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alcohol and depression

 

This leaflet is written for:

  • anyone who feels depressed and suspects they may be drinking too much.
  • anyone who suspects they may be drinking too much and is feeling 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 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. 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, society has become wealthier and alcohol has become cheaper. We are starting to drink at a younger age and we are drinking more. More than 1 in 4 men, and about 1 in 7 women are drinking more than is medically safe for them. According to the Department of Health, around 1 in 8 men is physically addicted to alcohol.

How does alcohol affect the brain?

Tolerance

Alcohol is like many other drugs that act on the brain, such as tranquillisers. If we drink it regularly, we find that it has less effect on us. We need to drink more and more to get the effect we want. This is called ‘tolerance’ and is a powerful part of becoming addicted to alcohol.

 

Alcohol can also lead to:
  • Dementia - memory loss, rather like Alzheimer’s dementia.
  • Psychosis - long- term drinkers can start to hear voices.
  • Dependence - if you stop drinking, you get withdrawal symptoms such as shaking, nervousness and (sometimes) seeing things that aren’t there.
  • Suicide - 40% of men who try to kill themselves have had a long- standing alcohol problem. - 70% of those who succeed in killing themselves have drunk alcohol before doing so.

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.
 
  • If we drink too much, too regularly, we are more likely to become depressed.

 

Regular drinking can leave us tired and depressed. There is evidence that alcohol changes the chemistry of the brain itself and that this increases the risk of depression.
 
Hangovers create a cycle of waking up feeling ill, anxious, jittery and guilty.
 
Regular drinking can make life depressing - family arguments, poor work, unreliable memory and sexual problems.
 
  • If we drink alcohol to relieve anxiety or depression, we will become more depressed

 

Alcohol helps us to forget our problems for a while. It can help us to relax and overcome any shyness. It can make talking easier and more fun, whether in the pub, a club or at a party. It is 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, the drinking becomes part of a routine, and you have to keep drinking more to get the same effect.

How much alcohol is too much?

How much alcohol is too much?

Some drinks are stronger than others. The easiest way to work out how much we are drinking is to count “units” of alcohol. 1 unit is 10 grammes of alcohol - the amount in a standard pub measure of spirits, a half pint of normal strength beer or lager, or a small glass of wine.

 
If a man and woman of the same weight drink the same amount of alcohol, the woman will have a much higher amount in her bodily organs than the man. So, unfair as it may seem, the safe limit is lower for women (14 units per week) than for men (21 units per week).

“Binge” drinking

How much you drink at one time is also important. These “safe limits” assume that our drinking is spread out through the week.
 
In any one day, it is best for a man to drink no more than 4 units and for a woman to drink no more than 3 units. Drinking over 8 units in a day for men, or 6 units for women is known as ‘binge drinking’.
 
You can drink above the safe limit on one night, but still remain within your “safe” limit for the week. There is some evidence that, even a couple of days of binge drinking, may start to kill off brain cells. This was previously thought only to happen with people who drank continuously for long periods of time. Binge drinking also seems to be connected with an increased risk of early death in middle aged men.

Guide to units of alcohol

Guide to units of alcohol
This table below gives a rough guide to the amount of alcohol found in standard measures of different drinks.
 
These guidelines are approximate and may vary depending on the brand chosen and the size of measure. All alcohol sold in the UK above 1.2% ABV (Alcohol By Volume) should state how strong it is in percentages (%).
 
The higher the percentage, the more alcohol it has in it. Pub measures are generally rather smaller than the amount we pour ourselves at home.
 
Beer, Cider &
Alcopops
Strength
ABV
Half
Pint
Pint
Bottle/
Can
330ml
Bottle/
Can
500ml
Bottle
1 Litre
Ordinary strength beer, lager or cider eg. Draught beer, Woodpecker
3-4%
1
2
1.5
1.9
-
“Export” strength beer, lager or cider eg.
Stella, Budweiser, Heinekin, Kronenbourg, Strongbow
5%
1.25
2.5
2
2.5
-
Extra strong beer, lager or cider eg.
Special Brew, Diamond White, Tennants Extra
8-9%
2.5
4.5
3
4.5
9
Alcopops eg.
Bacardi Breezer, Smirnoff Ice, Reef, Archers, Hooch
5%
-
-
1.7
-
-
 
Wines & Spirits
Strength
ABV
Small glass/
pub measure
Wine glass
Bottle
750 ml
Table Wine
12-14%
-
1.5 - 2.5
10
Fortified wine
(sherry, martini, port)
15-20%
0.8
2-3
14
Spirits
(whisky, vodka, gin)
40%
1
-
30

How much am I drinking?

