By Elizabeth Ossip, LCSW, CAP, ICADC
Co-occurring alcoholism and depression is one of the most common “dual diagnosis.” According to a report by NIAAA “Alcohol-dependent respondents were 3.9 times more likely to have had major depressive disorder (27.9 percent) during the previous year than those who were not alcohol dependent.” Alternatively, almost a third of people with Major Depression Disorder also have a drinking problem. Often the depression comes first and is followed by progressively worsening alcohol use. People who have had teenage depression are twice as likely to develop alcohol problems and women are more likely to drink problematically when they have a history of depression.
So why is there this connection? There are several possible factors. Genetics and family history play a part in both alcoholism and depression. People with a family history of alcoholism or depression are more likely to develop either depression or alcoholism. There is also some research that points to a gene variation that is common between the two disorders.
Another causal factor may be that alcohol is a depressant. Abusive use of alcohol can alter the brain and cause depression. Alcoholics are substantially more likely to develop depression than non-alcoholics and depressed mood is common in alcoholism. If the alcoholism is the primary disorder, the depressive symptoms may lessen or resolve when the drinking stops when withdrawal is completed and recovery progresses, but if the depression persists, relapse of alcoholism is likely. That is why it is important to determine if the depression is a symptom of the alcoholism or if it is primary and co-occurring and to treat the depression and the alcoholism concurrently.
Many people drink to self-treat their depression. A glass of wine or a drink may initially and temporarily help to lift the spirits, but if continually relied upon to improve mood or numb feelings a dependency may develop. The alcohol also acts as a depressant, making the depression worse and this sets up a vicious cycle of drinking and depression. For people with depression, alcohol use can increase the frequency and severity of depressive episodes, as well as increasing suicidality. Alcohol use can also alter the efficacy of antidepressants.
It’s not just alcoholism. Depression can go hand in hand with other addictions and other health conditions. Opioid dependence is commonly seen with co-occurring depression. According to the CDC “Depression is associated with higher rates of chronic disease, increased health care utilization, and impaired functioning.” Middle-aged adults between the ages of 45 and 64, females, African Americans and Hispanics, people who are unable to work or who are chronically unemployed and people who lack private medical insurance or public health benefits all are more prone to depression.
If you experience symptoms of depression; feelings of hopelessness, anxiety, loss of appetite/weight loss, increased appetite/weight gain, sleeping too much or too little, tearfulness, ache and pains, loss of energy, feelings of guilt, a sense of worthlessness, general irritability, difficulty concentrating on daily tasks, a loss of interest in activities or hobbies, or suicidal thoughts or suicide attempts, you should seek help and get evaluated. You should also avoid alcohol.
If you drink more than you want to, have a hard time stopping drinking, experience remorse or feelings of guilt when you drink, have blackouts or hangovers, develop a tolerance for and have cravings for alcohol you may have alcoholism. Again, it is imperative that you seek medical attention and treatment. Alcohol withdrawal can be dangerous and may require medical detox. Do attempt to stop on your own without proper evaluation and medical supervision.
Co-occurring alcoholism and depression are treatable but require a dual-diagnosis program with proper psychiatric care and knowledgeable staff. The program should include educational and therapeutic components to educate about both depression and alcoholism and treat both conditions. Cognitive Behavioral Therapy (CBT) is an effective therapy for both conditions and medication management is an important component. Activities such as yoga and art therapy can also be helpful. Support groups such as AA are important for early recovery, as well as on-going maintenance. A long-term approach to treatment and an understanding that daily care and attention to both conditions is necessary will help to ensure continuous recovery. Getting the right start with a treatment program that prepares you appropriately will ensure a smoother road to recovery.