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The Comorbidity of Alcoholism and Depression

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  • The Comorbidity of Alcoholism and Depression
    • August 13, 2021
    • Post by: Vicky Magobet

    Content medically reviewed by Vicky Magobet, PMHNP-BC, on August 13, 2021.

    The Comorbidity of Alcoholism and Depression

    Substance addiction comes with a variety of distressing and destructive health risks. One of these risks is the comorbidity of alcoholism — also known as alcohol use disorder (AUD) — and depression. There are many reasons why these disorders occur simultaneously. When paired together, AUD and depression can cause interrelated problems that are challenging to address separately. If you're experiencing mental disorders comorbidly with alcoholism, it's helpful to understand why and how this happens as you take steps toward recovery.

    What Is Comorbid Addiction?

    Comorbid addiction happens when an individual experiences two or more illnesses or disorders. In the context of addiction, comorbidity refers to instances where addiction and mental illness coexist. These disorders could be in effect at the same time, or they could happen one after the other. Regardless of how they begin, comorbid disorders often interact in ways that worsen the effects of each disorder.

    You may hear the terms "comorbid" and "co-occurrence" used interchangeably when talking about AUD and depression. Though comorbid and co-occurrence have similar meanings in a broad sense, comorbid can refer to any two coexisting conditions — like cancer and generalized anxiety disorder. Co-occurrence tends to be used exclusively to reference addiction and mental illness.

    According to the National Institute on Drug Abuse, comorbidity between AUD and depression is fairly common. In fact, about 50% of those who struggle with mental illness will deal with a substance use disorder at some point in their life. Comorbid addiction and mental illness can feel complex, and it often has nuanced beginnings.

    Can Depression Lead to Excessive Drinking?

    In some cases, depression may lead to excessive drinking. Those who experience major depressive disorder or other mood disorders deal with difficult symptoms, including:

    • Difficulty making decisions, remembering or concentrating
    • Fatigue and decreased energy
    • Feelings of helplessness, guilt and worthlessness
    • Feelings of pessimism and hopelessness
    • Insomnia, oversleeping or early-morning waking
    • Irritability and restlessness
    • Loss of pleasure or interest in hobbies or sex
    • Low appetite and weight loss
    • Overeating and weight gain
    • Persistent sadness, anxiety or emptiness
    • Persistent headaches, digestive issues or pain that do not improve with treatment and cannot be otherwise diagnosed
    • Thoughts of death, suicidal ideation or suicide attempts

    Depression symptoms can be hard to cope with. Without healthy coping mechanisms, an individual may turn to alcohol for the burst of energy and respite it provides. They may find temporary relief from their depression and anxiety symptoms when drinking, which may lead to increased or excessive drinking.

    How Does Depression Turn Into AUD?

    There are a few mental and biological factors that drive the progression from depression to AUD, including:

    • Ease of use: Alcohol can feel like easy and effective relief in the midst of depression. When an individual has struggled without relief, a seemingly simple solution can feel irresistible and necessary.
    • Related risk factors: Unfortunately, mental illness can become a risk factor for developing AUD. Even if an individual does not self-medicate with alcohol, the fact that they are depressed can increase their risk for excessive drinking.

    Plus, depression can cause brain changes that make alcohol seem more rewarding. Depression impacts the amygdala, thalamus and hippocampus. Each of these areas supports a different type of brain function and well-being:

    • Amygdala: The amygdala is associated with fear, sorrow, anger, pleasure and sexual arousal. When an individual is depressed or sad, amygdala activity increases and remains heightened following recovery from depression.
    • Thalamus: The thalamus directs speech, movement, thinking, behavioral reactions and learning. Depression may impair the thalamus' ability to link sensory input to unpleasant and pleasant feelings.
    • Hippocampus: The hippocampus works with the amygdala to register fear and other emotions in context with your experiences and memories. One study showed that depressed women had a 9% to 13% smaller hippocampus than women who weren't depressed. The stress associated with depression may inhibit the hippocampus's ability to produce new nerve cells, leading to a smaller size and impaired function.

    Each case of comorbid depression and AUD results from a different combination of biological and environmental factors. Some drugs or medications can make mental illness symptoms worse, which can fuel comorbidity.

    Can Drinking Too Much Make You Depressed?

    When substance use alters an individual's brain, they may be more susceptible to mental illnesses like depression. You likely notice the short-term effects of alcohol consumption after a few drinks. These symptoms could include:

    • Blurred vision
    • Difficulty walking
    • Impaired memory
    • Slowed reaction times
    • Slurred speech

    Alcohol's long-term effects are more serious and lasting. Heavy drinking may lead to the following:

    • Alcohol-induced brain damage and brain shrinkage
    • Increased learning and memory problems
    • Wernicke-Korsakoff syndrome, which results from a thiamine deficiency

    Alcohol is classified as a depressant, which means it affects the central nervous system to cause sedation and drowsiness. Experiencing alcohol's natural depressing effects may strengthen the impact of major depressive episodes.

