Alcohol and Psychological Disorders

Alcohol and Depression

Some people, women more likely than men, drink alcohol to get depression relief ^[1]. Alcohol does not improve your mood but enhances your current mood: when you are depressed, drinking may make you more depressed.

Alcohol may cause depression relief until the blood alcohol concentration reaches about 0.1-0.15 g/100 mL blood (up to 4-7 drinks in one hour by a 160 lbs man) and above that concentration it may cause dysphoria (depression, feeling of unease). Additionally, alcohol tends to have a pleasant effect until the blood alcohol concentration is rising and unpleasant effects when it is falling (after 10-90 minutes after the last drink ^[2].

Depression is more common in binge drinkers than regular drinkers despite the same total weekly amount of alcohol drunk, probably due to frequent hangovers and withdrawals, which may be associated with depression ^[4]. Binge drinking in adolescence may cause permanent brain changes that result in increased risk of depression later in adulthood ^[5].

A drinker may get depressed during hangover ^[7] or alcohol withdrawal ^[6].

A combination of alcohol and a sleeping pill zolpidem may cause depression ^[8].

Many chronic alcoholics are depressed until they drink, but only some of them remain depressed during abstinence ^[9]. According to one 1986 study, 80% of alcoholics who have major depression, has no depression symptoms after 2 weeks of sobriety ^[10]. Individuals dealing with protracted withdrawal syndrome may remain depressive for more than a year, though ^[6].

Depressed individuals who abuse alcohol are at increased risk of suicide ^[9].

Deficiencies of vitamins B3, B6, B12 and folate, common in chronic alcoholics, may contribute to depression. Alcohol abstinence and correcting vitamin deficiencies with supplements may help.

Alcohol and Anxiety

Some people, women more likely than men, drink to get anxiety relief ^[1].

Alcohol may cause anxiety relief until the blood alcohol concentration reaches about 0.15 g/100 mL blood (up to 6-7 drinks in 1 hour by a 160 lbs man) and above that concentration it may cause feeling of unease and anxiety. Alcohol tends to have a pleasant effect until the blood alcohol concentration is rising and unpleasant effects, including depression, when the blood alcohol concentration is falling (after 10-90 minutes after the last drink) ^[2].

Alcohol intoxication (at 0.08 g alcohol/100 mL blood) can reduce the anxiety (worrying) about unpredicted unpleasant events, but not the fear of predicted unpleasant events, such as having a stressful speech or expecting an electric shock ^[11]. With other words, alcohol intoxication by itself does not relieve anxiety when you are concentrating on an important realistic problem you have at the time.

Alcohol intoxication in combination with a distracting activity, such as reading or conversation, may decrease the anxiety about the expected unpleasant event, while neither alcohol intoxication or distraction separately do not ^[18].

Alcohol and Bipolar Disorder

Individuals with bipolar disorder tend to drink more than they are depressed ^[12]. When their bipolar disorder is treated successfully they often stop to drink ^[13]. Alcohol drinking may aggravate the course of bipolar disorder and increase the risk of suicide ^[13,14].

Alcohol and Panic Attacks

Some people drink to prevent panic attacks ^[15]. This may distract them from learning to cope with the problem and, on the long-term, worsen their symptoms ^[16].

According to one 2007 study and one 2011 review study, panic disorder increases the risk of alcohol abuse, alcohol abuse increases the risk of panic attacks and the risk of alcohol abuse is increased in individuals with a family history of panic disorder ^[16,17].

Alcohol and Pathological Jealousy

Alcoholism may contribute to developing pathological jealousy ^[19].

Alcohol and Post-Traumatic Stress Disorder (PTSD)

Many people with post-traumatic stress disorder abuse alcohol to distract themselves from unpleasant memories or as a sleep aid ^[20].

Alcohol abuse aggravates symptoms of PTSD and also increases emotional numbness, social isolation, anger and the risk of suicide ^[20].

Naltrexone may help in treatment of alcohol addiction in PTSD ^[21].

Alcohol and Schizophrenia

Individuals with schizophrenia commonly abuse alcohol, some of them to find symptoms relief or overcome boredom, others in the hope that drinking will help them built a social network and identity ^[22,23].

Integrated treatment of schizophrenia and alcohol abuse is more successful than separate treatment of both disorders ^[23].

Alcohol and Alzheimer’s Disease

Long-term moderate alcohol drinking, particularly in female nonsmokers, is associated with lower risk of Alzheimer’s disease and dementia than abstaining, heavy drinking or binge drinking ^[24,25,26].

Alcohol-Induced Psychosis

Alcohol-induced psychosis may, rarely, develop in chronic alcoholics during or within a month of either acute alcohol intoxication or alcohol withdrawal ^[27,28]. Symptoms may persist from several minutes to as much as a month ^[27].

Symptoms may include distorted visual sensations (illusions), false visual sensations (visual hallucinations, such as seeing insects or worms crawling on walls or over the skin, mice running over the room, etc.), false hearing sensations (auditory hallucinations, such as “threatening voices” or hearing music), false tactile sensations, false beliefs (delusions) or fear of harm by somebody (paranoia) ^[27]. A person with alcohol-induced psychosis is fully alert and oriented, unlike a person in delirium tremens, but is not aware that symptoms are caused by alcohol ^[28].

Alcohol-related psychosis may spontaneously resolve within several weeks of abstinence, but may, sometimes, develop into chronic schizophrenia-like syndrome ^[27]. In this case, treatment with antipsychotic drugs and thiamin, among other, may help ^[30].

Alcohol-induced psychosis is usually related with a long history of heavy drinking and therefore bad prognosis for an individuals suffering from it ^[27].

Thiamin (vitamin B1) deficiency in chronic alcoholics on a poor diet may contribute to alcohol-induced psychosis, which is usually reversible and Korsakoff psychosis with a short-term memory loss, which is usually permanent.

Disulfiram, a drug intended to help maintain abstinence, may, rarely, especially when taken in high doses, trigger psychotic symptoms ^[31,32].

Alcohol and Sex

In one 1995 study, sexually secure men, who believed that alcohol consumption increases pleasant sexual experience drunk more alcohol and  more frequently than sexually insecure men or secure or insecure women ^[33].

Alcohol intoxication may increase the subjective feeling of sexual arousal, but may decreases sexual performance ^[34]. Some, but not all, intoxicated men may experience weaker erection, mainly at blood alcohol concentrations above 0.08 g alcohol/100 mL blood ^[35].

Alcohol intoxication increases the probability of having sex with casual partners and risky sexual behavior ^[34,36].

Few large studies have not found association between chronic alcohol drinking and erectile dysfunction ^[37].

Alcohol and Aggression

In a hostile environment, inebriated persons tend to be more focused to salient provocative cues than to subtle inhibitory cues ^[38,39]. Alcohol is neither a necessary nor sufficient agent to stimulate aggression, though ^[40].