Alcohol and Depression | Royal College of Psychiatrists (2023)

alcohol and us

In the UK, just over half of men and just under half of women drink alcohol.¹. For most of us, it is part of our culture and we are comfortable with it. Drinking at low risk levels²it doesn't cause many problems. This equates to 7 liters of beer or 14 individual measures of liquor or just over a bottle of wine per week.

However, since 1980, alcohol has become 64% more accessible.³

Although young people still drink more than other age groups, fewer people start drinking earlier.⁴.

Not UK:

• In the past 5 years, the number of hospital admissions for mental health and alcohol-related problems has increased by 4 percent. Older people explain this increase, while admissions of young people have decreased⁵
• Around 1 in 100 adults in Britain are dependent on alcohol⁶

How does alcohol affect us?

immediate effects⁷

Alcohol tastes good to most adults, though generally not to children.

Alcohol can help you relax, which can make talking to other people easier, especially if you're a bit shy. The downside is that it can make you unable to drive, operate machinery, and affect your ability to make decisions. It also hinders your ability to receive information and react to changes in your environment to a lesser extent, depending on how much alcohol you consume.

If you keep drinking, you start to talk slurred, you get shaky, and you might start saying and doing things that aren't like you, that you might regret when you're sober.

If you drink even more, most people start to feel drowsy, nauseated, or dizzy. You could pass out. The next day, you may not be able to remember what happened while you were drinking. Occasionally this can take the form of an alcoholic blackout and is a sign that your drinking might be becoming a problem.

Becoming dependent on alcohol⁸

In small amounts, alcohol can relax you for a couple of hours. With larger amounts, it can make you feel worse.

Desiring that short-lived feeling doesn't work, especially if your body has built up a tolerance to alcohol and you drink more to feel the same effects.

The problem is that it's easy to switch to drinking regularly, using it as medicine. The benefits soon wear off and drinking becomes part of the routine.

You also begin to realize that:

• instead ofpicking outto drink, youfeel the desirehave a
• you wake up with shaky hands and a jittery feeling
• you start drinking earlier and earlier in the day
• your work begins to suffer
• your drinking begins to affect your relationships
• you keep drinking despite the trouble it causes
• you start to "heavy drink" (see below) regularly
• you start to neglect other parts of your life

Long-term effects

Alcohol can lead to:

• psychosis - hearing voices when no one is around⁹
• memory problems alone (Korsakoff syndrome or affecting other areas of the brain as well (alcohol-related dementia) - similar but not the same as Alzheimer's dementia¹⁰
• Physical: it damages the organs, such as the liver or the brain.¹¹

What is the connection between depression and alcohol?

We know there is a connection: self-harm and suicide are much more common in people with alcohol problems.^{12 13}. It seems that it can work in two ways:

• you drink too much on a regular basis, including (including "binge drinking"), which makes you feel depressed OR
• It is drunk to relieve anxiety or depression.

Either way:

• Alcohol affects brain chemistry, increasing the risk of depression.
• A hangover can create a cycle of waking up sick, anxious, nervous, and guilty.
• Life becomes more difficult: arguments with family or friends, problems at work, memory and sexual problems.

How age affects you

younger people¹⁵

Young people in the UK drink for fun, to lose control, to socialize more easily with others, to feel more attractive and because their friends do it.

Around 4 in 10 people aged 16-24 drink to excess at least once a week, more than in most other European countries.

Alcohol has the same depressing effect on young people as it does on adults.

About a third of suicidal youths drank alcohol before they died, and increased consumption may be to blame for rising suicide rates among male adolescents.

older people^sixteen

As we age, the amount of water in our body decreases. In addition, our liver is less capable of breaking down the alcohol that is carried in the blood.

Thus, for the same amount of alcohol consumed, the effects are worse for an older person than for a young person.

how much alcohol is too much?

Some drinks are stronger than others.

The easiest way to tell how much you're drinking is to count the "units" of alcohol in your drinks.¹⁴.

