Can Alcoholism Cause Mental Illness?

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The relationship between alcoholism and mental illness is complex. Alcohol can affect your thoughts, feelings, and actions. Alcohol misuse may cause new mental health symptoms, worsen existing symptoms, and in some cases lead to the development of alcohol-induced mental health disorders.

What’s the Connection Between Alcohol and Mental Health?

When the chemicals in your brain are balanced, you experience typical emotional reactions to events, but your brain is able to regulate extreme emotions normally. When brain chemistry is disrupted, it can manifest as stress, depression, anxiety, hypervigilance, and other mental health symptoms.

Research observes several ways that alcohol and mental health are related.

Changes in Brain Chemistry

Alcohol use causes an intense chemical reaction in the brain, triggering the release of neurochemicals in much higher amounts than the brain naturally releases. This is why alcohol, and other substances, are called “mind-altering.”

Use of alcohol can alter both brain chemistry and brain structure over time, leading to changes in how your brain reacts to stimuli and changes in the availability of vital chemicals.¹

For example, because the brain can’t produce the same “high” as alcohol naturally, a person may experience depressive symptoms when they don’t feel as much pleasure from normal activities as they did before using alcohol chronically.

Self-Medication Loop

Individuals whose brain chemistry is already disrupted—such as those with depression or anxiety—may use alcohol or another substance to manage their symptoms. Using alcohol to feel calmer, happier, less anxious, more relaxed, etc. is known as “self-medicating.”

Self-medication is typically implemented as a coping mechanism for one or both of two reasons:²

1. The substance temporarily resolves symptoms
2. You do not currently have other coping skills to deal with the symptoms

While self-medicating can appear to reduce symptoms in the moment, research indicates that there is a dynamic feedback loop when a person uses a non-prescription substance to manage mental health symptoms.¹

Long-term alcohol use increases the risk of experiencing depression, anxiety, and the associated symptoms.³ This loop also can lead to a rapid increase in the amount of alcohol used and how often, increasing the risk of developing physical dependence, tolerance, withdrawal symptoms, and addiction.

Sleep Disturbances

Some individuals self-medicate to improve their ability to fall asleep and stay asleep. However, alcohol increases sleep disturbances during the deeper parts of your sleep cycle. This disturbance then impacts the quality of your sleep.⁴ Since quality sleep is essential to positive well-being, alcohol use can negatively impact our mental health in many ways.

High Rate of Co-Occurring Disorders

Alcohol addiction has a high rate of comorbidity with certain mental health conditions. The most common dual diagnoses are:⁵

• Depressive disorders
• Bipolar disorder and related disorders
• Anxiety disorders
• Sleep disorders
• Sexual dysfunction
• Post-traumatic stress disorder (PTSD)

More than 25% of adults who experience a serious mental health issue also experience a substance use disorder.⁶ Alcohol and anxiety, and alcohol and depression are common mental health and substance use disorders that co-occur.⁶

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Neurocognitive disorders that are not caused by alcohol persist after intoxication and withdrawal have resolved.⁵

Can Alcohol Cause Mental Illness?

It is not uncommon to have major depressive disorder and alcohol use disorder. Some studies even suggest that having one doubles the risk you will have the other.⁷

The connection between mental health and substance use disorders is complex. It is even more complicated during stages of alcohol withdrawal when symptoms of anxiety and depression are present regardless of whether you have a diagnosis of anxiety or depression.

The disruption to neurotransmitters in the brain caused by alcohol and other substance use can mimic the symptoms of other mental health conditions, as they also interact with these neurotransmitters.^{1, 8}

In addition to co-occurring disorders, alcohol and substance use can cause specific mental health disorders. These disorders meet the criteria of mental health disorders but are specifically attributed to alcohol and substance use. These disorders are classified as substance/medication-induced disorders.

Alcohol-Induced Disorders

When you experience a mental health condition that is directly attributed to your alcohol use, you may be diagnosed with an alcohol-induced disorder. These disorders include:⁵

• Alcohol-induced depressive disorder
• Alcohol-induced anxiety disorder
• Alcohol-induced bipolar or a related disorder
• Alcohol-induced psychotic disorder
• Alcohol-induced major or mild neurocognitive disorder

Common factors of substance/medication-induced disorders include:⁵

• The symptoms have the same level of impact as a non-alcohol-induced disorder and align with the criteria of that disorder
• Alcohol is capable of producing the symptoms
• Other explanations—specifically another mental health condition or combination of mental health conditions—do not explain the symptoms better based on:
  • Symptoms occurred after exposure, intoxication, or withdrawal from alcohol
  • A full mental health disorder does not last after withdrawal from alcohol
• Symptoms are present without delirium

Substance/medication-induced mental health disorders typically resolve within one month becoming sober from the substance and going through the withdrawal period.⁵

How Does Alcohol Induce Mental Illness?

There is evidence to suggest the relationship between alcoholism and mental illness comes almost exclusively from the effects of alcohol on the brain.

Alcohol can causes significant and long-term changes. It can disrupt the levels of neurotransmitters, such as dopamine and serotonin.

The dysregulation of dopamine, serotonin, and GABA is heavily involved in the development of depression. So, when these neurotransmitters become out of balance, your mood can be significantly impacted.¹

Alcohol can also influence neuronal circuit activity—or the messaging system in your brain—which is crucial for decision-making and behavior. It can also impact your epigenome—which is a group of chemicals that gives your genes instructions. Both of these can influence your mental health and the worsening or developing of mental illness.⁸

Alcohol use can also reduce white and gray matter volumes and the microstructure of nerve fibers in the brain. It is hypothesized that changes to the white and gray matter and the nerve fibers are related to major depression.¹

How Are Joint Alcoholism and Mental Illness Assessed?

To ensure the best diagnostic accuracy, when a person with both alcohol addiction and another mental health condition is assessed, the clinician considers your:

• Alcohol and drug use history
• Family history of mental illness and substance use
• History of symptoms

A full picture of whether your mental health disorder symptoms are alcohol-induced typically requires that you be abstinent for at least one month.⁵

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It is also not uncommon for providers to conduct a reevaluation once you have maintained sobriety. This allows symptoms that can solely be attributed to your alcohol use to resolve so that your clinician can evaluate remaining symptoms without the interference of alcohol.

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Resources

1. Bell, S. & Britton, A. (2014, June 03). An exploration of the dynamic longitudinal relationship between mental health and alcohol consumption: a prospective cohort study. BMC Medicine, 12, 91.
2. Alexander, A. C. & Ward, K. D. (2017, May 29). Understanding post-disaster substance use and psychological distress using concepts from the self-medication hypothesis and social cognitive theory. Journal of Psychoactive Drugs, 50(2), 177–186.
3. Centers for Disease Control and Prevention. (2021, December 29). Alcohol Use and Your Health.
4. Ebrahim, I., Shapiro, C., Williams, A., & Fenwick, P. (2013). Alcohol and Sleep I: Effects on Normal Sleep. Alcoholism: Clinical and Experimental Research, 37(4), 539-549.
5. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
6. U.S. Department of Health & Human Services. (2019, March 22). Mental Health and Substance Use Disorders.
7. Farré, A., Tirado, J., Spataro, N., Alías-Ferri, M., Torrens, M. & Fonseca, F. (2020, July 02). Alcohol induced depression: Clinical, biological and genetic features. Journal of Clinical Medicine, 9(8), 2668.
8. Egervari, G., Siciliano, C., Whiteley, E., & Ron, D. (2021). Alcohol and the brain: from genes to circuits. Trends In Neurosciences, 44(12), 1004-1015.