As a former mental health nurse who has personally struggled with mental health and alcohol addiction issues, I think this topic doesn’t receive enough attention. In my practice, I saw many people come into the hospital with both of these issues. Unfortunately, the treatments and approach rarely overlapped in a meaningful way. This meant that people often fell through the cracks, causing both issues to spiral out of control.
In my personal life, I realized (after I got sober) how much alcohol caused and worsened my depression. I also watched my father slowly die from the horrors of both conditions that were largely untreated by the many doctors he would visit.
As I write and explore these uncharted territories, I have many people sending me messages about their own personal struggles with mental illness and alcohol addiction. And one only has to glance at the statistics to know that mental illness and alcohol abuse have risen sharply and dramatically over the past several decades.
The problem is, we rarely discuss how entwined these two debilitating conditions are. We rarely explore addiction issues in people diagnosed with mental illness. Likewise, people with addiction issues are rarely explored for co-occurring mental health problems. In my nursing practice, those who would be followed up for both conditions usually had to get sick enough to warrant further exploration.
Also, an important factor in all of this is that most people with both conditions feel too shamed by society to explore both addiction and mental health issues with their doctors. That, in and of itself, is why these issues tend to get shoved under the carpet until a crisis occurs. Add in the fact that most people can’t even access care if they wanted to and you have the makings of our current mental health and addictions disaster.
So, because I know how little we discuss this in the public sphere, I want to address some important issues that could help if you think you have both a mental health and alcohol addiction issue.
You’re not alone.
As I said above, alcohol addiction and mental health issues affect far more people than we realize. In 2016, 71.7% of U.S. adults had drunk alcohol within the past year. Furthermore, 36.4% of that cohort engaged in heavy drinking—which is consuming more than 60 grams of alcohol (~ six drinks) on at least one occasion in the past month. Only 28.3% of the U.S. population abstained from alcohol use.
When looking at mental health statistics, we see that about 16.9% of the U.S. population had some type of mental health issue. The experts who compiled these statistics admit that these numbers are likely underreported. And currently, these numbers are taking a sharp rise upward since the start of the pandemic.
Another interesting statistic to look at is the disease burden of having both a mental health and substance use issue. Disease burden looks at years of life lost due to disability and declining health. In 2019, the disease burden of both mental health and substance use hovered at 6.56% in the U.S. This means that in the total population, 6.56% of adults lost years of life to either death or disability from both a mental health and substance use issue. Again, this number will likely rise as the aftereffects of the pandemic start to settle in.
Knowing this, we can see that we’re not alone in this. Many others are struggling with the same issues even though we rarely talk about them.
If you’re a heavy drinker, alcohol is a key component in declining mental health.
Even though we initially use alcohol to numb the pain, eventually alcohol will either cause a mental health issue or cause an existing one to decline severely. This is because alcohol seriously affects our nervous system, which in turn affects our mental health.
Alcohol causes our nervous system to bend out of shape, if you will. This is because, in order to manage the toxicity of alcohol on the nervous system, neurotransmitters have to increase or decrease to help accommodate the drug. By doing so, it throws everything off and causes a hyper-aroused state. The main side effect of alcohol withdrawal is anxiety, and this is directly caused by a nervous system that’s maintained in a hyper-aroused state due to alcohol use.
As such, heavy alcohol use can cause anxiety and even depression. But it also will definitely throw off an existing mental health issue. I think of my writer friend Glenna Gill, who opened up to me about her bipolar depression and how alcohol made it 10 times worse. She noticed a steep improvement when she stopped drinking. Not only did her bipolar symptoms improve, but her medications worked much better to control her mental illness.
If you take medication for mental health issues, alcohol is likely disturbing the functioning of your medication.
This brings me to an important issue: Alcohol can decrease the effect of some mental health medications. This generally happens within the SSRI medications, but can also happen in some mood stabilizers as well. What this means is that people often take medications to help a mental health issue but then use alcohol to self-medicate, which decreases the effect of their medication. Then, because the medications aren’t working, people often abuse more alcohol to medicate the distress of their mental health condition, and then it becomes a vicious circle.
For other medications, alcohol can interfere in a way that causes more toxicity or can potentiate the effect of the medications. For example, mixing alcohol with sedatives like Xanax or clonidine can cause increased sedation leading to overdose. But also, this can exacerbate depression symptoms due to high amounts of sedation.
The combination of both mental health and alcohol issues will eventually erode your physical health.
As mentioned above, mixing medications with alcohol can exacerbate mental health issues; however, it can also worsen physical health issues. Many medications taken for mental health issues are hard on the organs, especially the liver. Over time, heavy alcohol use combined with certain mental health medications can cause liver, brain or kidney damage.
There are other ways that having both a mental health and alcohol addiction can damage our physical health. Namely, both conditions cause considerable disability which can absolutely affect physical well-being. Over time, mental illness can erode our ability to take care of ourselves, eat properly and get enough activity in our day. Adding alcohol to that mix usually makes getting and staying healthy even harder.
If there are other physical health issues on top of the mental health and alcohol abuse, these conditions usually don’t get properly treated. For example, my father, who struggled with both alcohol and mental health issues, couldn’t get his diabetes properly treated. Alcohol use destroyed his blood sugar levels, mixed dangerously with his medications, and stopped him from having motivation to eat well and exercise. Unfortunately, I saw this same scenario dozens of times in my professional practice as a nurse.
If you want to start somewhere, start with the alcohol addiction first.
Most research and expert opinion on co-occurring mental health and alcohol abuse issues suggest that treatment should start with the substance use issue first. This is because of everything I mentioned above. Alcohol exerts such a strong pull on the nervous system that it needs to be eliminated first before the mental health issue can be properly treated. However, some experts believe that for more serious mental illness, these conditions need to be treated simultaneously.
As mentioned, treatment for mental health issues often involves medication which can be seriously compromised by alcohol use. Many people find that their mental health issues improve when they get sober simply because their medications start working properly. But also, without the alcohol, the nervous system can at least come back to a baseline that allows for deeper mental health treatment to occur. For example, it’s pretty difficult to examine our deeper feelings or reactions in therapy when our nervous system is so hijacked by alcohol use.
For these reasons, it may be better to start with treating the alcohol abuse issue first. However, that’s easier said than done, especially if alcohol was used as a prominent coping strategy for a mental health issue. Be sure to consult your doctor and let them know that you’re struggling with both alcohol use and a mental health issue.
These are some key issues that you need to know if you have both a mental health and alcohol use issue. As I said, we rarely look at these commonly co-occurring issues, yet they are fairly common and cause serious disability and mortality. I am deeply concerned about this, especially given the rise in both disorders due to the pandemic. However, I have faith that the more we call attention to this and the more we talk about it, the more people are empowered to create change.