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The Royal College of Psychiatrists Improving the lives of people with mental illness
  alcohol and depression  

Alcohol and Depression


 
 

Readable and well-researched information for the public

For anyone who is worried about themselves, a friend or a relative.

  alcohol and depression  

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About this leaflet

This leaflet is written for:

  • anyone who feels depressed and thinks they may be drinking too much
  • anyone who thinks they may be drinking too much and feels depressed
  • friends, family or colleagues of anyone who is both depressed and drinking.

It contains some basic facts about alcohol and depression, how to help yourself, how to help people you care for, how to get further help, and where to find more information.

Alcohol and us

More than 9 out of 10 people in the United Kingdom drink alcohol. For most of us it is part of our culture and we feel comfortable with it. Moderate drinking doesn't cause many problems. However, over the last 30 years, the UK has become wealthier and alcohol has become cheaper. We are starting to drink at a younger age and then drinking more. In the UK:

  • About 1 in 3 men and 1 in 6 women will develop some sort of health problem caused by alcohol
  • Around 1 in 11 men and 1 in 25 women are physically dependent on alcohol.

How does alcohol affect us?

Immediate effects

Alcohol tastes good to most adults although not, usually, to children (although drinking is starting younger). It can help you to relax, which can make it easier to talk to other people, especially if you are a bit shy. The downside is that it can make you unfit to drive, to operate machinery and affects your ability to make decisions. It also dulls your perception to a greater or less extent, depending on the amount of alcohol consumed.

If you go on drinking, your speech starts to slur, you become unsteady on your feet and may start to say things you may regret the next day.

If you drink even more, most people start to feel sleepy, sick or dizzy. You may pass out. The next day you may be unable to remember what happened while you were drinking.

Becoming dependent on alcohol

Alcohol can be a very effective way of feeling better for a few hours. If you are depressed and lacking in energy, it can be tempting to use alcohol to help you keep going and cope with life. The problem is that it is easy to slip into drinking regularly, using it like a medication.  The benefits soon wear off and the drinking becomes part of a routine. You start to notice that:

  • instead of choosing to have a drink, you feel you have to have it
  • you wake up with shaky hands and a feeling of nervousness
  • you start to drink earlier and earlier
  • your work starts to suffer
  • your drinking starts to affect your relationships
  • you carry on drinking in spite of the problems it causes
  • you find you have to drink more and more to get the same effect (tolerance)
  • you start to ‘binge drink’ (see below) regularly
  • other things have less importance than alcohol.

Long-term effects

Alcohol can lead to:

  • psychosis -  hearing voices when there is nobody there
  • dementia - memory loss, rather like Alzheimer's dementia
  • physical - damage organs, such as the liver or brain.

What is the connection between depression and alcohol?

We know that there is a connection – self-harm and suicide are much more common in people with alcohol problems. It seems that it can work in two ways:

  • you regularly drink too much including (including ‘binge drinking’) which makes you feel depressed OR
  • you drink to relieve anxiety or depression.

Either way:

  • Alcohol affects the chemistry of the brain, increasing the risk of depression.
  • Hangovers can create a cycle of waking up feeling ill, anxious, jittery and guilty.
  • Life gets depressing – arguments with family or friends, trouble at work, memory and sexual problems. 

How much alcohol is too much?

Some drinks are stronger than others. The easiest way to work out how much you are drinking is to count the ‘units’ of alcohol in your drinks. 1 unit is 8 grams /10 ml of pure alcohol - the amount in a standard 25 ml measure of spirits, a half pint of 3.6% beer or lager, or a 100 ml glass of 12% wine (see table below).

If a man and woman of the same weight drink the same amount of alcohol, the woman will end up with a much higher amount in the organs of her body. So the safe limit is lower for women (14 units per week) than for men (21 units per week).

Drink Aware has further information on 'what is an alcohol unit?'

What about younger people?

Young people in the UK drink to have fun, to have the experience of losing control, to socialise more easily with others, to feel sexier – and because their friends do. Around a third of 15-16 year olds binge-drink three or more times a month - more than in most other European countries.  Alcohol seems to have the same depressant effect in younger people as it does in adults. Around a third of young suicides have drunk alcohol before their death, and increased drinking may have been to blame for rising rates of teenage male suicide.

What about older people?

As we get older, we tend to lose muscle and to put on fat. Alcohol isn't absorbed by fat, so it ends up in the non-fatty tissues of the body. So, an older person who is the same weight as a younger person will tend to have more alcohol in their vital organs (non-fatty tissues) such as brain, muscles and liver. This means that alcohol will affect an older person more.

Binge’ drinking

The published weekly safe limits assume that you spread your drinking out with at least 2 alcohol-free days per week. This may not be the case – you drink a lot on one night, but still remain within your ‘safe’ limit if you don’t drink for the rest of the week.  There is now evidence that even a couple of days of heavy drinking can start to kill off brain cells, as happens with people who drink continuously.