    Alcohol's effects also extend beyond the body. When an individual consumes alcohol, they may be more likely to make poor decisions that could have distressing consequences — like losing a job, ending a relationship, becoming injured or straining finances. These consequences could lead to depression or compound the effects of existing depression.

    Additional Comorbid Diseases for Alcoholism

    According to the National Institute on Alcohol Abuse and Alcoholism, 27.2% of people with AUD had a comorbid major depressive disorder. Some common comorbid psychiatric disorders include:

    • Anxiety disorders: 36.9% of those with AUD.
    • Mood disorders: 29.2% of those with AUD.
    • Generalized anxiety disorder: 11.6% of those with AUD.
    • Post-traumatic stress disorder: 7.7% of those with AUD.
    • Panic disorder: 3.9% of those with AUD.
    • Bipolar disorder: 1.9% of those with AUD.

    Excessive drinking could lead to one of these disorders, or the issue could surface after recovery. Either way, the disorders are considered comorbid if they are tied to each other in some way.

    Why These Disorders Coexist and How They Contribute to One Another

    It can be difficult to pinpoint why comorbid addiction happens and how each disorder fuels the other. Research has identified a few key reasons why AUD and depression may coexist, including genetics and environmental factors:

    1. Genetic Factors

    Your genetic makeup dictates many of your physical and personality traits. Though genes are not wholly responsible for who you become, they play a foundational role in shaping your body and mind. Research points to a connection between your genetic makeup and your risk for alcohol dependence and psychiatric disorders.

    According to a recent study, the gene called ADH1B may influence your comorbidity risk. This gene regulates how the body turns alcohol into the substance acetaldehyde — which feels unpleasant in the body and helps discourage people from overdrinking. Some individuals have a variant of the ADH1B gene that makes the alcohol-to-acetaldehyde conversion quicker, typically cutting off the overindulging faster with bodily symptoms. The research also found that the genetic factors related to AUD were linked to risk factors for psychiatric disorders.

    The genes you've received are an unchangeable part of you. Some genes may be expressed according to your lifestyle and environment, which you may be able to influence to some degree.

    2. Environmental Factors

    Your environment can trigger trauma, stress or other factors that increase your risk for comorbid addiction. Environmental factors may differ based on your race, ethnicity, family of origin, socioeconomic status and more. According to research, environmental factors for AUD may impact racial and ethnic minorities at a disproportionate rate. Some of these factors include:

    • Social norms: A culture's connection to drinking can influence how much exposure and access an individual has to alcohol. For example, certain Asian American subgroups are accustomed to heavy drinking and drunkenness. Certain Latino and Hispanic subgroups also partake in heavy drinking. Whether or not a group drinks in public or at home can impact how much drinking occurs. Research shows African Americans may be more likely to drink in a public setting, which typically encourages increased alcohol consumption.
    • Socioeconomic disadvantage: Poverty and socioeconomic disadvantage are linked to excessive drinking and AUD in adulthood. African Americans experience higher rates of individual and neighborhood poverty compared to Hispanics, Latinos and Whites, which serves as a risk factor for AUD.
    • Alcohol availability: Neighborhoods with increased access to alcohol and exposure to other drugs serve as a risk for AUD. Local policies about alcohol taxing and advertising may also discourage or encourage alcohol consumption — especially in adolescents.
    • Racial stigma and discrimination: Racial discrimination and stigma are unfortunate stressors that affect mental health. Black, Latino, Hispanic and Asian Americans may face an increased risk for AUD and depression due to discrimination.
    • Co-occurrence of environmental risks: Many of the above environmental factors are closely related to one another and happen simultaneously. Much like comorbid addiction, co-occurring environmental factors can complicate an individual's risk and recovery.

    The environmental factors for depression differ from those for AUD. Some of the lifestyle risk factors for depression include:

    • Chronic health issues
    • Substance use disorder
    • Poor diet and sleep
    • Lack of exercise
    • Distressing life events at work or home

    Depression risk factors may stem naturally from many of the AUD risks. For example, those with convenient alcohol availability may be more likely to develop a substance use disorder that leads to depression. Those at a socioeconomic disadvantage may be more likely to have a poor diet and chronic health issues from lack of access to good food and healthcare.

    This interplay is quite complicated. Having certain genetics and environmental factors doesn't always lead to comorbidity or addiction. When comorbidity does happen, each disorder can contribute to the overall issue in different ways, depending on whether the major depressive disorder happened before or after the AUD began. Alcohol addiction itself is considered a mental health disorder, which blurs the lines of comorbid AUD and depression.

    Which Disorder Came First ⁠— Does It Matter?

    Even if one disorder surfaces first, it can be difficult to determine if it caused the second disorder in comorbid addiction. In some cases, it may be impossible to establish which disorder came first. Whether your depression started first and led to AUD or your AUD brought on depression, your treatment needs are similar. With a dual diagnosis, it's important to address both disorders during treatment. You're not dealing with isolated depression or AUD — the two are interwoven and can worsen each other in ways that may not be addressed with depression-focused or AUD-focused treatment.

