Mental Health and Alcoholism (And Their Connection in Addiction Treatment)

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People who struggle with long-term alcohol-related issues often experience associated mental health conditions, also known as a dual diagnosis. Experts estimate that 9.5 million U.S. adults experienced both mental illness and a substance use disorder in 2019.¹

It’s sometimes difficult to know which came first—the mental health diagnosis or the alcoholism. Either way, the effects that alcohol misuse can have on mental health can be progressive. If you or someone you know is struggling with alcohol use disorder and you suspect there is a mental health issue involved, it’s best to educate yourself on risk factors, find dual diagnosis resources, and seek treatment.

In this article: 

• How Does Alcoholism Affect Mental Health?
• Dual Diagnosis
• Common Dual Diagnosis Disorders Tied to Alcoholism
• PTSD and Alcoholism
• Treatment for Dual Diagnosis and AUD
• Sources

How Does Alcoholism Affect Mental Health?

The definition of alcohol misuse includes any alcohol use that harms your health, puts your safety at risk, or causes other alcohol-related problems. If alcohol use gets in the way of your everyday tasks or causes other problems, you likely have an alcohol use disorder (AUD). AUD can range from mild to severe. Alcohol misuse is associated with several mental health disorders, such as anxiety, depression, schizophrenia, and bipolar disorders.²

Serotonin levels in your brain are lower when you are consuming alcohol. Serotonin is the neurochemical that helps to regulate your mood. When there is a decrease in serotonin, negative emotional responses, such as anger, aggression, anxiety, or depression, can be more prevalent.

Dual Diagnosis

Dual diagnosis is the diagnosis for when someone has both AUD and mental health issues. Other commonly used terms for dual diagnosis include:

• Co-occurring disorders
• Co-morbid disorders
• Comorbidity

Among the approximately 9.5 million Americans who meet the criteria for dual diagnosis disorder (with any substance use disorder and any mental health condition), alcohol is the most commonly cited substance.¹

Common Dual Diagnosis Disorders Tied to Alcoholism

Depression: Alcohol is a central nervous system depressant, so consuming an excessive amount of alcohol can lead to more severe depression symptoms.⁴

Anxiety: Anxiety can be a normal stress response, but a diagnosis of an anxiety disorder may be present when symptoms persist. People with anxiety may use alcohol to “calm their nerves.” The alcohol may work temporarily, but when it wears off, it can increase anxiety symptoms. This is due to an imbalance in your brain’s dopamine and serotonin levels.

Personality disorders: People with a severe alcohol use disorder have a high co-occurrence rate of personality disorders. The National Epidemiologic Survey on Alcohol and Related Conditions found that those diagnosed with a personality disorder are 5 times more likely to have alcohol use disorder than the general population.⁵

Bipolar disorder (BPD): Research shows that many people who have BPD also struggle with AUD or other addiction issues at some point in their lives.⁶ Alcohol use can increase during manic phases, which can lead to dangerous disinhibition or recklessness.

Obsessive-compulsive disorder (OCD): About 25% of people diagnosed with OCD also struggle with alcohol use disorder.⁷ Although alcohol may be a distraction for OCD sufferers, it could also trigger binge drinking, which can worsen alcohol dependence.

Post-Traumatic Stress Disorder (PTSD): PTSD is one of the most frequently paired co-occurring disorders. First observed in war veterans, it is seen in many forms in relation to AUD. Anything that reminds a person of the traumatic event can trigger alcohol use or other unhealthy coping strategies.⁷

PTSD and Alcoholism

Twenty-five to 50% of people receiving treatment for substance use disorder have a co-occurring post-traumatic stress disorder (PTSD) diagnosis.⁸ It’s common to experience more severe symptoms or have a higher risk for relapse and other mental health issues in these instances. Research also indicates that a reduction in PTSD symptoms is more likely to cause a reduction in substance use rather than the other way around.⁸

PTSD develops when you are exposed to a shocking, dangerous, or life-threatening event. The sudden, unexpected death of a loved one may also spark PTSD symptoms. While PTSD can occur in mild to moderate levels, each person is uniquely impacted. Many people have experienced a traumatic event, but most tend to recover naturally.

