By: Tracey Basett, Psy.D.
The relationship between depression and alcohol use is a very complicated one. This is because both depression and alcohol can exacerbate the effects of each other in unhealthy ways. Although there is the common perception that depression causes alcohol misuse, the majority of studies show that alcohol use actually increases the likelihood of depression (1 & 2). In addition, studies also report a co-morbid relationship between depression and alcohol that actually increases with age. It has been shown that the combination of Alcohol Use Disorder and Depression is “associated with higher risk of alcohol dependence, suicide attempt, lower global functioning, and life dissatisfaction” (3).
The complex relationship between alcohol and depression for a lot of people was further exacerbated by the pandemic in which depression and anxiety tended to increase for those that increased alcohol use during this period (4). The combination of depression and alcohol use can create a challenging cycle that is difficult to interrupt, leaving some feeling very hopeless. To better understand this relationship and how to break this cycle, I, an NYC alcohol addiction psychologist, would like to explore a couple of questions.
1. How Does Alcohol Increase the Likelihood of Symptoms of Depression Developing or Worsening?
A phrase that I have heard frequently about alcohol is: “Alcohol is a depressant.” What this phrase refers to is that alcohol “depresses” or slows down the functioning of the brain and nervous system. Alcohol can also impact the chemicals in the brain responsible for regulating mood, which, in turn, can make a person feel more depressed over time. So, for someone that is already experiencing symptoms of depression, alcohol can certainly exacerbate these feelings.
2. How Does Depression Increase the Likelihood of an Alcohol Use Increase Over Time?
As we know, depression can come in many forms. I have found that, for most people, it can manifest as the following:
- Low Motivation
- Withdrawn Behaviors
- Poor Concentration
- Poor Sleep
- Poor Appetite
- General Melancholy
Many of these symptoms can put an individual at a higher risk of increasing alcohol use because of the way the symptoms interplay and reinforce each other.
Because depression can be a very uncomfortable feeling, many people will resort to alcohol (or other substances) to numb or avoid these uncomfortable feelings. From my experience, I have noticed that the pattern of feeling uncomfortable and using alcohol to cope occurs most often at night. Over time, it can become easy for people to fall into a habit of using alcohol on a regular basis. This can result in people needing to intake more and more alcohol to create the same numbing effect.
In addition to using alcohol to numb uncomfortable feelings, many people who struggle with depression tend to have trouble falling asleep at night. It is easy for worries, fears, and general thoughts about life to be the loudest at night when on is trying to sleep. This is because you no longer have the distractions of the outside world to tune them out. So, again, it can be easy to turn to a substance like alcohol to turn down the volume of the thoughts. Initially, using alcohol can make it easier to fall asleep. However, over time, this can become routine and can eventually lead to dependence on a substance to fall asleep because the user feels that they need it.
A big challenge some people face when curbing alcohol is sleep. This is because when alcohol is initially removed from the sleep routine, especially when proper sleep hygiene has not been implemented, people can experience an increased trouble with sleep. This challenge can lead a person back to the cycle of using alcohol to help them sleep. In addition, alcohol creates a worse night sleep, therefore making it likely that someone will wake even more fatigued.
3. How Can One Break the Cycle of Alcohol Use and Depression?
Now that we can understand how the cycle between increased alcohol use and depression develops and what factors contribute to reinforcing the cycle, we can look at how to break the cycle. Often, the best treatment for alcohol use is a two-prong approach:
- Alcohol use
- The social and emotional factors that are co-occurring with use
Since research has shown that it is not uncommon for people that struggle with alcohol use to be more likely to struggle with depression (5), if only one side of the problem is treated, it is not uncommon for the cycle to begin again. If both aspects can be treated, the cycle can be broken for good.
Therapy can include the following:
- Exploring the relationship between emotions and alcohol
- Teaching coping mechanisms for when symptoms flare up
- Addressing the root of depression
- Exploring what type of relationship with alcohol an individual can best benefit from
For some people a therapeutic approach is enough, and, for other people, medication can be supportive in changing the relationship with alcohol both in the short term and in the long term. Although there are certainly common patterns and challenges in the relationship between alcohol and depression, everyone is unique in how it impacts them, so finding the right provider that understands this complicated relationship can aid in developing the right treatment plan and breaking the cycle.
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1 Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction (Abingdon, England), 106(5), 906–914. https://doi.org/10.1111/j.1360-0443.2010.03351.x
2 Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2009). Tests of causal links between alcohol abuse or dependence and major depression. Archives of general psychiatry, 66(3), 260–266. https://doi.org/10.1001/archgenpsychiatry.2008.543
3 Brière, F. N., Rohde, P., Seeley, J. R., Klein, D., & Lewinsohn, P. M. (2014). Comorbidity between major depression and alcohol use disorder from adolescence to adulthood. Comprehensive psychiatry, 55(3), 526–533. https://doi.org/10.1016/j.comppsych.2013.10.007
4 Stanton, R., To, Q. G., Khalesi, S., Williams, S. L., Alley, S. J., Thwaite, T. L., Fenning, A. S., & Vandelanotte, C. (2020). Depression, Anxiety and Stress during COVID-19: Associations with Changes in Physical Activity, Sleep, Tobacco and Alcohol Use in Australian Adults. International journal of environmental research and public health, 17(11), 4065. https://doi.org/10.3390/ijerph17114065
5 McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol research : current reviews, 40(1), arcr.v40.1.01. https://doi.org/10.35946/arcr.v40.1.01