1 unit is 8 grams / 10 ml of pure alcohol - the amount in a standard 25 ml measure of spirits, half a liter of 4% beer or lager or a 100 ml glass of 12% wine (see table below) .

The current advice is for everyone to stay under the 14-unit weekly limit, for both men and women, but also have days without drinking.

drunkenness

Drinking more than 8 units per day for men or 6 units for women is known as binge drinking.

Excessive alcohol consumption is also associated with an increased risk of premature death in middle-aged men, and probably with depression.

If you regularly drink up to 14 units per week, it's best to spread your intake evenly over 3 or more days, otherwise you put your health at even greater risk.¹⁷.

Alcohol Units Guide

Beer, cider and alcopops

wine and spirits

Monitoring your alcohol intake

Most of us underestimate how much we drink; we often do not pay attention to it when counting the units regularly.

To check what's really going on, keep a diary of your drinking over the course of a week.

This can give you a better idea of ​​how much you're drinking. It can also help highlight any risky situations: regular times, places, and people where you seem to drink the most.

I'm worried I'm drinking too much, what are the warning signs?

warning signs¹⁹

• You regularly use alcohol to deal with anger, frustration, anxiety, or depression.
• You use alcohol regularly to feel safe.
• You have 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 say that when you drink you feel sad, bitter or aggressive.
• You need to drink more and more to feel good.
• You stop doing other things to spend more time drinking.
• You begin to feel nervous and anxious in the morning after having drunk the night before.
• You drink to stop those feelings.
• You start drinking early in the day.
• People around you or with you seem embarrassed or uncomfortable.

What if I'm drinking too much?¹⁹

• Set a goal to reduce the amount of alcohol you drink.
• Avoid high-risk drinking situations (check your diary).
• Drink less strong but flavorful drinks, such as 4% beer or 10% wine.
• Find out other things you can do instead of drinking.
• Involve your partner or a friend. They can help you set a goal and track your progress.
• Discuss this with your GP. For many people, this simple step helps them reduce their alcohol intake.
• Caution: if you are drinking heavily, do not stop suddenly, see your GP.

Some people can stop suddenly without any problem. Others may have withdrawal symptoms: cravings, tremors, and restlessness. If this happens, ask your GP for help.

Help depression and stop drinking.

helping depression

We know that most depressed drinkers will begin to feel better within a few weeks of cutting back on alcohol. So it's usually best to fight the alcohol first and then deal with the depression if it doesn't go away after a few weeks.

After a few weeks without alcohol, you are likely to feel fitter and in a better mood. Friends and family may find it easier to deal with. If your feelings of depression improve, it's likely that they were caused by your drinking.

If depression persists after four weeks of not drinking, talk to your doctor for further help. It can help to talk about your feelings, especially if your depression seems to be related to a crisis in your life. Common problems are relationship problems, unemployment, divorce, bereavement, or some other loss. Counseling can be helpful.

If the depression does not improve and is particularly severe, your doctor may recommend a talk treatment called "cognitive behavioral therapy" (CBT).¹⁹or suggest antidepressant medication.

In either case, you will need to reduce or stay away from alcohol and continue treatment for several months. There are some medications that are used to reduce cravings for alcohol, but they are usually prescribed by a specialist.

stop drinking²⁰

If you're concerned about quitting or cutting back on alcohol, or if you just can't cut down, it may help to talk to an alcohol specialist. Your GP can tell you about local services: you can refer them yourself or ask your GP for a recommendation.