People who continue to experience problems may be diagnosed with PTSD.⁹ When symptoms are untreated, PTSD can lead to alcohol misuse and other harmful drug use. People with co-morbid PTSD and substance use disorder (SUD) have more severe PTSD symptoms, higher rates of other mental health disorders, and are at a greater risk for suicide.^8,9

PTSD is a serious mental health condition that can diminish the quality of your life. The good news is that a reduction in PTSD symptoms correlates with an improvement in SUD symptoms.⁸

Treatment for Dual Diagnosis and AUD

There are many combinations of mental health conditions and substance use disorders that make up dual diagnoses. Because co-occurring disorders and AUD can occur simultaneously, mental health clinics use specific drug screening tools to identify your risk factors.¹ Symptoms of AUD may include:

• Isolation from friends and family
• Abrupt or erratic changes in behavior
• Engaging in risky behaviors
• Developing tolerance and withdrawal symptoms
• Psychological dependence

After a risk assessment is completed, a treatment plan is then created. The most effective treatment for dual diagnosis is an integrated approach when you receive care for both diagnoses.¹ This may include detox, a stay at an inpatient treatment center, outpatient treatment, therapy, or any combination of these options. Some common treatments for alcohol and mental health issues include:^{1, 10}

Detoxification: The first major step that people with a substance use disorder may have to overcome is detoxification. During detox, trained medical staff monitor you 24/7 until the substance of use, alcohol in this case, is eliminated from your body and your withdrawal symptoms have subsided.  Medical personnel may help you taper off or administer medication to lessen the effects of withdrawal.

State-funded rehabs: These programs accept state-funded insurance such as Medicaid and Medicare and are usually free or reduced cost. State-funded rehabs are generally available in all U.S. states.

Inpatient residential: These rehab programs provide a 24-hour structured routine, generally in a non-hospital setting. The length of stay can range from 30 days to 12 months. These programs generally use multiple therapies and provide comprehensive care.

Intensive outpatient (IOP): These programs vary in structure and intensity, generally cost less than residential inpatient treatment, and are more suitable for people with jobs and strong social support. The programs usually work well for individuals who must keep up with daily responsibilities.

Psychotherapy: Psychotherapy and behavioral therapy are often added to enhance substance use treatment. One modality in particular–cognitive-behavioral therapy (CBT)—helps people with dual diagnoses learn how to change unproductive patterns of thinking that trigger alcohol or drug use and switch to healthier coping skills.

Supportive housing: Group homes and sober houses are bridges or second-stage treatment facilities that may help you re-enter society if you are newly sober. There are many different types of sober homes, including women’s, men’s, and co-ed homes.

Self-help and support groups: People with a dual diagnosis often benefit from support groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) or mental health/recovery groups. These resources are available through community health clinics, social services, or recovery specialists.

The effects of alcohol on mental health are pervasive. The combination of alcoholism and mental illness can create significant obstacles in your life, which often affects families, friends, and loved ones.

However, there is hope. The stigma surrounding mental health and substance use is lessening. Professional help and treatment are widely accessible. If you or someone you know may benefit from dual-diagnosis treatment, you can call 800-948-8417 Sponsored to speak to a specialist today. We are here to support you every step of the way.

Resources

1. National Alliance on Mental Illness. (2020). Substance Use Disorders. 
2. Mayo Clinic. (2021). Alcohol use disorder. 
3. Pereira, G., Wood, L., Foster, S., & Haggar, F. (2013). Access to alcohol outlets, alcohol consumption and mental health. PLOS ONE 8(1), e53461.
4. Imam, I. (2010). Alcohol and the central nervous system. British Journal of Hospital Medicine (London), 71(11),635-9.
5. Sansone, R. A., & Sansone, L. A. (2011). Personality Disorders: A Nation-Based Perspective on Prevalence. Innovations in Clinical Neuroscience, 8(4), 13-18.
6. Helle, A. C., Watts, A. L., Trull, T. J., & Sher, K. J. (2019). Alcohol use disorder and antisocial and borderline personality disorders. Alcohol Research: Current Reviews, 40(1), arcr.v40.1.05.
7. Mancebo, M. C., Grant, J. E., Pinto, A., Eisen, J. L., & Rasmussen, S. A. (2009). Substance use disorders in an obsessive compulsive disorder clinical sample. Journal of anxiety disorders, 23(4), 429.
8. Killeen, T.K., Back, S.E., & Brady, K.T. (2015). Implementation of integrated therapies for comorbid post-traumatic stress disorder and substance use disorders in community substance abuse treatment programs. Drug and Alcohol Review, 34, 234-241.
9. National Institute of Mental Health. (2016). Post-Traumatic Stress Disorder. 
10. Substance Abuse and Mental Health Services Administration (2015). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol (TIP 45).