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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 have some sort of health problem caused by alcohol
• Around 1 in 15 men and 1 in 50 women are physically dependent on alcohol.

How does alcohol affect us?

Immediate effects

Alcohol tastes good to most adults although not, usually, to children. 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.

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.

Long-term effects

Alcohol can lead to:

• psychosis -  hearing voices when there is nobody there
• dementia - memory loss, rather like Alzheimer's dementia.

What is the connection between depression and alcohol?

We know that there is a connection – self-harm and suicide are much commoner 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 mls 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).

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 evenly over every 7 days.  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 percent.  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.

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

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.

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 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 psychotherapy’ or suggest antidepressant medication. In either case, you will need to 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 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 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 Alcohol Recovery Project
• 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

Davidson K.M. (1995) Diagnosis of depression in alcohol dependence: changes in prevalence with drinking status. British Journal of Psychiatry 166: 199-204

Department of Health (1999) Statistics on alcohol: 1976 onwards. 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

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.

Alcoholics Anonymous: Contact details for all English AA meetings.  There is a quiz to determine whether AA is the right type of organisation for, in individual, and a frequently asked question section about AA and alcoholism. www.alcoholics-anonymous.org.uk

Tel: 0845 769 7555. email: aanewcomer@runbox.com

Think and a drink – information and advice about alcohol from the NHS.

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

Drink Aware: Campaigning and educating to reduce alcohol harm.

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.

Further reading

Tackling alcohol together. Duncan Raistrick, Ray Hodgson & Bruce Ritson. Free Association Books (1999).

Self-help books

Overcoming Problem Drinking Marcantonio Spada. Robinson Publishing (2006)

A range of materials for carers of people with mental health problems has also been produced by the ‘Partners in Care’ campaign. These can be downloaded from http://www.partnersincare.co.uk/.

For a catalogue of our materials, contact the Leaflets Department, Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. Tel: + 44 (0)20 7235 2351 ext. 259; Fax: + 44 (0)20 7235 1935; Email: leaflets@rcpsych.ac.uk.

Illustration by Lo Cole/Inshed.co.uk

© June 2008 Royal College of Psychiatrists, all rights reserved.  This leaflet may not be reproduced in whole, or in part, without the permission of the Royal College of Psychiatrists.

This leaflet is made available through the generosity of the Charitable Monies Allocation Committee of the mental health charity St Andrew's, Northampton.

Series editor:    Dr Philip Timms.

Expert Review:  Addictions Patients and Carers Group

Editorial Board: Dr Ros Ramsay, Dr Martin Briscoe and Deborah Hart

• About our leaflets

© June 2008 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 the Head of Publications. 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, 17 Belgrave Square, London SW1X 8PG. Telephone: 020 7235 2351 x259

 

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

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