If you are among the more than 14 million Americans who have ever experienced alcohol dependency, then you know that the effects of drinking are often far more than physical (1). Alcohol dependency and abuse not only carry with them potentially profound health risks, from cardiovascular disease to liver failure, but they also wreak havoc on your mental and emotional health, possibly intensifying or resulting in anxiety and/or depression (2, 3, 4, 5, 6, 7). The relationship between alcohol abuse and mental and emotional health is probably far more significant, and far more complex than you might have imagined.
A Vicious Circle
The consumption of alcohol is nearly as old as human civilization itself. For millennia, humans have been making and drinking liquor in myriad forms. For centuries, these ancient concoctions have served as a sort of centerpiece of human society. Happy events are celebrated with a toast. Sad occasions are softened with a drink to drown one’s sorrow. Reaching the legal drinking age is a veritable rite of passage, and, for many young adults, the “college experience” is synonymous with four years of alcohol-lubricated partying (8).
There are, it seems, nearly as many reasons for drinking as there are drinkers. But far beyond the social aspects of alcohol consumption are the deeper physiological and psychological motivations that not only compel one to drink but that also often pave the way to alcohol dependency and abuse. A significant body of literature suggests that chronic or binge drinkers often have risk factors that both incite them to drink and leave them vulnerable to addiction. Among the most significant of these, unsurprisingly, is a genetic predisposition to addiction disorders in general and to alcohol use disorder (AUD) in particular (9).
However, you don’t have to have a genetic predisposition or a family history of alcohol addiction to find yourself reaching for the bottle. There is mounting evidence of a strong link between alcohol use and psychiatric conditions, particularly anxiety, depression, and post-traumatic stress disorders (6, 7,10, 11, 12). Studies show that up to 15% of Americans have major depressive disorder (MDD), the most prevalent psychiatric disorder in the US (6). The research has also found that alcohol use disorder (AUD) is the most common co-occurring diagnosis in those with major depressive disorders. In fact, the same studies have found that people with AUD were 2.3 times more likely than the general population to also have major depressive disorder (6).
The connections between mood disorders and alcohol use don’t end with depression. Up to 50% of people receiving treatment for alcohol dependency also meet the diagnostic criteria for one or more anxiety disorders (7). Indeed, studies suggest that people with undiagnosed or inadequately managed depression, anxiety, or trauma may often turn to alcohol in an attempt to self-medicate. This is not surprising, given our society’s tendency to perceive and use alcohol as an emotional coping mechanism. Feeling nervous? Take a shot. Had a hard day? Unwind with a glass of wine.
The use of alcohol as an emotional balm may indeed be a social commonplace, a cultural cliche. But it’s also bad science. Science is increasingly proving what experienced drinkers, especially those battling AUD, already understand all too well: that drinking doesn’t help your anxiety, depression, or stress. Rather, it makes them worse. Often, it makes them far worse (6, 7).
And it’s much more than the social, familial, and professional repercussions of excessive drinking that lead to this exacerbation in mental health symptoms, though these are certainly significant. The worsening of mood after drinking is also physiological, the result of demonstrable changes in the structures and the functioning of the brain. For example, studies of the pathology of addiction have found that prolonged exposure to alcohol produces changes in the deep structures of the brain, including the ventral striatum and the amygdala (7).
Among other things, these structures help to regulate pleasure, motivation, stress, and anxiety. In the early stages of alcohol addiction, exposure to alcohol triggers the pleasure-inducing and stress-reducing mechanisms of these structures, giving you the happy and relaxed feeling you crave, especially if you are feeling anxious. However, repeated exposure to alcohol changes these structures.
The brain begins to adapt to and to “expect” the introduction of alcohol. So these deep brain structures no longer generate the same pleasurable and relaxing responses as in the first stages of addiction, when alcohol exposure was novel. This is when you enter the second stage of addiction: when these structures have come to depend on exposure to alcohol to release mood-regulating neurotransmitters, such as norepinephrine (7). Once you’ve reached this phase, you’re no longer drinking to feel good and relaxed. You no longer receive the rush of pleasure you did when you first started drinking. Now, you’re drinking just to feel somewhat “normal” and to avoid the symptoms of withdrawal (7).
