Dual Diagnosis: Alcoholism & Depression

The Relationship Between Abuse & Depression

Alcohol use disorder (AUD) is prevalent throughout the United States — in fact, approximately 14.4 million American adults suffered from this condition in 2018.1 Long-term alcohol abuse can lead to serious physical and mental health problems, particularly depression.

Alcohol abuse may exacerbate symptoms of depression, and depressive symptoms may aggravate alcohol abuse — leading to a vicious cycle that can be difficult to break. If you struggle with either of these conditions, help is available through residential treatment, medication, therapy, and other forms of care specially designed for co-occurring AUD and depression.

What is Depression?

alcoholism & depression

Depression is a mental health condition characterized by persistent feelings of sadness and a loss of interest in activities you once enjoyed. This condition impacts your thoughts, behaviors, feelings, and actions, and may influence your daily activities.

Depression is a common condition, affecting 17.3 million U.S. adults in 2017 alone.2 This condition is not a sign of weakness, nor is it something you could ignore until it disappears.

This condition is highly treatable, with options including medication, psychotherapy, and residential programs. Seeking professional help is the first step to relieve these symptoms and allow you to enjoy your life to the fullest.

Suicidal ideation is a common depressive symptom. If you experience thoughts of suicide, you are not alone and help is available. Call the Prevention Lifeline at 1-800-273-8255 for 24/7 support from a trained counselor. 

What is Alcohol Use Disorder

Alcohol use disorder is a condition characterized by a dependence on and uncontrollable craving for alcohol. The difference between healthy alcohol consumption and AUD is the extent that drinking interferes with your daily activities and relationships.

Symptoms of AUD include:

Being unable to control drinking

Unsuccessful attempts to cut back on drinking

Strong cravings for alcohol

Being unable to fulfill responsibilities due to drinking

Reducing social or work obligations to drink

Developing a tolerance for alcohol

Spending most of your time drinking, buying alcohol, or being hungover

Using alcohol in dangerous situations

AUD can lead to serious complications, including liver damage, heart problems, and neurological issues.3 Alcohol abuse can also have an adverse effect on your mental health, including increased symptoms.4

Types of Depression

alcoholism & depression

Depression is not a monolith — there are multiple forms of this condition you could be diagnosed with. While these conditions may share similar characteristics, each form of depression carries a unique set of symptoms, triggers, and causes.

Major or Depressive Disorder

Major depressive disorder (MDD) is one of the most common forms of depression, characterized by persistent and frequent sadness and a loss of interest or pleasure in daily activities.

Symptoms of MDD include:

alcoholism & depression

Loss of interest in previously-enjoyed activities

Unexplained physical issues, such as headaches

Difficulty sleeping or sleeping too much

Feelings of sadness, emptiness, or hopelessness

Frequent or reoccurring thoughts of suicide.

Irritability & frustration

Difficulty concentrating

Fatigue & tiredness

The exact cause of MDD is unknown, but genetics, hormones, and brain chemistry may play a role in the development of this condition.

Seasonal Affective Disorder

Seasonal affective disorder (SAD) is a form of depression that is directly related to the current season, beginning and ending around the same times each year. Most people with SAD experience symptoms in the fall and winter that disappear in the spring or summer, although the condition can occur at any time of year.5

Symptoms of SAD may include:

Persistent, daily feelings of depression

Loss of interest in previously-enjoyed activities

Difficulty concentrating

Feelings of hopelessness & worthlessness

Sluggishness

Lack of energy

Weight gain

Overeating

Oversleeping

alcoholism & depression

If your SAD begins in the spring or summer, symptoms include:

Loss of appetite

Insomnia

Agitation & Anxiety

Weight loss

No one knows the exact cause of SAD. Your serotonin and melatonin levels, as well as your biological clock, may play a role in the development of this condition. A family history of SAD and pre-existing major depressive disorder may also heighten your risk.

