Do you think you or a loved one has a problem with alcohol addiction? While drinking in moderation is rarely a cause for alarm, it’s important to be cognizant of the amount of alcohol you and those around you consume. For women, drinking one alcoholic beverage per day and a maximum of seven alcoholic beverages per week is generally acceptable. Men, on the other hand, can usually drink up to two alcoholic beverages per day and a maximum of 14 alcoholic beverages a week without experiencing adverse effects.

If you or someone you care about regularly drinks in excess of these ranges, however, alcohol use disorder (AUD) is a possible diagnosis. AUD is a chronic, relapsing brain disease that can impact the life of anyone, regardless of age, gender, ethnicity, body type, and personal beliefs. This indiscriminant condition is extremely dangerous and causes those impacted to compulsively crave alcohol in quantities that exceed daily and weekly ranges on a regular basis. In addition to an inability to control intake, AUD patients often experience emotional and physical dependencies that result in potentially life-threatening withdrawal symptoms when alcohol is unavailable. Further, continuous and unchecked drinking habits increase the chance of certain cancers, heart disease, high blood pressure, stroke, digestive problems, and memory loss. It also makes the participation in risky behaviors and activities far more likely.

Unfortunately, alcohol addiction and many mood disorders often go hand-in-hand. It’s quite common for AUD patients to be diagnosed with depression as well. According to the National Institute of Mental Health Epidemiologic Catchment Area Study (ECA) conducted in the 1980s, almost one third of individuals struggling with depression had a substance abuse disorder. Approximately 17 percent of those with co-occurring conditions were diagnosed with AUD.

What is Dual Diagnosis?

When an individual is diagnosed with both a mental disorder and a substance abuse disorder, it’s called a dual diagnosis. Some of the most common mental disorders diagnosed simultaneously with AUD are:

  • Depression
  • Anxiety
  • Bipolar Disorder
  • Schizophrenia
  • Obsessive-Compulsive Disorder

Dual diagnosis, which is often referred to as co-occurring disorders, is actually very common. In fact, the 2014 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration found that more than 18 percent of adults age 18 and older possessed a mental disorder. Additionally, roughly 8.4 percent of adults age 18 and older possessed a substance abuse disorder. That’s approximately 43.6 million people who suffered from mental illness and about 20.2 million people who suffered from substance abuse. Of those, 7.9 million people had co-occurring disorders in the United States alone.

What is Depression?

Depression, sometimes referred to as major depressive disorder, is a very common and serious mental illness that results in symptoms that impact the way a person feels, thinks, and acts on a daily basis. As one of the most common mental disorders in the United States, the condition impacts everyone differently. In some cases, people aren’t even aware they’re depressed at all. While there are a wide variety of symptoms, the most commonly experienced are:

  • Feeling sad, worthless, or “empty” of emotion
  • Loss of interest in hobbies and activities previously enjoyed
  • Eating too much or not wanting to eat at all
  • Change in body weight
  • Difficulty sleeping or sleeping too much
  • Neglecting self-care, including not bathing
  • Expecting only bad things to happen
  • Feeling anxious, irritable, hopeless, and/or guilty
  • Falling behind in school or work
  • Not following through with tasks
  • Loss of energy and/or feeling very tired
  • Moving and/or speaking slower than normal
  • Inability to sit still for too long
  • Difficulty concentrating, remembering things, and/or making decisions
  • Aches, pains, headaches, cramps, and/or digestive issues
  • Thoughts of death and/or suicide
  • Suicide attempts

While it’s normal for people to experience one or more of these symptoms after a bad day, an argument with a loved one, or a traumatic event, it’s uncommon for them to last for an extended period of time. Generally, feelings of sadness pass after a few days. Those diagnosed with depression, however, exhibit symptoms for at least two weeks. Additionally, the symptoms often cause significant problems at home, school, and work, as well as in various social situations.

Those diagnosed with depression won’t always experience all of the symptoms. Frequency, severity, and duration also vary from individual to individual. Research does indicate, though, that people with depression are at a greater risk of being depressed again in the future.

Signs of depression usually begin to become apparent between the ages of 18 and 29 and it’s not uncommon for adolescents and adults to develop drastically different symptoms. It’s important to realize that the condition can strike individuals at any age. Various treatment methods have been found to be successful and the longer an individual goes without depression, the less likely the condition is to return.

