Alcohol and depression | Royal College of Psychiatrists (2024)

Alcohol and us

In the UK, just over half of men and just under half of women drink alcohol¹. For most of us, it is part of our culture and we feel comfortable with it. Drinking at low risk levels² doesn't cause many problems. That is the equivalent of 7 pints of beer or 14 single measures of spirit or just over a bottle of wine, a week.

However, since 1980, alcohol has become 64% more affordable³

Although younger people still drink more than other age groups, fewer people are now starting to drink at a younger age⁴.

In the UK:

• Over the past 5 years, the number of hospital admissions for mental health problems and alcohol problems occur together, cause has risen by 4 per cent. Older people account for this rise, whereas admissions for younger people have fallen⁵
• Around 1 in 100 adults in Britain have alcohol dependence⁶

How does alcohol affect us?

Immediate effects⁷

Alcohol tastes good to most adults although, not usually, to children.

Alcohol 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 ability to take in information and react to changes in your environment to a lesser 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 and do things that are out character, which you may regret when you are sober.

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. This may occasionally take the form of is called an alcoholic blackout and is a sign that your drinking may be becoming a problem.

Becoming dependent on alcohol⁸

In small amounts, alcohol can relax you 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 to feel the same effects.

The problem is that it is easy to slip into drinking regularly, using it like a medicine. The benefits soon wear off and the drinking becomes part of a routine.

You also start to notice that:

• instead of choosing to have a drink, you feel the urge to have one
• you wake up with shaky hands and a feeling of nervousness
• you start to drink earlier and earlier in the day
• your work starts to suffer
• your drinking starts to affect your relationships
• you carry on drinking despite the problems it causes
• you start to ‘binge drink’ (see below) regularly
• you start to neglect other parts of your life

Long-term effects

Alcohol can lead to:

• psychosis - hearing voices when there is nobody there⁹
• memory problems either on their own (Korsakoff’s Syndrome or also affecting other areas of the brain (alcohol related dementia)-rather like but not the same as Alzheimer's dementia¹⁰
• physical - damage organs, such as the liver or brain¹¹

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^{12 13}. 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 more difficult – arguments with family or friends, trouble at work, memory and sexual problems.

How age affects you

Younger people¹⁵

Younger people in the UK drink to have fun, to have the experience of losing control, to socialise more easily with others, to feel more attractive – and because their friends do.

Around 4 in 10 people 16 to 24 year olds binge-drink at least once a week-more than in most other European countries.

Alcohol has 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.

Older people¹⁶

As we get older, the amount of water in our bodies become less. Also, our liver is less able to break down alcohol carried in the blood.

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

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 drinks¹⁴.

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

The current advice is for everyone to remain below the weekly limit of 14 units for both men and women but also to have drink free days.

Binge drinking

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

Binge drinking is also connected with an increased risk of early death in middle-aged men and probably depression.

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 even higher risk¹⁷.

Guide to alcohol units

Beer, cider and alcopops

Wine and spirits

Keeping track of your alcohol intake

Most of us underestimate 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.

I worry I might be drinking too much – what are the warning signs?

Warning signs¹⁹

• 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?¹⁹

• 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 drinkers with depression 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 behavioural therapy’ (CBT)¹⁹or suggest antidepressant medication.

In either case, you will need to reduce or stay away from alcohol and persist with the treatment for several months. There are some medications used to reduce the craving for alcohol, but these are usually prescribed by a specialist.

Stopping drinking²⁰

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.

Drinking safely

Dos and don'ts of drinking safely²¹

• 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 switch to lower strength or alcohol-free drinks.
• Do (for wine) avoid those ‘large’ 250 ml glasses in bars and restaurants.
• 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.

Finding help

Here are some groups and organisations that can provide 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

Aspecialist drug and alcohol treatment charity. Their addiction services are free and confidential.

Tel: 020 7251 5860

Email:info@addacton.org.uk

Alcoholics Anonymous

Contact details for all English AA meetings. There is a quiz to determine whether AA is the right type of organisation for anindividual, and a frequently asked question section about AA and alcoholism.

Tel: 0800 9177 650

Email:help@alcoholics-anonymous.org.uk

Alcohol Change

National agency on alcohol misuse which works to reduce the number of people with and costs of alcohol-related harm and to increase the range and quality of services available to people with alcohol-related problems.

Tel: 0203 907 8480

Email:contact@alcoholchange.org.uk

Drinkline – National Alcohol Helpline

If you're worried about your own or someone else's drinking, contact Drinkline for a confidential conversation.

Tel: 0300 123 1110 (Free; weekdays 9am – 8pm, weekends 11am – 4pm).

NHS Choices

Information on alcohol, including a units calculator and an iphone app.

Local Alcohol Addiction Service

An online search engine that helps to find the most appropriate alcohol treatment service.

References

1. Office of National Statistics. Adult drinking habits in Great Britain: 2017. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/bulletins/opinionsandlifestylesurveyadultdrinkinghabitsingreatbritain/2017
2. UK Chief Medical Officers’ drinking guidelines, August 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf
3. NHS Digital. Statistics on Alcohol, England 2018. https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2018/part-7#affordability-of-alcohol
4. Fat LN, Shelton N, Cable N. Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England 2005–2015. BMC Public Health. 2018 Dec;18(1):1090. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5995-3
5. NHS Digital. Hospital Admitted Patient Care Activity 2018-19. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/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 Adult with Alcohol Dependence: Prevalence, Trends, and Amenability to Treatment. https://www.sheffield.ac.uk/polopoly_fs/1.693546!/file/Estimates_of_Alcohol_Dependence_in_England_based_on_APMS_2014.pdf
7. NHS Choices. Risks of Alcohol Misuse-Short term effects of alcohol consumption https://www.nhs.uk/conditions/alcohol-misuse/risks/
8. 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/
9. National Institute of Health and Care Excellence. Psychosis and drug and/or alcohol use-Information for the Public https://www.nice.org.uk/guidance/cg120/ifp/chapter/Psychosis-and-drug-andor-alcohol-use
10. Alzheimer’s Society. Symptoms of alcoholic dementia. https://www.alzheimers.org.uk/about-dementia/types-dementia/alcoholic-dementia
11. NHS Choices. Risks of Alcohol Misuse-Long term effects of alcohol consumption https://www.nhs.uk/conditions/alcohol-misuse/risks/
12. Sullivan LE, Fiellin DA, O’Connor PG. The prevalence and impact of alcohol problems in major depression: a systematic review. The American Journal of Medicine. 2005 Apr 1;118(4):330-41.
13. Mcintosh C. & Ritson B. Treating depression in substance misuse, 2001,Advances in Psychiatric Treatment,7, 357-364
14. Drinkaware. Latest Alcohol Unit Guidance. https://www.drinkaware.co.uk/alcohol-facts/alcoholic-drinks-units/latest-uk-alcohol-unit-guidance/
15. DrinkAaare. Underage Drinking. https://www.drinkaware.co.uk/advice/underage-drinking/understand-why-children-drink-alcohol/
16. Rao R, Crome I. Alcohol misuse in older people. BJPsych Advances. 2016;22(2):118-26.
17. DrinkAware. What is binge drinking? https://www.drinkaware.co.uk/alcohol-facts/drinking-habits-and-behaviours/binge-drinking/
18. Warning Signs of Alcoholism Warning Signs of Alcoholism. https://www.alcoholrehabguide.org/alcohol/warning-signs/
19. NHS Choices. Cognitive behavioural therapy (CBT) https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/
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