Persistent Depressive Disorder

alcoholism & depression

Persistent depressive disorder, also known as dysthymia, is a form of chronic, continuous depression. With this condition, it can feel difficult to remain upbeat or happy, even in celebratory situations.

Symptoms of persistent depressive disorder include:

Low self-esteem and persistent self-criticism

Decreased productivity

Loss of interest in daily activities​

Feelings of sadness, hopelessness, and emptiness

Sleep problems​

Avoidance of social situations

Fatigue

Difficulty making decisions or concentrating

Feelings of irritability

While their frequency and intensity may fluctuate, persistent depressive disorder symptoms usually do not disappear for more than two months.6 This condition can lead to a reduced quality of life and substance abuse, along with difficulty maintaining relationships.

Psychotic Depression

Psychotic depression is a combination of major depression symptoms and some form of psychosis, usually in the form of hallucinations or delusions. These hallucinations or delusions usually involve symptoms of depressions, reaffirming feelings of worthlessness or hopelessness.

Symptoms of psychosis depression include:

Sadness and hopelessness

Loss of interest in daily activities

Agitation & irritability

Hallucinations

Delusions

Difficulty sleeping

Hypochondria

Suicidal thoughts​

Psychotic depression can be difficult to identify. If you experience hallucinations or delusions related to your depression, you might feel ashamed or want to hide these symptoms from those around you.

These feelings are normal, but it’s important to remember that help is available. Treatment options include medication, psychotherapy, and social support, and residential programs.

alcoholism & depression

Diagnosing Depression

Your doctor may run a blood test to rule out other conditions that may contribute to your symptoms.

Your doctor will ask you questions about your symptoms, emotions, and behaviors to understand your mental state.

Depression may be linked to an underlying condition. Your doctor may perform a physical exam to check for these conditions.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the criteria for depression diagnosis. Your doctor will evaluate your symptoms against the DSM-5 criteria to identify your diagnosis.

After a diagnosis, your doctor will determine the best treatment option for you. 

Depression Evaluation

Do you believe you have depression? This evaluation can help you identify common symptoms.

If your results indicate that you may have depressive symptoms, schedule an appointment with a mental health professional to discuss your condition.

Please keep in mind that this evaluation is NOT INTENDED for diagnosis. If you believe you have depression, visit a medical professional as soon as possible.

Depression & Alcohol Abuse

Alcohol abuse and depression often go hand-in-hand. People with alcohol use disorder (AUD) often drink too much alcohol on frequent  occasions, which can result in severe physical and mental health consequences.

One of these consequences is the exacerbation — and sometimes development — of depressive symptoms. Approximately one-third of people with major depression have an alcohol problem, and oftentimes, the alcohol is used as a coping mechanism for depressive symptoms.7

People with depression often use alcohol as an unhealthy coping mechanism. Alcohol’s effects alleviate depressive symptoms in the short-term, creating bursts of euphoria and feelings of happiness. Reliance on alcohol over time to create these feelings of euphoria and cope with depressive symptoms, however, can lead to the development of alcohol use disorder. AUD also worsens feelings of depression, leading to a vicious cycle and a dependence on alcohol that can be difficult to break free from.8

Does Drinking Alcohol Make you Depressed?

alcoholism & depression

People who drink frequently are more likely to experience symptoms of depression, and alcohol use disorder can exacerbate these underlying emotions and behaviors. This is because of how alcohol functions in the body.

Alcohol is a depressant, which means that it slows down your brain function and leads to the impairments that we typically experience while drinking, like slurred speech. Long-term alcohol use impacts how your brain operates, heightening your risk of developing depression. 9

Alcohol abuse and depression often go hand-in-hand. People with alcohol use disorder (AUD) often drink too much alcohol on frequent  occasions, which can result in severe physical and mental health consequences.