The risk factors of depression have been thoroughly researched. While there is no single cause for the disorder and every situation is different, commonly associated risk factors include:

  • Being diagnosed with depression in the past
  • Having a family member who has or had depression
  • Having a family member who has or had a substance use disorder
  • Experiencing a major life change, like the loss of a job, divorce, or death of a loved one
  • Experiencing a traumatic or stressful life event
  • Being diagnosed with certain physical illnesses
  • Being prescribed certain medications
  • Exposure to dangerous materials or toxins at a young age

There are also several positive factors which can help people avoid depression. These include:

  • Being physically active
  • Interacting positively with friends and family
  • Receiving support from loved ones
  • Living with a sense of purpose
  • Being involved spiritually
  • Connecting with the community as a whole
  • Participating in personally meaningful activities
  • Being thankful for the good things in life

Depression must be diagnosed and treated by a licensed healthcare provider. While depression is its own disorder, there are a few additional distinctive forms of the condition:

Persistent Depressive Disorder

Patients diagnosed with persistent depressive disorder experience depression symptoms that last for a period of at least two years. While consistently present, symptoms may fluctuate between episodes of extreme depression and less severe depression.

Postpartum Depression

Patients diagnosed with postpartum depression experience extreme sadness, anxiety and exhaustion during pregnancy and/or after childbirth. Many women experience “baby blues,” which consists of mild depression and anxiety after giving birth. While this typically passes quickly, postpartum depression occurs over a longer period of time and negatively impacts the mother’s ability to care for herself and her child.

Psychotic Depression

Patients diagnosed with psychotic depression experience severe depression symptoms in conjunction with delusions and/or hallucinations. Psychotic symptoms generally have roots in one or more depression symptoms.

Adjustment Disorder

Patients diagnosed with adjustment disorder experience depression symptoms that occur after a particularly stressful or upsetting event. This can include a variety of situations, such as relationship problems, financial issues, disasters, illnesses, or the death of a loved one.

Seasonal Affective Disorder

Patients diagnosed with seasonal affective disorder experience social withdrawal, an increase in sleep, and weight gain. These depression symptoms occur primarily in the winter, however, and dissipate during the spring and summer months. This is generally attributed to a decrease in natural light.

Drinking’s Effect on Depression

Alcohol consumption is very common among individuals who have been diagnosed with depression. Research shows that women frequently suffer from depression before they become addicted to alcohol, whereas men typically abuse alcohol first and then develop depression.

While everyone responds differently, there are a number of reasons these two conditions become linked:

  • Intention to use alcohol to ease the anxiety, irritation, and/or guilt associated with their depression
  • Use of alcohol with the hopes that it will allow them to care less about social and professional problems
  • Hope that the use of alcohol will mask the presence of depression-related symptoms
  • Belief that drinking larger than acceptable quantities of alcohol will help escape feelings of sadness, hopelessness, and “emptiness”

The biggest problem is that alcohol is a depressant that impacts the central nervous system. Instead of lifting the spirits of a patient with depression, it’s far more likely to trigger or intensify symptoms like sadness, hopelessness, and lethargy. Drinking regularly also lowers serotonin levels, which makes it harder for the brain to regulate emotions.

Unfortunately, being diagnosed with either depression or AUD significantly raises the risk of developing the other condition. In fact, the symptoms of each frequently worsen the other. Both disorders also produce a number of negative effects that can complicate the treatment process. Dual diagnosis depression and AUD patients often develop a very unhealthy cycle of alcohol use and mood instability.

Unique Issues Faced by Depression Patients with AUD

A significant issue faced by many depression and AUD patients is failure to properly diagnose both conditions. As is the case with many co-occurring disorders, it’s not uncommon for only one condition to be identified and treated. Some potential reasons for this include:

  • Not all depression patients mention or admit to the use of or dependency on alcohol
  • Withdrawal can often generate mental and physical symptoms similar to depression
  • Increased alcohol consumption is often caused by or contributes to emotional distress, but doesn’t always mean there’s an addiction
  • Depression symptoms can be difficult to identify, especially when certain medications are involved
  • Some healthcare providers do not possess the training or experience required to appropriately diagnose the disorders together

While there are a variety of potential reasons for misdiagnosis, it’s absolutely imperative that both conditions are treated simultaneously. If both conditions are not adequately addressed, only partial recovery is possible and the chance of relapse is much higher.

