Alcohol and Mental Health Problems
Alcohol can be described as both a tonic and a poison. The difference between “tonic and
poison” lies in the dose. Part of Alcoholics Anonymous (AA) mantra is that there is “no
problem that alcohol cannot make worse.” Of the problems that alcohol can cause or
worsen, mental illness is one of the most frequent, serious, and frequently underdiagnosed.
People with a mental illness, irrespective of the diagnosis, can face serious consequences
by misusing alcohol. Alcohol can cause depression, anxiety, sleep problems and can have
harmful interactions with psychiatric medications. A person who drinks alcohol while
receiving psychiatric treatment (especially when taking medication) is advised to cut out
alcohol completely. Of course, an addicted person may be unable to cut out alcohol and may
need professional help to the deal with both the addiction and mental illness. Cutting out
alcohol use is massive first step but will not be easy. Stopping alcohol use does not
guarantee that someone’s mental illness will improve or can be treated adequately.
Nonetheless, discontinuing alcohol removes a big impediment to effective treatment. Recent
scientific studies suggest that nearly one-third of people with mental illness experience
alcohol problems. Conversely, more than one-third of all alcohol abusers are also battling
mental illness.
Units of alcohol
Alcohol is measured in units. A unit of alcohol is 10g of pure alcohol. This is about half a pint
of lager or a single measure (25ml) of spirits. A small glass (125ml) of wine contains one and
a half units of alcohol.
Increased-risk drinking
Increased-risk drinking is classified as regularly drinking 22 to 50 units of alcohol per week
(men), or 15 to 35 units per week (women). However, binge drinking can be dangerous even
if within the weekly limit. Binge drinking is drinking alot of alcohol in a short time period,
considered eight units in a day for men and six units in a day for women.
Harmful drinking
Regularly drinking more 50 units of alcohol a week (men) or over 35 units a week (women) is
classified as harmful drinking. This type of drinking can cause health problems like
depression, alcohol-related accidents and acute pancreatitis. Many health problems caused
by harmful drinking do not cause symptoms for a number of years but can eventually lead to
high blood pressure, heart disease, cirrhosis (scarring of the liver) and cancers such
as mouth cancer and bowel cancer. Other problems include social problems such as
relationship difficulties, unemployment, domestic violence, committing crimes and
homelessness.
Dependent drinking
Alcohol is both physically and psychologically addictive and it is easy to become dependent
on it. Alcohol dependence is an inability to function without it with drinking becoming an
important or sometimes the most important aspect the person’s life. Depending on the level
of dependence, withdrawal symptoms can occur if alcohol drinking is stopped abruptly.
Symptoms of alcohol withdrawal can be both physical and psychological in nature.
Physical withdrawal symptoms include hand tremors (known as “the shakes'), nausea,
sweating, visual hallucinations and seizures. Psychological withdrawal symptoms include
depression, anxiety, irritability, restlessness and insomnia.
Severely dependent drinkers can experience severe withdrawal symptoms leading to vicious
circle of the person drinking to avoid withdrawal symptoms. Severely dependent drinkers can
tolerate very high levels of alcohol, amounts that would comatose or even kill moderate
drinkers.
How do you know if you’re drinking too much alcohol?
You could be drinking excessively if:
 You feel you need to cut down on drinking
 You feel guilty or ashamed about your drinking
 Other people are critical of how much you drink
 Sometimes have memory loss of drinking sessions
 You need a drink first thing in the morning to settle nerves or ease a hangover
 Drink at least a few drinks every day
 Regularly go binge drinking
 Not doing as expected due to drinking (eg) missing an appointment or work due to
being drunk or hungover.
Alcohol and it relationship with mental health
problems
It can be difficult to assess or diagnose mental health problems for people who abuse or are
dependent on alcohol because heavy drinking associated with alcoholism can contribute to
mental health problems, can result from mental health problems or can be independent of
the mental health problem. Alcoholism can complicate or mimic practically any psychiatric
condition, which makes it difficult sometimes to accurately diagnose mental health problem.
Diagnosing alcohol problems in patients suffering from mental health problems
People with alcohol problems seldom volunteer information about their alcohol problem
when they present with psychiatric complaints. Unless asked directly about their alcohol use,
patients tend to deny alcohol problems, meaning important information is withheld. This
makes assessment and diagnosis difficult. In addition, heavy alcohol use can impair
memory, which may make the patient's information less reliable. Therefore, health
professionals need to gather information from several resources when assessing patients
with possible alcohol related problems, including close contacts of the patient (e.g., a
spouse, relative, close friend), the patient's medical history, laboratory tests (eg. liver
function tests can indicate alcoholism), and physical examination.