  • Drinking over 8 units in a day for men, or 6 units for women is known as binge drinking.
  • In any one day it is best for a man to drink no more than 3-4 units and for a woman to drink no more than 2-3 units.

Binge drinking also seems to be connected with an increased risk of early death in middle-aged men and probably depression.

Guide to units of alcohol

This table gives a rough guide to the amount of alcohol (measured in units) found in the quantities commonly seen in different drinks.

All alcohol sold in the UK above 1.2% ABV (Alcohol By Volume) should state how strong it is in per cent.  The higher the percentage (%) the more alcohol it has in it. Pub measures are generally rather smaller than the amount you might have at home.  These amounts will vary according to the brand of drink and size of glass.

 

Beer, Cider & Alcopops                                 

 

Strength

ABV

Half

Pint

 

Pint

Bottle/

can

330 ml

Bottle/

can

500ml

Bottle

1 litre

Mild strength beer, lager or cider -  Eg Draught beer, Heineken, Woodpecker

3 - 4%

1

2

1.5

2

-

Normal strength beer, lager or cider - Eg Stella, Budweiser, Kronenbourg, Strongbow

5%

1.5

3

1.7

2.5

-

Extra strong beer, lager or cider -  Eg Special Brew, Diamond White, Tennants Extra

7.5 - 9%

2.5

5

3

4.5

7.5-9

Alcopops - Eg Bacardi Breezer, Smirnoff Ice, Reef, Archers, Hooch

5%

-

-

1.7

-

-

 

Wine and Spirits

Strength

ABV

Pub Measure

Small Wine Glass (125 ml)

Large Wine glass (250 ml)

Bottle

750 ml

Table Wines

12-14%

1.5 to 2

1.5 to 1.8

3 to 3.5

9 to 10.5

Fortified wines (sherry, martini, port)

15-20%

0.8 to 1

 

 

14

Spirits (Whisky, vodka, gin)

40%

1

 

-

30

Cocktails

Variable

 

2-5 units

How much am I drinking?

Most of us under-estimate the amount we drink – we don't usually keep an eye on it by counting units regularly. To check what is really happening, keep a diary of your alcohol intake over the course of a week. This can give you a clearer idea of how much you are drinking. It can also help to highlight any risky situations - regular times, places and people when you seem to drink more.

Diary table

Day         

 

How much?

When

Where

Who with?

Units

TOTAL

Monday

 

 

 

 

 

 

Tuesday

 

 

 

 

 

 

Wednesday

 

 

 

 

 

 

Thursday

 

 

 

 

 

 

Friday

 

 

 

 

 

 

Saturday

 

 

 

 

 

 

Sunday

 

 

 

 

 

 

Total for week

 

 

 

 

 

 

 

Warning signs

  • You regularly use alcohol to cope with anger, frustration, anxiety or depression.
  • You regularly use alcohol to feel confident.
  • You get hangovers regularly.
  • Your drinking affects your relationships with other people.
  • Your drinking makes you feel disgusted, angry, or suicidal.
  • You hide the amount you drink from friends and family.
  • Other people tell you that, when you drink, you become gloomy, embittered or aggressive.
  • You need to drink more and more to feel good.
  • You stop doing other things to spend more time drinking.
  • You start to feel shaky and anxious the morning after drinking the night before.
  • You drink to stop these feelings.
  • You start drinking earlier in the day.
  •  People around/with you look embarrassed or uncomfortable.

What if I am drinking too much?

  • Set yourself a target to reduce the amount of alcohol you drink.
  • Avoid high-risk drinking situations (check out your diary).
  • Drink lower-strength, though full-taste, drinks, like 4% beers or 10% wines.
  • Work out other things you can do instead of drinking.
  • Involve your partner or a friend. They can help to agree a goal and keep track of your progress.
  • Talk it over with your GP. For many people this simple step helps them to cut down their drinking.
  • Caution: if you are drinking heavily, do not stop suddenly ... consult your GP.

Some people can stop suddenly without any problems. Others may have withdrawal symptoms - craving, shakiness and restlessness. If this happens, ask your GP for help.

Helping depression and stopping drinking

Helping depression

We know that most depressed drinkers will start to feel better within a few weeks of cutting out alcohol. So, it is usually best to tackle the alcohol first, and then deal with the depression afterwards if it has not lifted after a few weeks.

After a few alcohol-free weeks, you will probably feel fitter and brighter in your mood.  Friends and family may find you easier to get on with. If your feelings of depression do lift, it's likely that they were caused by the drinking.

If the depression is still with you after four weeks of not drinking, talk to your GP about further help. It may be useful to talk over your feelings, particularly if your depression seems linked to some crisis in your life. Common issues are relationship problems, unemployment, divorce, bereavement or some other loss. Counselling may be helpful.

