“It’s just one drink!” Why Depression and Alcohol Don’t Mix

Alcohol is part of our culture. You can scarcely walk a city block or drive a suburban mile without passing a liquor store or bar. Champagne is synonymous with celebration.  Wine is a stand-in for relaxation. And beer —if you believe the pervasive ads—is a prerequisite for good times with attractive, fun-loving friends.

What the media doesn’t advertise is that alcohol is a depressant. Depressants are a class of drugs that slow brain activity.  Symptoms include decreased inhibition and loss of motor skills. But because alcohol use is socially accepted and can temporarily produce feelings of euphoria, the depressive effects are often ignored.

The holidays are coming, a time when global consumption of alcohol typically increases. Many families are planning meals or holiday parties to include a festive cocktail or special bottle of wine.  But if someone you love is living with a depressive disorder, here are a few things to keep in mind when planning for the holidays this year:

Alcohol alters brain chemistry, often making depression worse

Alcohol initially causes the release of endorphins and other “feel good” chemicals. However, alcohol can also shut down the processes by which the brain produces these chemicals naturally, creating a net deficit. People living with mood disorders, in particular, can end up feeling more depressed than they did before they started drinking.

Alcohol interferes with antidepressant medications

Antidepressant medications work by restoring the balance of certain neurotransmitters in the brain. Neurotransmitters are chemical messengers that are involved in a variety of neurological processes, from memory and movement to mood. Alcohol upsets this balance by slowing the brain’s production of certain neurotransmitters and by reducing the number of receptors available for them. Alcohol use can also reduce compliance with medications or other treatments by lowering motivation and inhibiting memory. 

Alcohol interferes with sleep

Although alcohol feels sedating in the short-term, it can actually disrupt sleep and aggravate sleep disorders such as apnea.

 Alcohol impairs judgment and lowers inhibitions

This can be especially dangerous for people who have suicidal thoughts. In fact, multiple studies have observed that alcohol use is a risk factor for suicide.

 Approximately one-third of people living with a depressive disorder have a co-occuring substance use disorder

Substance use, including but not limited to the use of alcohol, often begins as a (sometimes subconscious) effort to manage symptoms of depression or bipolar disorder.  But because tolerance can build quickly, higher quantities of alcohol are soon needed to produce the same effect.  People living with depressive disorders often find themselves in a destructive cycle of drinking more but experiencing less relief and suffering more debilitating symptoms in the long term.

Tips for Concerned Caregivers

“For individuals who are struggling with alcohol or substance use disorder, their addiction is not just a personal issue–it definitely and directly impacts a family.”  –Dr. Maria Sullivan, addiction treatment specialist, in an interview with FFDA

Identifying the problem

Considering the facts above, one could argue that any alcohol consumption by someone living with a depressive disorder is problematic. However, only a mental health professional can determine the extent to which your loved one’s drinking is interfering with their functioning and/or the functioning of the family. This link provides the diagnostic criteria for substance use disorder, but just because your loved one doesn’t meet all of the criteria does not mean their drinking is not a problem.

Deciding which disorder to treat first

Addiction specialist Dr. Maria Sullivan advises treating either the disorder causing the most immediate harm or the disorder your loved one is more motivated to treat. In the case of chemical dependency, your loved one may need to complete a detox program before proceeding with other treatments.

Dealing with resistance

Dr. Sullivan notes that with both depressive disorders and substance use disorders, a person’s “frame of reference tends to get very narrow.” Your loved one may not be able to recall what life was like before the disorder and may not be able to plan for the future. Dr. Sullivan notes that caregivers can be helpful in providing this perspective to their loved ones. Caregivers can also reinforce that both depressive disorders and substance use disorders are diseases that can be effectively treated, not personal failings.

Resources

For caregivers who are concerned about a loved one living with a depressive disorder and substance abuse, Dr. Sullivan recommends CRAFT, short for Community Reinforcement And Family Training. CRAFT focuses on positive communication and reinforcing what is working.

The relationship between depression and substance use is complicated, and even teenagers get caught in the tangle. Whether an adolescent turned to substances to self-medicate or the use of substances led to developing symptoms of depression, we know that the combination increases the risk for both self-harm and suicide attempts. Learn how to navigate teen depression and substance use as a family in our webinar.

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Lindsay Schwartz is a psychotherapist in private practice in Acton, MA, where she specializes in the treatment of depressive and anxiety disorders. She has a background in school counseling and a special interest in mindfulness-based treatments.  Lindsay earned her Bachelor’s degree in Psychology and English from Williams College, and her Master’s degree in Social Work from Simmons College. In her free time, Lindsay enjoys writing, reading, running, and spending time with her husband and 2 children.