How alcohol can contribute or cause mental health problems
Heavy alcohol use directly affects brain function and alters various brain chemicals and
hormonal systems known to be involved in the development of many common mental
disorders (e.g., mood and anxiety disorders). For example, regular drinking reduces
serotonin levels in the brain that can lead to lower mood and sometimes depression.
Because of this, alcoholism can manifest itself in a broad range of psychiatric symptoms and
signs. Mental health problems often are the first problems for which an alcoholic patient
seeks help. In addition to the direct chemical effects of alcohol on brain function, abuse of
alcohol can lead to other personal problems including legal, financial, relationship and family
problems which may indirectly contribute to ongoing alcohol related symptoms, such as
sadness, despair, and anxiety.
Mental health problems independent of alcohol abuse (but which can make a person
more prone to alcohol problems)
Alcoholism is also associated with several mental health problems that develop
independently of the alcoholism and may pre-date alcohol use and abuse. These
independent mental health illnesses can make people more likely to develop alcohol
problems. Mental health illnesses associated with alcoholism include personality disorder,
depression, schizophrenia, insomnia, obsessive compulsive disorder (OCD), social phobia,
panic disorder, post–traumatic stress disorder, eating disorders, psychotic symptoms and
drug related problems,
Mental health problems associated with alcohol
abuse
Independent Major Depression
According to drinkaware.co.uk, people in Britain who experience anxiety or depression are
twice as likely to be heavy or problem drinkers. Warning signs that alcohol is affecting mood
include:
 disturbed sleep
 feeling lethargic and tired all the time
 low mood
 experiencing anxiety in situations where you would normally feel comfortable
Up to 40% of alcoholics suffer from at least one bout of major depression. It is questionable
which disorder comes first, the depression or the alcoholism. Depression frequently predates the development of an alcohol problem, especially in women. However, studies have
found that in 60% of cases, the depression is caused by the alcohol abuse, especially in
men. The remaining 40% of alcoholic patients who suffer from depression most likely have
an independent depressive disorder (ie. the depression occurred before the person
developed an alcohol problem).
Bi-polar disorder
Bipolar disorder is also known as manic-depressive illness. Bipolar disorder is characterised
by periods of deep, prolonged, and profound depression that alternate with periods of an
excessively elevated and/or irritable mood known as mania. Many people refer to the manic
phase as a “high”. Put simply, bi-polar disease is characterised by periods of highs and lows.
Bipolar disorder patients experience alcohol dependence more than those with any other
mental illness. Among patients with bi-polar disorder, 50–60% misuse or develop addictions
to alcohol or other drugs. Evidence indicates that it is more difficult to treat alcoholism in
people suffering from bi-polar disorder and that they experience ore profound symptoms and
higher suicide rates. Counselling and medication forms part of the treatment in patients
suffering from both bipolar disorder and alcohol problems. Medications such as sodium
valproate (Epilim®) and carbamazepine (Tegretol®) are often used as mood stabilisers and
can also help with detoxification from alcohol.
Anxiety Disorders
Anxiety problems are not understood to occur at higher rates among alcoholics compared to
moderate of non-drinkers. However those with specific anxiety disorders, such as panic
disorder, social phobia, and post-traumatic stress disorder have higher rates of alcoholism.
Another disorder that has high alcohol abuse rates among suffers is panic disorder with
agoraphobia. It occurs in about 6% of the general population but about 20% of alcoholics
suffer from panic disorder.
An anxious alcoholic finds that alcohol initially eases their anxiety. The immediate relief
alcohol gives to anxious feelings entices the person to continue drinking even though they
know it will only make them feel worse after.
Alcohol induced anxiety disorders tend to ease relatively quickly when alcohol is stopped.
Independent anxiety disorders (those that commenced before the alcohol problem
developed) can be harder to treat and do not ease when alcohol is given up. Safer treatment
options should be tried initially, including counselling, cognitive-behavioral therapy (CBT)
and hypnosis. Stronger medication such as benzodiazepine (eg. Valium®) may be required
to treat anxiety in people with alcohol addiction problems. Benzodiazepines can create its
own addiction problem so must only be used short term in moderation and under
supervision. In this case, the doctor will only prescribe drugs like Valium® when the benefits
outweigh the risks.