Treatments for problems with alcohol and depression help, especially if you can regularly see someone you can trust: your own doctor, an alcohol counselor or specialist, or an experienced psychiatrist. Changing habits and lifestyle is always a challenge and it can take some time.

drink safely

The do's and don'ts of drinking safely²¹

• Drink your drink slowly, do not swallow it.
• Space out your drinks with a non-alcoholic drink in between.
• Do not drink on an empty stomach. Eat something first.
• Don't drink every day. Have two or three alcohol-free days a week.
• Switch to softer or non-alcoholic drinks.
• Avoid (for wine) those 'big' 250ml glasses in bars and restaurants.
• Provide interesting non-alcoholic drinks, as well as alcohol if you are having a party.
• Ask your doctor or pharmacist if it is safe to drink alcohol with any medication you have been prescribed.
• Monitor your consumption every few weeks with your consumption diary.
• Stick to the drinking goal (amount of alcohol per week) that you have set for yourself.
• Do not drink too much; again, check the journal.

find help

Here are some groups and organizations that can help.

UK and Ireland Al-Anon Family Groups

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

additional action

A charity specializing in drug and alcohol treatment. Their dependency services are free and confidential.

Telephone:020 7251 5860

alcoholics anonymous

Contact details for all AA meetings in English. There is a quiz to determine if AA is the right type of organization for a person and a section on frequently asked questions about AA and alcoholism.

Telephone:0800 9177 650

Email:ayuda@alcohólicos-anónimos.org.uk

alcohol change

National agency on alcohol abuse that works to reduce the number and costs of alcohol-related harm and increase the scope and quality of services available to people with alcohol-related problems.

Telephone:0203 907 8480

Email:contact@alcoholchange.org.uk

Drinkline - National Alcohol Support Line

If you are concerned about your or someone else's alcohol use, please contact the Drinkline for a confidential discussion.

Telephone:0300 123 1110 (free call; Monday to Friday from 9 a.m. to 8 p.m., weekends from 11 a.m. to 4 p.m.).

National Health Service Options

Alcohol information, including a units calculator and an iPhone app.

Local alcohol addiction service

An online search engine that helps you find the most suitable alcoholism treatment service.

References

1. Office of National Statistics. Adult drinking habits in Great Britain: 2017.
2. UK Medical Directors Guidelines on Alcohol Consumption, August 2016.
3. Digital NHS. Alcohol Statistics, England 2018
4. Fat LN, Shelton N, Cable N. Investigating the growing trend of not drinking among youth; Analysis of repeated cross-sectional surveys in England 2005-2015.BMC Public Health. 2018 Dec;18(1):1090.
5. Digital NHS. Care Activity for Hospitalized Patients 2018-19.
6. Pryce R, Buyk P, Gray L, Stone T, Drummond C, and Brennan A. Estimates of alcohol dependence in England based on APMS 2014, including estimates of children living in a household with an alcohol-dependent adult: prevalence, trends and treatment amenity.
7. Options of the National Health Service. Risks of Alcohol Abuse - Short-Term Effects of Alcohol Consumption
8. drink well Signs to look out for suggest that you are becoming dependent on alcohol.
9. National Institute of Excellence in Health and Care. Psychosis and drug and/or alcohol use - Information for the public
10. Alzheimer's Society. Symptoms of alcoholic dementia.
11. Options of the National Health Service. Risks of Alcohol Abuse - Long-Term Effects of Alcohol Consumption
12. Sullivan LE, Fieldin DA, O'Connor PG. The prevalence and impact of alcohol problems on major depression: a systematic review.The American Journal of Medicine. 2005 Apr 1;118(4):330-41.
13. Mcintosh C. & Ritson B. Treatment of Depression in Substance Abuse, 2001,Advances in psychiatric treatment,7, 357-364
14. drink well Latest Guidelines on Alcohol Units.
15. DrinkAware. Alcohol consumption by minors.
16. Rao R, Crome I. Alcohol abuse in the elderly.Avances BJPsych. 2016;22(2):118-26.
17. DTrack aware. What is binge drinking?
18. Warning signs of alcoholism Warning signs of alcoholism.
19. Options of the National Health Service. Cognitive behavioral therapy (CBT)
20. drink well How to reduce alcohol consumption
21. Options of the National Health Service. Alcohol support: tips to reduce alcohol consumption.