Alcohol and Mental Health

Article 1

Why people drink

There are many reasons why people drink. Some drink to celebrate life's victories, others to escape, drown their sorrows, and forget life's miseries. One may drink to feel better in the moment, relaxed, free, and confident, or drink to forget, dull pain, and fill the emptiness of loneliness. However, any momentary desirable effects of alcohol are short-lived. As any positive effect rather quickly wears off, one may feel worse physically, mentally, socially, and spiritually. Hangovers, mistakes, regrets, hurt, harm. What's done in a moment may lead to detrimental consequences that endure a lifetime, or cut life short, one's own or someone else's. Alcohol is not a solution to any problem.

Article 2

The effects of alcohol on thoughts, feelings, and actions

Alcohol is a brain-depressant. It partially shuts down parts of the brain, especially the parts involved in thinking (the frontal lobe), feeling (the limbic system), as well as balance and coordination (the cerebellum). Alcohol makes it harder for these brain areas controlling balance, emotions, impulses, memory, speech, and judgment to do their jobs, resulting in a higher risk of injuries and other negative outcomes (NIAAA).

When alcohol shuts down the thinking and feeling parts of the brain, one may feel relaxed, happier, more confident, and less anxious, fearful, and worried. These effects are related to the release of dopamine and the triggering of opioid receptors in the brain, both of which are linked to its reward systems. These reward systems play a key role in the development of alcohol use disorders. But any positive effects do not last. The impaired function of the thinking part of the brain may make it harder to know what one really is feeling, and what the consequences of one's impulses and actions may be. Typically, as one continues to drink, and eventually when the alcohol concentration in the blood begins to drop, negative feelings may take over, such as irritability, anger, depression, or anxiety, partly related to the amygdala in the feeling part of the brain becoming hyperactive (NIAAA). 

When someone drinks too much, they may eventually pass out, fall asleep or lose consciousness. Extreme intoxication may also cause death. At lower levels of intoxication, one may experience what is called blackouts. During a blackout, a person is still awake, but their brain is not creating new memories. Gaps occur in the person’s memory of events while they were drunk. These gaps happen because the transfer of memories from short-term to long-term storage is blocked. While blackouts typically occur at higher alcohol concentrations in the blood, they may also occur at lower levels, especially when significant amounts of alcohol are consumed in a short time, or when someone is taking certain sleep or anxiety medications. Because of their body composition, women may be at higher risk of blackouts. Blackouts are dangerous because they occur when impulse control, attention, judgment, and decision-making abilities are significantly impaired, and they are unpleasant because one may have no recollection of what happened (NIAAA).

Long-term abuse of alcohol will eventually damage crucial parts of the brain, and lead to increasing dysfunctions and impaired ability to regulate and manage thoughts and feelings. Unfortunately, when such difficulties increase, one may feel inclined to drink again and again to temporally escape them. But this just makes things worse and may develop into a vicious downward spiral of alcohol abuse. 

Article 3

Alcohol use disorder

Alcohol use disorder is the (DSM-5) diagnostic term for what is considered to be a medical and psychiatric condition requiring treatment. In the United States, 11.3% of adults ages 18 and older (28.6 million) had an alcohol use disorder in 2021 according to the National Survey on Drug Use and Health (SAMHSA). It is characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the everyday term, alcoholism. It is considered to be a brain disorder with lasting changes in the brain caused by alcohol misuse that maintain the condition and make individuals vulnerable to relapse. However, no matter how severe the condition may seem, evidence-based treatment with behavioral therapies, mutual-support groups, and/or medications can help people achieve and maintain recovery (NIAAA).

Article 4

Alcohol use and mental disorders

It is well established that alcohol use disorders often co-occur with other mental disorders and that they may contribute to the complexity and recovery challenges of various conditions. Depression and anxiety are the most common mental disorders, and not surprisingly, alcohol use disorders are at least twice as common in those who struggle with these disorders (R. K. McHugh & Weiss, 2019) (Lai et al., 2015). In other disorders like bipolar disorders and trauma disorders (like PTSD), rates of alcohol use disorders tend to be even higher, with up to half of the patients struggling with such comorbidity (Grunze et al., 2021) (Neupane et al., 2017). 

Alcohol use also plays a significant role in many suicides and suicidal behavior. Studies indicate that the odds of suicidal behavior are about three times higher in people with an alcohol use disorder. Second to mood disorders, alcohol use disorders are the most common mental disorder in people who suicide (Conner & Bagge, 2019). One US study showed that about one in three who died of suicide had alcohol in their blood (Kaplan et al., 2013).

Article 5

Alcohol as self-medication

Given all we know about the harmful effects of alcohol, why do the majority of the population still drink (NIAAA)? People drink because they think the gains outweigh the pains, and because they choose the moment over the future. Since alcohol may briefly elevate positive feelings and suppress negative feelings, it may be tempting to seek immediate pleasure, or escape emotional or physical distress. 

The self-medication hypothesis is well established and helps us understand why people drink, and the comorbidity of mental disorders and alcohol use disorder. Alcohol is commonly used as a coping strategy to deal with symptoms of mental disorders. The more alcohol is used as a coping mechanism, the more likely the person is to develop an alcohol use disorder. At the same time, we also know that alcohol use itself may play a role in developing mental disorders like depression and anxiety. Therefore, alcohol is a commonly used, yet dangerous strategy for dealing with painful thoughts and feelings. The more it's used, the worse the problems typically become. And, it may even be the cause of the problems in the first place (Turner et al., 2018). 

Individuals who self-medicate tend to have poorer functioning and lower mental health-related quality of life, and they are at a greater risk for developing a substance use disorder (R. McHugh & McBride, 2020). Self-medication with alcohol often becomes a vicious downward spiral.

Article 6

Coping strategies

Dag Hammarskjöld, the 2^nd Secretary-General of the United Nations, entered this reflection into his diary, later published in 1964 in the book Markings:

"The devils enter uninvited when the house stands empty. 
For other kinds of guests, you have first to open the door."
- (Hammarskjöld, 2006)

When the mind is troubled, when it's filled with distressing thoughts and feelings, when the heart is lonely, hopeless, and aching, sprinkling some alcohol on it, or even soaking everything in its dulling bath, may seem so appealing. But, when alcohol is let into the house, it's a malicious intruder that soon may turn out to be a devil. 

Alcohol is not a solution to any problem. Nor is it a life enhancer. Alcohol wreaks havoc on the brain, mind, and life. There are better strategies to work out problems and improve quality of life than sedating the brain with alcohol. There are better guests to open the door for. Joy, meaning, and hope are not found in any substance, but in the world beyond our selves. We need connection, community, and social support where we can be fully present and fully ourselves. We need to live life according to its God-given principles. And, when life in its thoughts, emotions, and actions become painful and unmanageable, we need and can seek treatment from well-trained professionals who have knowledge and skills on how to cope with challenges like ours.

"Life only demands from you the strength you possess.
Only one feat is possible – not to have run away."
- (Hammarskjöld, 2006)

Don't run away with alcohol or anything else. Stand your ground. It's your life. Face it fully present in your mind, body, and soul.

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