Schizophrenia
Schizophrenia is a mental illness associated with symptoms which include hallucinations
(can include seeing and hearing things), delusions (false ideas), disordered thoughts, and
problems with mood, behaviour and motivation. It can cause a person to lose touch with
reality and thus become unable to tell what is real and what is not. Patients with
schizophrenia frequently use and misuse alcohol. Studies indicate that up to 50% of patients
suffering from schizophrenia develop alcohol problems.
Patients with schizophrenia are more likely to abuse alcohol due to a number of factors.
Firstly, alcohol is a readily available, fast-acting relief to the fears and pain that occur with
symptoms like hallucinations and paranoid delusions. Secondly, alcohol use can be one of
the only pleasurable social activities available to long-term schizophrenics who have lost
contact with friends and no longer experience the social norms of socializing due to the
upheaval their condition has on their lives. Drinking can give a sense of acceptance among
“drinking comrades”. Finally, alcohol is legal, easily obtainable, and relatively cheap, making
it an attractive social lubricant. The symptoms of schizophrenia and alcohol abuse can be
similar so a period of abstinence must occur before making a definite diagnosis.
Psychosis
Extreme levels of drinking (more than 50 units per day for several weeks) can occasionally
cause psychosis, a severe mental illness where hallucinations and delusions of persecution
develop. Psychotic symptoms can also occur when very heavy drinkers suddenly stop
drinking and develop a condition known as ‘delirium tremens’ (DTs). Symptoms of DTs
include body tremors and confusion. Alcohol-related psychosis clears quickly with
discontinuation of alcohol. Distinguishing alcohol-related psychosis from other psychotic
disorders (eg. schizophrenia, mania) can be challenging for a doctor.
Antisocial personality disorder (ASPD)
Antisocial personality disorder is characterized by a disregard for other people’s
entitlements, often ignoring and violating their rights. A person with antisocial personality
disorder is sometimes referred to as psychopath or sociopath in popular culture. Antisocial
Personality Disorder causes the person to lack empathy and they may be callous, cynical,
and contemptuous of the feelings, rights, and problems of others. Antisocial personality
disorder (ASPD) is often associated with alcoholism. Studies find that compared with nonalcoholics, alcohol dependent men are up to 8 times more likely, and alcoholic women are
up to 17 times more likely, to have ASPD. Thus, approximately 20% of alcoholic men and
10% of alcoholic women have ASPD, compared with 4% of men and approximately 0.8% of
women in the general population.
Alcohol’s effect in memory
Soon after drinking alcohol, brain processes slow down and memory can be impaired. After
large quantities of alcohol, the brain can stop recording into the ‘memory store’. That’s why
people can wake up the next day with a ‘blank’ about the night before. This short-term
memory failure or ‘black out’ doesn’t mean that brain cells have been damaged, but frequent
heavy sessions can damage the brain.
Drinking heavily over a long period of time can also have long-term effects on memory. As a
person ages, the brains shrinks at an average of approximately 2% per decade. However
heavy drinking accelerates the shrinkage of key areas in the brain leading to memory loss
and other symptoms of dementia. Heavy drinking can also lead to mild but potentially
debilitating problems including a person’s ability to plan, make judgments, solve problems
and perform complex tasks which most people can perform to allow normal function. As well
as causing damage to the brain, heavy drinking can cause nutritional deficiencies such a
vitamin b deficiency which when severe can cause dementia.
Treatment
Medication used for the treatment of alcoholism can be effective for mentally ill patients.
Psychiatric medications have few interactions with alcohol detox medications. Medications
like benzodiazepines and mood stabilisers can help with detoxification. Naltrexone which
acts to stop cravings may be used with the mentally ill person as effectively as other
patients. Disulfiram can cause some problems for mentally ill patients with alcohol problems.
Disulfiram works by causing unpleasant physical reactions if alcohol is consumed thus acting
as a deterrent. These can include nausea, chest pain, vomiting, flushed skin and dizziness.
Patients prescribed disulfiram must realise that alcohol if taken with disulfiram will bring on
an unpleasant reaction. The patient must be motivated and must understand they must
avoid alcohol (eg) for example the mental illness may reduce a person’s comprehension
which could lead them drinking alcohol despite warnings. If a person exhibits self-harm traits
they may drink to experience a disulfiram reaction intentionally, thus the medication should
not be prescribed. However, most mentally ill alcoholics can be prescribed disulfiram safely.
See more information on medication used for alcohol detox and abstinence in Eamonn’s
other article on the physical problems caused by alcohol abuse at www.whelehans.ie.
Disclaimer: Please ensure you consult with your healthcare professional before making any
changes recommended
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or
dial 04493 34591. You can also e-mail queries to info@whelehans.ie.