Alcoholism and Mental Health Problems
- Effects of Alcohol Addiction on The Brain
- Alcohol Addiction and Post-Traumatic Stress Disorder
- Does Alcohol Abuse Cause Stress?
- Alcohol Abuse and Depression
- Alcoholism and Suicide
- Does Alcohol Abuse Cause Memory Problems?
- Alcoholism and Anxiety Disorders
Effects of Alcohol AbuseAlcohol abuse and mental illness constitute a major public health problem.
- 0.7% of all years of life lost to poor health, disability or early death can be attributed to alcohol--the most for any psychoactive substance. 5.76% can be attributed to mental disorders.
- Additionally, mental disorders are responsible for around 19% of the Years Lived with Disability (YLD) world over.
Effects of Alcohol Addiction on The Brain
Prolonged alcohol abuse has been associated with structural and functional changes in the brain.
- Alcohol dependence can lead to generalized atrophic changes in the brain.
- Also, certain regions of the brain, such as frontal lobe systems, are more vulnerable to the adverse effects of alcohol as compared to other regions.
All these changes in the brain can contribute to the emergence of a comorbid psychiatric condition.
- It has been proposed that common neurobiological pathways may be involved in alcohol dependence and various psychiatric disorders.
- Moreover, the psychosocial stresses that go hand in hand with a life-impacting alcohol dependence can exacerbate a susceptibility to mental illness.
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The presence of a psychiatric disorder can also increase one's propensity to abuse substances.
It has been proposed that patients with psychiatric disorders may try to self-medicate with substances (including alcohol) to achieve:
- Relief from the psychiatric symptoms of the illness.
- Reduction in the adverse effects associated with medicines used to treat these disorders.
Alcohol Addiction and Post-Traumatic Stress Disorder
- PTSD and alcoholism may share a common genetic vulnerability that partially accounts for their co-occurrence.
- Additionally, the environmental factors associated with the emergence of PTSD can also explain the presence of comorbid alcohol abuse in these individuals.
There is limited research on the relative effectiveness of treatment interventions for co-occurring PTSD and alcohol dependence. The following interventions have demonstrated some success:
1. Sequential Treatment
- This program offers six weeks of skills development followed by six weeks of trauma processing.
- The participants have to complete a rehabilitation program with six months.
- It has been found significantly reduce symptoms, along with a reduction in alcohol use and drinking to extreme intoxication.
2. Concurrent treatment
Utilizing Cognitive Behavior Therapy (CBT) for PTSD in the addiction treatment setting has been associated with a reduction in PTSD symptoms and lower composite scores on the Addiction Severity Index (ASI).
3. Integrated treatment
Approaches based on group CBT have been found to be effective in reducing substance use and trauma-related symptoms in some studies but not in others.
- Recently, a randomized controlled trial of combined naltrexone and exposure therapy was shown to be a feasible intervention with potential benefits.
Does Alcohol Abuse Cause Stress?
Alcohol abuse has been reported to adversely impact stress. While alcohol in low doses may improve performance on complex mental tasks during stressful situations, its use has been shown to increase stress response mechanisms.
- Alcohol use has been found to alter the release of 'stress hormones' from the hypothalamus, pituitary, and adrenal glands.
- Experimental studies among humans have shown that while alcohol can lead to a reduction in the hormonal response to stress, it leads to an extended negative subjective experience of a stressful event and delays recovery.
- Finally, alcohol use can worsen one's response to stress.
Alcohol Abuse and Depression
- General population based surveys have reported the one-year prevalence rate of 27.9% and 1.9% for depressive disorder and bipolar disorder, respectively.
- Additionally, the risk of developing a depressive disorder and bipolar disorder is 3.9 and 6.3 times higher among those with alcohol dependence as compared to those without it.
What are the effects of having a mood disorder and also being addicted to alcohol?
Co-occurrence of alcohol dependence and mood disorders (including depressive disorders) is associated with adverse clinical outcomes like:
- Mood destabilization and a greater likelihood of hospitalization.
- Delayed recovery from alcohol dependence.
- The sedative effect of certain antidepressant medications - such as mirtazapine and paroxetine - can be magnified by the concurrent use of alcohol and can adversely impact coordination, judgment and reaction time.
Is there treatment for alcohol addiction and mood disorders?
The limited evidence on treatment approaches to co-occurring alcohol dependence and mood disorders support the role of integrated treatment.
Research on the effectiveness of pharmacotherapy is also limited and the findings are conflicting.
- While some studies support the role of antidepressants, others have failed to demonstrate its effectiveness.
- In a recent meta-analysis, nefazodone, desipramine, and imipramine were found to have the most robust effects.
- Use of naltrexone in combination with Selective Serotonin Reuptake Inhibitors (SSRIs) has been associated with higher abstinence rates from alcohol.
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Alcoholism and Suicide
The association between alcohol abuse and suicide has been established for a long time.
- Close to 40% of treatment seekers with alcohol dependence report at least one suicide attempt in their lifetime.
- Heavy alcohol drinkers are five times more likely to engage in suicidal behavior as compared to 'social drinkers'.
What Affects the Risk of Suicide among those Struggling with Alcohol Dependence?
- Separation or divorce.
- Poor social support.
- Severity of the alcohol problem.
- Co-morbid depression (especially with poor treatment adherence or treatment resistance).
- Polysubstance abuse, or comorbid use of other substances.
- Past incidence of suicidal behavior.
It is important for care providers to inquire about the presence of suicidal behavior among those with alcohol-related problems.
Interventions could be geared toward:
- Strengthening coping skills.
- Stress management.
- Developing social relationships.
Does Alcohol Abuse Cause Memory Problems?
Individuals with alcohol use disorders are more likely to experience problems with memory. The studies have reported a prevalence rate ranging from 10-24% for dementia among alcohol abusers.
Alcoholism and Anxiety Disorders
The one-year prevalence rate of anxiety disorders among those with alcohol dependence in the general population has been reported to be 36.9%.
- Individuals with an alcohol dependence have 2.6 times higher risk of developing an anxiety disorder as compared to those without alcohol dependence.
The co-occurrence of anxiety disorder and alcohol dependence adversely impacts the treatment outcome for both conditions. Therefore, both disorders need to be treated simultaneously. A recent Cochrane review concluded that 'the evidence base for the effectiveness of medications in treating anxiety disorders and comorbid alcohol use disorders is inconclusive.
How Do Anxiety Disorders Affect Alcohol Dependence?
Can Alcohol Dependence and Anxiety be Treated?
The co-occurrence of anxiety disorder and alcohol dependence adversely impacts the treatment outcome for both conditions. Therefore, both disorders need to be treated simultaneously.
A recent Cochrane review concluded that 'the evidence base for the effectiveness of medications in treating anxiety disorders and comorbid alcohol use disorders is inconclusive.
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