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Alcohol and Depression


Readable and well-researched information for the public

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

 

About this leaflet

Disclaimer: This web resource provides information, not advice. You should read our full disclaimer on the back page before using this web resource.

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

Just over half of the population 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 relatively more affordable. Although younger people still drink more than other age groups, fewer people are now starting to drink at a younger age. In the UK:

  • Over the past 5 years, the number of hospital admissions where alcohol is the main cause has risen by 14 per cent
  • Around 1 in 17 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 (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

In small amounts, alcohol can make you feel better for a few hours. With larger amounts, it can make you feel worse. The desire to have this short-lived feeling then does not work, particularly if your body has developed tolerance to alcohol and you drink more in the hope that you will feel better. 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).

The current advice is for everyone to remain below the limit of 14 units for both men and women

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

If you regularly drink as much as 14 units per week, it is best to spread your drinking evenly over 3 or more days, otherwise you put your health at higher risk.

Drinking over 8 units in a day for men, or 6 units for women is known as binge drinking[i].

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

 

 

 

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 xix

  • 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? xx xxi xxii

  • 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 xxxiii

  • Do sip your drink slowly – don’t gulp it down. xxxiv 
  • Do space your drinks with a non-alcoholic drink in between. xxxv
  • 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. xxxvi
  • Do switch to lower strength or alcohol free drinks.
  • Do (for wine) avoid those ‘large’ 250 ml glasses in bars and restaurants. xxxvii
  • 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. xxxviii

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

[i] Raistrick D., Management of alcohol misuse within the context of general psychiatry, Advances in Psychiatric Treatment, 1996, 2, 125-132

[ii] NHS Choices. Risks of Alcohol Misuse. https://www.nhs.uk/conditions/alcohol-misuse/risks/

[iii] DrinkAware. Signs to Look out for that Suggest you are Becoming Dependent on Alcohol. https://www.drinkaware.co.uk/alcohol-facts/drinking-habits-and-behaviours/am-i-alcohol-dependent/

[iv] NHS Choices. Causes of Psychosis and Risks of Alcohol Misuse. https://www.nhs.uk/conditions/psychosis/causes/ and https://www.nhs.uk/conditions/alcohol-misuse/risks/

[v] Berglund M & Ojehagen A. The influence of alcohol drinking and alcohol use disorders on psychiatric disorders and suicidal behaviour, 1998, Alcoholism: Clinical and Experimental Research, 22, 333S–345S.

[vi] Mcintosh C. & Ritson B. Treating depression in substance misuse, 2001, Advances in Psychiatric Treatment, 7, 357-364

[vii] DrinkAware. Health Effects of Alcohol. https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/mental-health/

[viii] DrinkAware. Latest Alcohol Unit Guidance. https://www.drinkaware.co.uk/alcohol-facts/alcoholic-drinks-units/latest-uk-alcohol-unit-guidance/

[ix] https://www.nhs.uk/conditions/alcohol-misuse/

[x] DrinkAware. Underage Drinking. https://www.drinkaware.co.uk/advice/underage-drinking/understand-why-children-drink-alcohol/

[xi] Hibell B  et al. The ESPAD Report 2003: Alcohol and other drug use among students in 35 European countries, 2004, Sweden: The Swedish Council for Information on Alcohol and Other Drugs

[xii] Newbury-Birch et al. Impact of Alcohol Consumption on Young People: A Systematic Review of Published Reviews, 2008, Department for Children Schools and Families. Research Report DCSF-RR067. http://dera.ioe.ac.uk/11355/1/DCSF-RR067.pdf

[xiii] Swahn M, Bossarte R, & Sullivent E. Age of alcohol use initiation, suicidal behavior, and peer and dating violence victimization and perpetration among high-risk, seventh-grade adolescents, 2008, Pediatrics, 121, 297-305

[xiv] Cederbaum AI, Alcohol Metabolism, 2012, Clinics in Liver Disease, 16, 667–685

[xv] UK Government Alcohol Strategy. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/224075/alcohol-strategy.pdf

[xvi] Choi NG, DiNitto DM. Heavy/binge drinking and depressive symptoms in older adults: Gender differences. 2011, Int J Geriatr Psychiatry, 26

[xvii] UK Chief Medical Officers’ Low risk drinking guidelines, August 2016. www.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf

[xviii] Office for National Statistics. Adult Drinking Habits in Great Britain 2017. https://www.ons.gov.uk/releases/adultdrinkinghabitsingreatbritain2017