One of these consequences is the exacerbation — and sometimes development — of depressive symptoms. Approximately one-third of people with major depression have an alcohol problem, and oftentimes, the alcohol is used as a coping mechanism for depressive symptoms.7

People with depression often use alcohol as an unhealthy coping mechanism. Alcohol’s effects alleviate depressive symptoms in the short-term, creating bursts of euphoria and feelings of happiness. Reliance on alcohol over time to create these feelings of euphoria and cope with depressive symptoms, however, can lead to the development of alcohol use disorder. AUD also worsens feelings of depression, leading to a vicious cycle and a dependence on alcohol that can be difficult to break free from.8

Dual Diagnosis Treatment

If you have co-occurring alcohol use disorder and depression, many treatments are available to target both of these conditions simultaneously. Visiting a rehabilitation facility or treatment center that specializes in alcohol use disorder can help you receive the comprehensive care you need to restore your quality of life. 

Detox

Before you can enter a rehabilitation program for both depression and alcohol abuse, you will need to detox from the alcohol itself. Dependence on alcohol leads to unpleasant withdrawal symptoms when you stop drinking, such as anxiety, tremors, vomiting, and agitation.

A medically-monitored detox from alcohol and manage your withdrawal symptoms under the supervision of substance abuse professionals. A week of detox can reduce these symptoms significantly, and you can move into different treatment programs once detox is complete.

Medication

alcoholism & depression

Medication can help manage both depression symptoms and AUD. While receiving treatment, your doctor will evaluate your conditions and prescribe medications based on your unique symptoms and co-occurring disorders.

For depression, your doctor may prescribe any of the following medications, depending on your symptoms:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Monoamine oxidase inhibitors
  • Tricyclic antidepressants
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Antipsychotic medications
  • Anti-anxiety medications

Your doctor may also prescribe medication for your AUD, including:

  • Acamprosate
  • Disulfiram
  • Naltrexone

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a form of psychotherapy that is very effective for people with co-occurring depression and AUD. The goal of CBT is to identify negative thoughts and behaviors, and challenge these ideas with positive messages.

In addition, CBT also helps you develop healthy coping mechanisms you can use to manage depressive symptoms. With healthier strategies on your side, you can combat triggers when they arise and reduce your dependence on alcohol.

Group Therapy

Sometimes, it can be difficult to seek help for AUD alone, and hearing from the experiences of others may be beneficial for our own growth. Group therapy sessions allow you to learn from others who experience the same issues.

alcoholism & depression

During a group therapy session, a trained therapist or counselor will guide your group through a series of activities and structured conversations. 

You gain healthier coping mechanisms and a sense of community by learning about the experiences of others, and can better understand your own experiences by sharing with the group.

Residential Treatment

For severe cases of AUD and depression, you may need to visit a residential treatment facility. Inpatient programs for alcohol abuse involve a detox program, individual therapy, support groups, and other activities designed to treat alcohol dependence and mental health conditions.

Residential rehab facilities employ counselors, psychiatrists, social workers, doctors, and other medical professionals with experience treating patients who have substance use disorders. With this treatment option, you will receive the holistic, comprehensive care you need to address both AUD and depression simultaneously.

Outpatient Treatment

alcoholism & depression

Residential treatment is an effective treatment option for intensive short-term care. In the long-term, you have the option to continue outpatient treatment once the residential program ends. 

Outpatient programs allow you to continue to engage in your daily activities while attending treatment sessions at a rehabilitation facility, which provides greater flexibility than around-the-clock care. 

You may receive medication therapy, attend counseling sessions, and continue interventions designed to treat co-occurring AUD and depression. 

Alcohol Abuse & Depression: Seek Help Today

Depression and alcohol use disorder do not go away on their own. These conditions often feed on each other, forming a cycle of dependence and increasing tolerance that can lead to serious complications without professional treatment. Luckily, help is available. 

If you struggle with these conditions, multiple treatment options are available to fit your needs, goals, and co-occurring disorders. Visit a mental health professional as soon as possible to discuss your symptoms and begin your path to recovery.