Alcohol and mental health

Heavy drinking distorts brain function, creating neurological conditions for depression and anxiety. At the same time, many people seek to ease symptoms of a pre-existing mental illness with alcohol and often end up trapped in a spiral of escalating drinking and worsening symptoms.

The impacts of alcohol on the brain

Almost all mental health disorders are linked to abnormalities and chemical imbalances in the brain. Because alcohol also impacts the brain’s functioning, wiring, and chemistry, many of the effects of heavy, excessive, or long-term drinking are psychological in nature. Alcohol use has profound effects on the brain’s chemistry, signaling, and function, leading to cognitive impairment, depression, and anxiety. 

Chronic alcohol use can cause the brain to release too much GABA, dopamine, and other neurotransmitters, causing these chemicals to become depleted over time. These neurotransmitters play a key role in helping to regulate stress and emotions, so depletion can make people feel anxious, depressed, and more easily stressed or upset. This can lead to a cycle of using alcohol to manage stress and difficult emotions, which makes people more vulnerable to developing alcohol addiction.

Addictions are formed when chemical pathways in the brain are formed in response to repeating a certain pleasurable behavior over and over again. Once these addiction pathways form, it becomes much harder for a person to stop or cut back on their drinking. Instead, they often need to consume more alcohol to combat their growing tolerance, which accelerates their addiction. If they try to stop or cut back on their own after this point, they risk experiencing dangerous or even fatal withdrawals. Serious withdrawal symptoms can include seizures, hallucinations, irregular heart rate, and even death.[1]

Brain impact for moderate drinkers

Even if a person does not develop an addiction, excessive drinking can still impact the brain. During acute alcohol intoxication, the brain is flooded with positive neurotransmitters, particularly GABA and dopamine. GABA, the brain’s main inhibitory transmitter, produces a feeling of calmness, augmented by the simultaneous suppression of the excitatory transmitter glutamate. This imbalance in GABA and glutamate can cause slurring, stumbling, impaired cognition, memory lapses and blackouts, unconsciousness, and in cases of alcohol poisoning, coma, and death.

Alcohol and adolescent brains

The developing brain is particularly vulnerable to alcohol’s toxic effects. Heavy drinking in adolescents and young adults can permanently alter the trajectory of brain development. Teens who use alcohol have less volume and density in their hippocampus, which governs memory and learning, and in their prefrontal cortex, which is involved in decision-making, impulse inhibition, planning, and attention.[2] Long-term alcohol use can also lead to a thiamine (B1) deficiency, which can cause Wernicke-Korsakoff syndrome, a neuropsychiatric disorder featuring, ataxia (poor muscle control for voluntary movements), vision problems, inattention, and loss of memory.[3]

Get help during covid-19

Get help during Covid-19

At Recovered, we recognize the impact COVID-19 has had and the continued challenges it poses to getting advice and treatment for substance use disorders. SAMHSA has a wealth of information and resources to assist providers, individuals, communities, and states during this difficult time and is ready to help in any way possible.

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Is alcohol addiction a mental illness?

Alcohol addiction can be considered a mental illness. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the ultimate diagnostic guide for all mental health conditions calls this condition alcohol use disorder (AUD). The symptoms of alcohol use disorder include:[4]

  1. Drinking alcohol in larger amounts or for a longer duration than intended. Example: A person intending to only have one or two drinks but ending up drinking an entire 6 pack 
  2. Wanting to or trying to cut down on alcohol use but not being successful. Example: A person trying to quit drinking but isn’t able to make it more than a day or two without drinking
  3. Spending a lot of time thinking about, obtaining, using, or recovering from alcohol use. Example: Drinking most nights and feeling hungover most mornings
  4. Experiencing cravings or urges to drink alcohol. Example: Craving a cocktail after a hard or stressful day at work
  5. Use of alcohol is interfering with ability to function or meet responsibilities in one or more area of life (ie: work, home, etc). Example: A pattern of calling out of work due to being hungover after a night of heavy drinking
  6. Continuing to drink alcoholeven after experiencing negative consequences in your social relationships. Example: Drinking after getting in to many fights with a significant other about it 
  7. Giving up or reducing time spent doing other important social, leisure, or occupational activities in order to drink alcohol. Example: Not meeting up with friends because you’re unable to safely drive yourself home afterwards
  8. Drinking alcohol in situations or settings where it could be physically hazardous or unsafe. Example: Drinking at a work conference 
  9. Continued drinking despite being aware that use of the substance is causing or related to a physical or psychological problem. Example: Not cutting back or stopping drinking after getting abnormal liver panels
  10. Noticing that over time, you need to drink more in order to get the same effects (i.e. developing a tolerance). Example: Needing to have 3 drinks to feel a ‘buzz’ when you used to only need 1-2 drinks
  11. Noticing physical or psychological discomfort (i.e. withdrawal symptoms) when you cut back or try to stop drinking. Example: Noticing that you’re much more edgy and irritable when you cut back or don’t drink for a day or two

Depending on how many of these symptoms are present, a person may be diagnosed with either a mild, moderate, or severe substance use disorder. A mild substance use disorder means that a person experiences 2-3 of the symptoms, 4-5 of the symptoms would indicate a moderate substance use disorder, and 6 or more indicates a severe substance use disorder.[4] Alcohol use disorder is a mental illness with serious consequences on your physical health, and it can also contribute to other mental illnesses like depression, anxiety, and psychosis.