Not everyone who is diagnosed with depression will develop AUD and vice versa. Those who possess co-occurring disorders, however, will face a number of unique issues. Specifics will vary from person to person, but problems may include:

  • Many, if not all, of the common symptoms associated with depression, including extreme sadness, hopelessness, inconsistent eating patterns, poor sleep habits, and various physical ailments
  • Many, if not all, of the common symptoms associated with AUD, including impulsive drinking, incapacity to stop drinking, and mental/physical withdrawals when alcohol isn’t available
  • Higher risk of many medical conditions, including:

    Headaches

    Certain cancers

    Diabetes

    Heart disease

    Liver disease

    Parkinson’s disease

    High blood pressure

    Stroke

    Alcohol poisoning

    Digestive problems

    Memory loss

  • Higher risk of many mental disorders, including:

    Anxiety

    Bipolar disorder

    Personality disorders

    Other substance abuse disorders

  • Higher risk of homelessness, medical illness, homicidal behaviors, suicide, and/or early death
  • Higher risk of relapse, binge drinking, and/or the need for hospitalization
  • Higher risk of developing a substance abuse disorder if medication(s) aren’t taken as prescribed
  • Poorer adherence to treatment, especially of prescribed depression medications requiring discontinued alcohol consumption
  • Need for additional and concurrent treatment to overcome each of the disorders
  • Slower recovery time and poorer prognosis

Mothers diagnosed with depression must also be cognizant that their children will be at a higher risk of developing a psychiatric disorder as well. Children who have at least one depressed parent are also over eight times more likely to be diagnosed with co-occurring conditions in the future.

Treatment

When diagnosed with depression and AUD, the first step to recovery is always speaking with a qualified healthcare professional. Because diagnosing the two conditions together can be difficult, it’s recommended that anyone with depression be assessed for AUD and vice versa. In most cases, however, it’s best if you or your loved one can abstain from drinking for a period of time before being assessed for depression.

While establishing sobriety is important, the two conditions must be treated simultaneously for the best results. Depression recovery is nearly impossible when patients continue to drink and sobriety is significantly more difficulty when emotional symptoms persist. Integrated treatment plans generally include varying measures of both therapy and medication.

Therapy

Therapy can be especially beneficial for depression and AUD patients. Patients actually often benefit from the same therapies, including motivational enhancement therapy, cognitive behavioral therapy, interpersonal therapy, relapse prevention therapy, and contingency management. Individual and group session can greatly assist in identifying relapse triggers and creating strategies to avoid them.

Medicine

Medicine has been successfully utilized to treat both depression and AUD. Depression patients often notice an improvement in symptoms when taking selective serotonin reuptake inhibitors (citalopram, fluoxetine, sertraline, etc.) and/or antidepressants (nefazodone, desipramine, imipramine, etc.). There are also several medications that can curb the desire to drink, as well as cause a negative physical response to alcohol. Common prescriptions for AUD include disulfiram, acamprosate, and naltrexone.

Other treatment options, including electroconvulsive therapy, repetitive transcranial magnetic stimulation, vagus nerve stimulation, and light therapy, may be required, but are not often considered until after a combination of medication and talk therapy are attempted. Every treatment plan will be different, as healthcare practitioners work to ensure it meets patient goals, as well as utilize strategies best suited to each individual.

Do you think you or a loved one has dual diagnosis depression and AUD? Your first step should be working with a trusted healthcare provider to determine an accurate diagnosis. Luckily, the help you need can easily be found by calling a local or national helpline.

References

  • Depression.https://www.mentalhealth.gov/what-to-look-for/mood-disorders/depression
  • Mood Disorders and Substance Use Disorder: A Complex Comorbidity.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/
  • Alcoholism and Psychiatric Disorders: Diagnostic Challenges. https://pubs.niaaa.nih.gov/publications/arh26-2/90-98.htm
  • Treatment of the Depressed Alcoholic Patient. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712746/
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