    Starting a Treatment Plan

    If you're experiencing comorbid AUD and depression, inpatient treatment can offer the recovery and healing you're searching for. At Diamond House Detox, we offer residential dual diagnosis treatment to address co-occurring addiction and mental illness. When you begin a treatment program, you'll work with experienced professionals to establish a history of your AUD and depression. This may include determining:

    • Your family's health and addiction history
    • Environmental factors you've experienced
    • The order of events for your disorders
    • The categories of your depression and AUD
    • How your AUD and depression interact

    Once a professional understands your unique situation, they can develop a treatment plan with the appropriate therapy, detoxification and medication.

    Treatment Options for Comorbid AUD and Depression

    Your treatment will be tailored to your needs and may consist of the following components:

    • Detoxification: Detoxing from alcohol is an important foundation for your recovery. At our residential facility, you can work through the challenges of withdrawal with professional support and monitoring. Those with severe addictions may experience severe or life-threatening side effects when abstaining from alcohol. Our supervised and medically assisted detoxification program can keep you safe and provide comfort while you work toward recovery.
    • Cognitive behavioral therapy: Cognitive behavioral therapy (CBT) can help you change the beliefs and behaviors that fuel your addiction and mental illness. As you change your thought patterns and develop healthy coping techniques, you are more prepared to control your feelings, thoughts and actions surrounding alcohol and depression.
    • Trauma therapy: If your AUD or depression stems from traumatic events in your life, trauma therapy can help you achieve healing that supports your overall recovery. Our professionals can provide group counseling, eye movement desensitization and reprocessing (EMDR), CBT and psychodynamic therapy to help you process and recover from trauma in your life.

    When you choose Diamond House Detox, you can enjoy an intimate and private setting for treatment. Our clients receive freshly prepared meals, 24/7 care, holistic treatment and incidental medical services to help them heal and grow as a whole person.

    Address Depression and Alcoholism Together at Diamond House Detox

    If you're looking for a residential recovery program in northern California, Diamond House Detox is here to help. We have treatment options to address comorbid disorders effectively while keeping your comfort in mind. We understand that peace and privacy are important during your detox, which is why you'll enjoy your own room and a relaxing environment at Diamond House Detox. We work hard to maintain a personal setting and provide individualized care.

    For more information about your treatment options and admission, contact us today.

    Sources:

    1. https://diamondhousedetox.com/what-is-the-difference-comorbidity-dual-diagnosis-vs-co-occurring-disorders/

    2. https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses

    3. https://www.webmd.com/depression/guide/alcohol-and-depresssion#1

    4. https://adaa.org/understanding-anxiety/depression/symptoms

    5. https://www.healthline.com/health/mental-health/alcohol-and-depression#coexisting

    6. https://www.health.harvard.edu/mind-and-mood/what-causes-depression

    7. https://pubs.niaaa.nih.gov/publications/aa63/aa63.htm

    8. https://www.ncbi.nlm.nih.gov/books/NBK20360/

    9. https://pubs.niaaa.nih.gov/publications/arh26-2/81-89.htm

    10. https://www.sciencedaily.com/releases/2018/11/181126123328.htm

    11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695556/

    12. https://www.mentalhelp.net/depression/environmental-causes/

    13. https://diamondhousedetox.com/drug-addiction-mental-illness/

    14. https://medlineplus.gov/dualdiagnosis.html

    15. https://diamondhousedetox.com/addiction-therapy/dual-diagnosis-treatment-center-of-northern-california/

    16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1089782/

    17. https://diamondhousedetox.com/addiction-treatment/alcohol-detox-and-rehab-program-in-sacramento-ca/

    18. https://diamondhousedetox.com/why-choose-diamond-house/medical-detox-assistance/

    19. https://diamondhousedetox.com/addiction-therapy/cognitive-behavioral-therapy/

    20. https://diamondhousedetox.com/addiction-therapy/trauma-therapy/

    21. https://diamondhousedetox.com/how-single-event-trauma-can-lead-to-addiction/

    22. https://diamondhousedetox.com/addiction-therapy/emdr-therapy/

    23. https://diamondhousedetox.com/what-sets-us-apart/

    24. https://diamondhousedetox.com/about-us/service-areas/

    25. https://diamondhousedetox.com/why-choose-diamond-house/

    26. https://diamondhousedetox.com/contact-us/

    Vicky Magobet
    Vicky Magobet
    Psychiatric Mental Health Nurse Practitioner at Diamond House Detox
    Vicky is a board certified Family Psychiatric Mental Health Nurse Practitioner, certified by the American Nurses Credentialing Center. She began her nursing career in healthcare by working in the intensive care unit, and then an inpatient psychiatric hospital. After realizing the mental health needs of both the patients and the families she served, she became a Psychiatric Nurse Practitioner. Throughout her experience working with clients, she has developed a passion for those with dual diagnoses and specializes in helping individuals recognize the issues driving their substance use. This recognition has been crucial to the individual’s success in treatment. Vicky opened Diamond House Detox so that she can address these issues early on in a therapeutic environment to allow clients to transition to the next level in their recovery.
    Vicky Magobet
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