooted in psychoeducation, relapse prevention, cognitive strategies, self-esteem, and healthy communication.

Therapy

Therapy can be beneficial for treating symptoms of depression and alcohol use disorder. There is no single “best” form of therapy, but more severe cases typically necessitate higher levels of care, including inpatient or rehabilitation-based programs. There are numerous in-person and online therapy options for people recovering from coexisting conditions.

When treating depression and alcohol dependence together, the first step is increasing awareness of the problem. From there, it’s essential to identify specific triggers and learn how to cope with them productively.

Therapeutic options for people experiencing depression and alcohol use disorder include:

• CBT for Depression: CBT for depression focuses on changing negative thought patterns that coincide with poor mental health and addiction.
• Acceptance and Commitment Therapy (ACT): ACT helps neutralize certain experiences and supports people to live their lives more congruently to their values.
• Interpersonal Therapy: Interpersonal therapy focuses on resolving interpersonal conflict and increasing social support.
• Mindfulness-Based Cognitive Therapy (MBCT):  MBCT integrates components of mindfulness with cognitive strategies to improve overall coping.
• Hypnosis for Addiction: Some people have found that hypnosis for addiction can help reduce substance cravings and promote sustainable change.
• Dialectical Behavior Therapy (DBT): DBT weaves mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance to enact change.
• Motivational Interviewing (MI): MI can be beneficial for people ambivalent about making certain changes, which is a common roadblock in addiction recovery.

Medication

Some people benefit from taking medication to improve their depression and alcohol use disorder symptoms. SSRIs are among the most commonly-prescribed medications for depression. Improving a depressed mood may also reduce stress and, thereby, decrease alcohol cravings. Antidepressants can help lift mood, improve concentration, and improve sleep and appetite problems.

Additionally, there are several FDA-approved medications for alcohol use disorder, including disulfiram, acamprosate, and naltrexone.

Rehabilitation

A rehabilitation program may be recommended for people with moderate or severe addiction or mental health needs. There are numerous types of rehabilitation programs available, and facilities may offer specific tracks separated by sex, age, and presenting issue. When examining inpatient or outpatient treatment programs, it’s essential to look for dual-diagnosis support (which treats both addiction and mental health needs).

In My Experience

I have extensive experience working with clients with severe substance use disorders in my clinical practice. Many of these individuals struggle with heightened depression during the early stages of recovery. This is common, and it may also correlate with symptoms of post-acute withdrawal syndrome (PAWS). Working on depression is paramount, and getting the right treatment offers invaluable support during this vulnerable time. Although it may be challenging, it’s absolutely possible to stay the course and get your life back on track.