How much am I drinking?

Most of us under-estimate the amount we drink. One way to check on this is to keep a diary of how much we drink over the course of a week. This can give us a clearer idea of whether we are drinking too much. It can also help to highlight any risky situations - regular times, places and people when we 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

Warning signs
  • You regularly use alcohol as a way of coping with feelings of 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.
  • 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.

What if I am drinking too much?

  • Set yourself a target to reduce the amount of alcohol you drink.
  • Avoid any high-risk drinking situations(check out your diary).
  • 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.

 

We know that many people are able to cut down their drinking after discussing it with their GP. Some people can stop suddenly without any problems. Others may have withdrawal symptoms - craving, shakiness and restlessness. If this happens, your GP can help.

Depression and stopping drinking

There is evidence that, although many heavy drinkers feel depressed when they are drinking, most will feel better within a few weeks of stopping. So, it is usually best to tackle the alcohol first, and then consider dealing with the depression if it has not lifted after a few weeks.
 
After a few alcohol-free weeks, you will probably feel fitter and less depressed. Friends and family may find you easier to get on with. If your feelings of depression lift, this strongly suggests that they were caused by the drinking.
 
If the depression is still with you after four weeks of not drinking, talk to your GP or about further help. It may be useful to talk about your feelings, particularly if your depression seems linked to relationship problems, unemployment, divorce, bereavement or some other loss. Counselling may be helpful.
 
If the depression does not lift and is particularly severe, your general practitioner may recommend a talking treatment called ‘cognitive psychotherapy’ or suggest anti-depressant 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 are usually only prescribed by a specialist.
 
Treatment for both alcohol problems and depression can be very successful. It helps to regularly see someone you can trust, either your own doctor, counsellor or a specialist psychiatrist. Changing our habits and style of life is always a challenge and takes time to achieve.

Dos and Don’ts of Drinking safely

Do's 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 provide non-alcoholic drinks as well as alcohol on social occasions.
  • Do ask your doctor or chemist if it is safe to drink with any medicine that you have been prescribed.
  • Do keep to the target (amount of alcohol per week) you have set yourself.
  • Do check your drinking every few weeks with your drinking 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
  • Self help groups, such as Alcoholics Anonymous or AlAnon
  • Voluntary alcohol agencies
  • Specialist treatment in the NHS - your general practitioner who will also know how to contact specialist services.

 

Other useful leaflets produced by the Royal College of Psychiatrists include: Depression
We also have factsheets on Antidepressants and Cognitive Behavioural Therapy.
 

References

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.
 
 

Helpful Organisations/ Websites

Depression Alliance Information, support and understanding for people who suffer with depression and for relatives who want to help. Self help groups, information, and awareness raising for depression. Tel: 0845 123 23 20

 

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

 

Alcohol Concern This site provides information and articles on a range of topics surrounding alcoholism. Includes 18 excellent factsheets crammed with information that would be very useful for professionals such as Alcohol and the Law and Drink-drive accidents, a search engine, and a good list of alcohol related links. Tel: 0I71 928 7377 email: contact@alcoholconcern.org.uk

 

Al-Anon Family Group Support group for friends and families of alcoholics. Includes a frequently asked questions section, pamphlets and other literature, and information on group meetings in the UK. Tel: 020 7403 0888

Institute of Alcohol Studies The IAS is a charity aimed at improving education about alcohol in the UK. The site provides publications on alcohol, as well as news. There are a large number of factsheets dealing with all aspects of alcohol in society, complete with facts and figures. Tel: 0207 222 4001. info@ias.org.uk

Recommended Reading

Alcoholism: The Facts. DW Goodwin. Oxford University Press (2000)
Tackling Alcohol Together. Duncan Raistrick. Free Association Books(1999)
Alcohol: The Ambiguous Molecule. G. Edwards, London: Penguin (2000)
 
This leaflet was produced by the Royal College of Psychiatrists’ Public Education Editorial Board.
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Series editor: Dr Philip Timms.
Last update: July 2006
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© 2006 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.

 
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Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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