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Humans have been using alcohol to alter their psychological and emotional state since prehistoric times. On the positive side, alcohol’s calming and relaxing effects can soothe the tensions of everyday life. It is often part of social gatherings because it lowers inhibitions and increases sociability. Lowered inhibitions can result in a feeling of self-confidence that can cause a person to turn to alcohol more and more frequently.
Over time and increased use, the impact of alcohol is less positive. This is particularly true for those already feeling lonely, angry, depressed, or suicidal. For these individuals the depressant and disinhibiting effects of alcohol can intensify these vulnerable emotions and can lead to verbal and physical aggression and violence. A person can become increasingly dependent on alcohol to soothe, build confidence, or deal with vulnerable feelings. This use can result in diminished psychological and emotional capacity to deal with life without it.
Anyone can move from appropriate use of alcohol to misuse, but those who have high levels of stress in their lives and who lack adequate healthy stress reduction strategies may be more susceptible to alcohol misuse. Stress may also serve as the switch that turns on a genetic predisposition to alcohol misuse and abuse.
Those who struggle with feelings of anxiety or low mood are also particularly vulnerable to alcohol misuse. This is true partly because of the calming effect of alcohol, but also because of the numbing effect, an anxious or depressed mood is not felt as keenly when under the influence. A history of trauma is also often present for those who misuse alcohol. While not all those who misuse alcohol have a history of trauma and not all those with a history of trauma turn to alcohol, there is a link between the two, and the calming and numbing effects of alcohol are likewise appealing to someone who has experienced trauma.
Clinicians and researchers have long noted the higher incidence of alcohol misuse among those diagnosed with anxiety and depression disorders. Some of this is for the reasons already mentioned, but it is also because of the ease of obtaining alcohol, a legal substance in most countries. For those who, for a variety of reasons, either do not have access to medical or therapeutic help or who prefer not to seek such help, alcohol is an easy anti-anxiety or anti-depressant “street medication.”
Complicating the diagnostic and treatment picture for clinicians is that alcohol can both help alleviate as well as cause symptoms of anxiety and depression. There is also a relationship between mood disorders such as anxiety or depression and alcohol use disorder in that having one increases the likelihood of having the other. Additionally, having both a mood disorder and an alcohol use disorder speeds the development of both. Recovery outcomes are poorer for those who have both a mood disorder and an alcohol use disorder.
Of particular concern for clinicians is the relationship between trauma and alcohol use disorder. According to the U.S. Department of Veterans Affairs, National Center for PTSD (23 March 2022), up to three quarters of those who survive abuse, or a violent traumatic event report a problem with alcohol. A regular consumer of the news might conclude that trauma in the world seems to be on the rise. This assumption is correct. The 2017 World Health Organization World Mental Health Survey found that 70.4 percent of respondents across 24 countries experienced lifetime trauma, with exposure averaging 3.2 traumas per capita (reported in the 27 October 2017 edition of the European Journal of Psychotraumatology). Thus, we can expect to see increased use and misuse of alcohol as incidents of trauma increase and as general stress levels rise across the planet.
The treatment implications for alcohol misuse and another mental health diagnosis present are complicated by the fact that both need to be treated. The symptoms of a mood disorder or trauma need to be addressed along with their underlying causes. Additionally, the misuse of alcohol along with any accompanying addictive patterns need to be tackled.
Frequently, a person will come to therapy to address anxiety, depression, or trauma and may not report alcohol misuse. This may occur for a variety of reasons ranging from shame to a lack of understanding of the connection between the person’s alcohol use, mood disorder, or trauma. If the clinician does not do a comprehensive background assessment, they may not be aware of the alcohol use and any therapeutic work done on the mood disorder or trauma will be compromised.
The good news is that when both conditions are treated in tandem, real progress and recovery can be achieved. When psychological and emotional factors are addressed through talk therapy, frequently in the form of cognitive-behavioral therapy, and healthy coping tools are developed for symptoms, the use of alcohol decreases as do symptoms of this mental health disorder.
Dr. Nancy Kluge is a primary therapist at Saint Luke Institute in Silver Spring, Maryland.
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