If the depression does not lift and is particularly severe, your GP may recommend a talking treatment called ‘cognitive therapy’ or suggest antidepressant medication. In either case, you will need to reduce or stay away from alcohol and go on with the treatment for several months. There are some medications used to reduce the craving for alcohol, but these don’t seem to help many people and are usually prescribed by a specialist.

Stopping drinking

If you are worried by the idea of stopping or cutting down your drinking, or if you just can’t cut down, it might help to talk with a specialist alcohol worker. Your GP can tell you about the local services - you can then refer yourself or ask your GP to refer you.

Treatments for alcohol problems and depression do help, especially if you can regularly see someone you can trust - your own doctor, a counsellor or a specialist alcohol worker or a specialist psychiatrist. Changing your habits and style of life is always a challenge and can take some time.

Dos and Don’ts of drinking safely

  • Do sip your drink slowly – don’t gulp it down.
  • Do space your drinks with a non-alcoholic drink in between.
  • Don’t drink on an empty stomach. Have something to eat first.
  • Don’t drink every day. Have two or three alcohol-free days in the week.
  • Do switch to lower strength or alcohol free drinks.
  • Do (for wine) avoid those ‘large’ 250 ml glasses in bars and restaurants.
  • Do provide interesting non-alcoholic drinks as well as alcohol if you are having a party.
  • Do ask your doctor or chemist if it is safe to drink alcohol with any medicine that you have been prescribed.
  • Do check your drinking every few weeks with your drinking diary.
  • Do keep to the drinking target (amount of alcohol per week) you have set yourself.
  • Don't binge drink – again, check the diary.

Finding help

If you just can’t stop drinking, or can’t keep it to a safe level, you can get help from:

  • your general practitioner
  • voluntary agencies that specialise in alcohol problems, such as Turning Point or Addaction
  • specialist treatment in the NHS - your GP who will also know how to contact specialist services
  • self help groups, such as Alcoholics Anonymous or AlAnon.

References

  • Davidson K.M. (1995) Diagnosis of depression in alcohol dependence: changes in prevalence with drinking status. British Journal of Psychiatry 166: 199-204.
  • The NHS Information Centre Lifestyle Statistics: Statistics on alcohol: England, 2012. The Health and Social Care Information Centre: London
  • Department of Health (2012) Alcohol needs research assessment project (ANARP). The 2004 national alcohol needs assessment for England, Department of Health: London.
  • Mcintosh C. & Ritson B. (2001) Treating depression in substance misuse. Advances in Psychiatric Treatment vol 7, 357-364
  • Raistrick D. (1996) Management of alcohol misuse within the context of general psychiatry, Advances in Psychiatric Treatment 2:125-132
  • Raistrick D, Heather N and Godfrey C (2006) Review of the effectiveness of treatment for alcohol problems. National Treatment Agency, London.
  • Treating depression in alcohol misuse (2008) Drugs & Therapeutics Bulletin, 46: 11-14.


Organisations that can help
Al-Anon Family Groups UK and Eire:

Provide understanding, strength and hope to anyone whose life is, or has been, affected by someone else's drinking. It is a fellowship of relatives and friends of alcoholics who share their experience, strength and hope in order to solve their common problems.

Addaction: A specialist drug and alcohol treatment charity. Their addiction services are free and confidential.

Alcoholics Anonymous: Contact details for all English AA meetings. There is a quiz to determine whether AA is the right type of organisation for an individual, and a frequently asked question section about AA and alcoholism. http://www.alcoholics-anonymous.org.uktel/: 0845 769 7555. email: help@alcoholics-anonymous.org.uk

Alcohol Concern: National agency on alcohol misuse which works to reduce the incidence and costs of alcohol-related harm and to increase the range and quality of services available to people with alcohol-related problems.

Alcohol – know your units

Drinkline – National Alcohol Helpline Tel: 0800 917 8282: Offers help to callers worried about their drinking and support to the family and friends of people who are drinking. Advice to callers on where to get help.

NHS Choices: have information on alcohol, including a unit calculator and an iphone app.

Turning Point: is a national health and social care provider, with information and advice for friends and family. Tel: 020 7481 7600 or for friends and family: tel: 020 7481 7600.

 
This leaflet was produced by the Royal College of Psychiatrists' Public Education Editorial Board.
Series editor: Dr Philip Timms.

Expert Review: Royal College of Psychiatrists' Addictions Patient and Carer Liaison Group

This leaflet reflects the best available evidence available at the time of writing.

Illustration by Lo Cole: www.locole.co.uk


©  April 2013. Due for review: April 2015. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.
 
For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 7235 2351 x 2552
 

The Royal College of Psychiatrists is a charity registered in England and Wales (228636) and in Scotland (SC038369)

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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