Alcohol addiction and dual diagnosis

Alcohol abuse disorder and other mental illnesses often co-occur (occur in a person at the same time). Having both an addiction and a mental health disorder is known as having a dual diagnosis or co-occurring disorder. Epidemiological surveys in the US found that nearly one-third (29.2%) of people dependent on alcohol have mood disorders such as depression and bipolar disorder. Alcohol-dependent people are also 3.9 times more likely to have a major depressive disorder (27.9%) in the previous year than the general public.[5] 

For many people, their mental health and alcohol dependence are closely intertwined. For example, they may drink to self-medicate their mental health symptoms but ultimately find that drinking worsens their symptoms. This can become a vicious cycle that leads to an overall worsening of their mental health and alcohol use disorder. A dual diagnosis can complicate treatment for both mental illness and alcohol abuse, but an integrated treatment approach can help treat both conditions at the same time.

Alcohol abuse and anxiety

Anxiety disorders are by far the most common mental health condition affecting Americans, but they’re twice as prevalent in alcohol-dependent people than in the wider population. People who abuse alcohol are four times more likely to be diagnosed with generalized anxiety disorder (GAD) and almost twice as likely to suffer from a panic disorder.[6] Alcohol stimulates GABA receptors in the brain, producing a feeling of calmness and relaxation that can temporarily ease the symptoms of anxiety. Because alcohol causes a short-term reduction in anxiety, it’s estimated that one in five people with anxiety disorders report self-medicating with alcohol.[7]

Long-term, alcohol abuse can actually make anxiety worse. When used long term, your body registers the surplus in GABA caused by excessive drinking and tries to restore balance by producing less of it than normal. That means when you go to bed after a night of drinking, your GABA levels fall and levels of the excitatory neurotransmitter glutamate spike. You’ll wake up feeling anxious—the so-called hangxiety or ‘the fear.’

If you continue drinking heavily regularly, your brain's production of GABA will decline, meaning you’ll need more and more alcohol to achieve a pleasurable effect. Instead, you’ll feel chronically anxious. This deficit in GABA can make stopping drinking alcohol very dangerous for those who have developed physical dependence. Withdrawals can include symptoms like anxiety, shaking, an elevated heart rate, seizures, and hallucinations and must be treated in a medical setting.

Alcohol dependence and withdrawal can cause such severe anxiety that it’s often difficult for doctors and patients to distinguish between alcohol-induced anxiety and an organic anxiety disorder. Usually, the only way is to have the patient undergo medical detox and then monitor their symptoms as the alcohol leaves their system.

Alcohol abuse and depression

As many as two-thirds of people with alcohol dependencies could meet the diagnostic criteria for major depressive disorder.  Heavy drinking can contribute to depression, especially in those who are predisposed to this disorder. In fact, alcohol could be categorized as a depressant because of the way it affects certain mood-related chemicals in the brain. For instance, it’s normal for people who drink too much to feel lethargic, sluggish, unmotivated, and irritable, which can also be symptoms of depression. Some people find they become emotional, sad, and lonely when they drink too much, especially if they’re already dealing with depressive symptoms.

However, in around a third of alcohol-dependent people, depression persists even after alcohol abuse treatment and long periods of abstinence, suggesting that it pre-dates or exists separately from alcohol abuse.

Many of these people may have begun drinking to ease their symptoms of depression and get caught in a vicious cycle of hangover blues and self-medication. Regardless of which condition came first, it’s still possible to get treatment for alcohol use disorder and depression at the same time. Addressing both conditions may include therapy (in an inpatient or outpatient setting) and for some people, also medication.

Alcohol and suicide

The relationship between alcohol and suicide is complex. At the most basic level, acute intoxication increases the risk of suicide by lowering inhibitions, depressing mood, impairing judgment, and increasing impulsivity and aggression. Alcohol is detected in the bloodstream of around a third of people who die by suicide in the US.[9] People treated for alcohol dependence have a risk of suicide that’s at least ten times and as much as 120 times higher than the wider population.[8] 

Even in the absence of addiction, people are six times more likely to commit suicide when drunk than sober.[10] Because alcohol reduces inhibitions, impairs decision-making, and causes people to become more impulsive, being under the influence increases the chances of attempting suicide.

Chronic heavy drinking disrupts brain chemistry, to increase feelings of depression, which is the single biggest risk factor for suicide. Alcoholism’s wider effects on an individual’s life include broken and stressed relationships, unemployment, and financial problems, which can all further compound the risk of suicide.

Getting help for alcohol abuse

Alcohol use disorder has many adverse effects on a person’s body, brain, and mental health. It can be difficult (and sometimes even dangerous) for people who are dependent on alcohol to stop drinking on their own, which is why many opt for treatment. Inpatient or outpatient rehab can help people establish their sobriety, while also beginning to treat other co-occurring mental health problems at the same time. Using a combined integrated approach, it’s often possible to safely detox from alcohol and stabilize in an inpatient treatment center before transitioning to outpatient care. 

People with less severe alcohol use disorders who aren’t at risk for serious alcohol withdrawals can sometimes begin their recovery at the outpatient level. If you or a loved one needs help finding the right level of treatment for alcohol or other substance use disorders, schedule an assessment with a licensed counselor or substance use professional. During your first appointment, you can get clarification on your diagnosis as well as your treatment options. In many cases, your health insurance can help to cover some of the costs of your treatment.

Visit our rehab directory to find alcohol addiction and dual diagnosis treatment near you.

Getting immediate help

If you're going through a difficult time, help is available.

In the US: Call the 988 Suicide & Crisis Lifeline by dialing 988 on any phone or phoning -800-273-TALK (8255). The Lifeline is available 24 hours a day, 7 days a week.

In the UK: Contact Samaritans, day and night, 365 days a year. Call them for free on 116 123, email them at [email protected], or visit samaritans.org to find your nearest branch.