As researchers continue to explore the neurological impacts of alcohol, they’re also discovering that the connection between drinking and brain functioning may be far stronger than initially suspected. There is mounting evidence that heavy alcohol use in adulthood significantly increases one’s risk for cognitive impairment and dementia later in life (13, 14).
As shown above, exposure to alcohol impacts neurotransmitter activity in the brain, particularly in the central amygdala, the primary site of both memory and emotion in the brain. The result is not less but more anxiety and heightened fear responses due to alcohol exposure (10). Similarly, alcohol functions as a depressant. (Which is why it makes you sleepy). If you are already experiencing low mood or negative emotions, as is the case with depressive disorders, then your depression symptoms are only likely to worsen after drinking alcohol (6, 7, 11, 12).
Thus, a vicious circle is born. You drink to deal with the depression, anxiety, or trauma you are battling. The alcohol provides some temporary relief, but then only exacerbates your symptoms. And so you drink again, often in increasing quantities, to escape the distress you feel for as long as possible, only to have it return again with a vengeance, rebounding and worsening as the alcohol changes the structures of the brain and impairs their functioning.
More than Physical
The vicious circle of drinking, depression, anxiety, and trauma is more than just biological, however. If you have ever battled alcohol dependency, then you know that even so-called “high-functioning” alcoholics cannot insulate their lives from the effects of the addiction. Sooner or later, the impacts of alcohol dependency will spill over into other areas of your life, from your relationships with family and friends to your career and finances.
Then, as your life begins to deteriorate and all that matters most begins to slip away because of your drinking, your depression and anxiety worsen–and so, too, does the temptation to drink. You may be plagued with feelings of shame, guilt, worthlessness, and self-blame. You may feel that this cycle is one that you can never escape.
Indeed, the evidence shows that the risk of alcohol dependence and relapse is strongly associated not only with genetic or physiological risks but also with socioeconomic and lifestyle factors. Exposure to alcohol in one’s social environment, poverty and unemployment, or dysfunctional personal and professional relationships have been shown not only to contribute to AUD, but also to establish the conditions in which comorbidities arise (7, 15, 16, 17). When you are anxious, traumatized, scared, and unhappy, you are more vulnerable to co-occurring alcohol use disorder and mental illness (i.e. Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder (GAD)).
How Bayshore Can Help
At Bayshore, we specialize in treating the whole person, not just the addiction. And that means that our alcohol addiction recovery programs include comprehensive solutions that help you address any co-occurring disorders, such as depression or anxiety, that may inhibit your recovery and prevent you from living the full and happy life you deserve. Our team of on-site mental health experts will work with you to identify your physical, emotional, and mental health needs, and devise a treatment strategy that serves your goals and suits your lifestyle. Options range from cognitive behavioral therapy (CBT) to prescription therapeutics, as appropriate.
We also work with our clients to help them cultivate a lifestyle that promotes wellness and recovery. As such, we offer a range of classes to meet your needs and preferences. This includes art and music therapy, yoga and mindfulness classes, and even acupuncture and massage. Bayshore’s holistic approach to treating co-occurring AUD and mood disorders is based on evidence-based practices that demonstrate the efficacy of “alternative” therapies.
Our comprehensive and highly individualized treatment plans are used to address alcohol dependency and the anxiety and depression intertwined with it. For example, studies have shown that acupuncture can be highly effective in regulating important neurochemicals associated with alcohol withdrawal symptoms, such as the release and transmission of endorphins (18). Similarly, there is mounting evidence to support the use of techniques ranging from mindfulness to art therapy to help prevent relapse in those recovering from alcohol dependency. These approaches equip patients with the tools they need to recognize and resist the triggers that would lead them to drink (19, 20).
At Bayshore, our ultimate goal is to work with our clients one on one to help them create an effective, holistic strategy for managing depression, anxiety, trauma, and stress without turning to alcohol to self-medicate. After all, addiction is about far more than the substance itself. So, we give you the tools to live a whole and wholly functioning life, which means promoting healing from addiction wherever its roots may lie, whether in past traumas or present pain. We know that our clients are more than their addiction and that a beautiful, joyous, and sober life awaits them on the other side of recovery.