[xix] DrinkAware. https://www.drinkaware.co.uk/

[xx] Hester RK. Behavioral self-control training.  In R. K. Hester & W. R. Miller (Eds.), Handbook of Alcoholism Treatment Approaches: Effective Alternatives, (2nd edition) (pp. 148–159). Needham Heights, MS: Allyn and Bacon, 1995

[xxi] NHS Choices. Alcohol Support: Tips on Cutting Down on Alcohol. https://www.nhs.uk/live-well/alcohol-support/tips-on-cutting-down-alcohol/

[xxii UK Chief Medical Officers’ Low risk drinking guidelines, August 2016. www.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf

[xxiii] Copello A, Orford J, Hodgson R, Tober G & Barrett C. on behalf of the UKATT Research Team, Social behaviour and network therapy: Basic principles and early experiences, 2002, Addictive Behaviors, 27, 354–366

[xxiv] NICE Guideline CG100, Alcohol-use disorders: diagnosis and management of physical complications, 2010, National Institute of Health and Care Excellence

[xxv] DrinkAware. How to Reduce Your Drinking. https://www.drinkaware.co.uk/advice/how-to-reduce-your-drinking/how-to-cut-down/how-to-stop-drinking-alcohol-completely/

[xxvi] Davidson KM., Diagnosis of depression in alcohol dependence: changes in prevalence with drinking status, 1995, British Journal of Psychiatry 166, 199-204

[xxiv] NICE Guideline CG115, Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, 2011, National Institute of Health and Care Excellence, nice.org.uk/guidance/cg115

[xxvii] NHS Choices. Alcohol Support: Tips on Cutting Down. https://www.nhs.uk/live-well/alcohol-support/tips-on-cutting-down-alcohol/

[xxix] The management of harmful drinking and alcohol dependence in primary care: a national clinical guideline http://www.sign.ac.uk/pdf/sign74.pdf

[xxx] Buckman, Naismith, Saunders, Morrison, Linke & Leibowitz, The Impact of Alcohol Use on Drop-Out and Psychological Treatment Outcomes in Improving Access to Therapies Services: an Audit, 2018, Behavioural and Cognitive Psychotherapy, 46, 513-522

[xxvii NICE Guideline CG90, Depression in Adults: Recognition and Management, 2018, National Institute of Health and Care Excellence, nice.org.uk/guidance/cg90,

[xxxii] NICE Guideline CG115, Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, 2011, National Institute of Health and Care Excellence, nice.org.uk/guidance/cg115

[xxxiii Raistrick D, Heather N & Godfrey C, Review of the effectiveness of treatment for alcohol problems, 2006, National Treatment Agency, London.

[xxxv] UK Chief Medical Officers’ Low risk drinking guidelines, August 2016. www.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf

[xxxv] UK Chief Medical Officers’ Low risk drinking guidelines, August 2016. www.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf

[xxxvi] UK Chief Medical Officers’ Low risk drinking guidelines, August 2016. www.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf

[xxxvii] NHS Choices. Alcohol Support: Tips on Cutting Down. https://www.nhs.uk/live-well/alcohol-support/tips-on-cutting-down-alcohol/

[xxxviii] UK Chief Medical Officers’ Low risk drinking guidelines, August 2016. www.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf

[xxxix] NICE Guideline CG115, Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, 2011, National Institute of Health and Care Excellence, nice.org.uk/guidance/cg115


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: Tel: 020 7251 5860; email: info@addacton.org.uk;  A specialist drug and alcohol treatment charity. Their addiction services are free and confidential.

Alcoholics Anonymous: Tel: 0800 9177 650; email: help@alcoholics-anonymous.org.uk. 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.

Alcohol Concern: Tel: 020 7566 9800; email: contact@alcoholconcern.org.uk. 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: If you're worried about your own or someone else's drinking, contact Drinkline for a confidential conversation. Call free on 0300 123 1110 (weekdays 9am – 8pm, weekends 11am – 4pm).

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

Turning Point: Tel: 0207 481 7600; email: info@turning-point.co.uk. A national health and social care provider, with information and advice for friends and family.

 
This leaflet was produced by the Royal College of Psychiatrists' Public Engagement Editorial Board.
 
Series Editor: Dr Philip Timms.
Series Manager: Thomas Kennedy
 
With grateful thanks: Dr Tony Rao
 
 

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.

 


© September 2018 Royal College of Psychiatrists.

 

Disclaimer

 

This leaflet provides information, not advice

 

The content in this leaflet is provided for general information only. It is not intended to, and does not, amount to advice which you should rely on. It is not in any way an alternative to specific advice.

You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this leaflet.

If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay.

If you think you are experiencing any medical condition you should seek immediate medical attention from a doctor or other professional healthcare provider.

 

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