Alcohol and mental ill-health: what’s the connection?

Alcohol Awareness Week 2020 focuses upon the theme of alcohol and mental health. In this blog, Julia Sinclair, Professor of Addiction Psychiatry University of Southampton and Chair of the Addictions Faculty at the Royal College of Psychiatrists, writes about how alcohol can impact our mental health and why it is important to treat mental ill-health and alcohol addiction together.

November 2020 is the time to be talking about alcohol and mental health.

We know that people’s mental health is suffering during the pandemic and is likely to worsen during this second winter lockdown, and also that many of us are consuming more alcohol than usual.

The trouble is that alcohol presents itself as an immediate (but short-term) solution to feeling anxious, low mood, winding down from a stressful day, difficulty falling asleep, and moving on time when it hang heavily on our hands. Lockdown may add relationship and financial stresses, and significantly reduces our access to other options for destressing.

However, the short-term fix that alcohol provides starts to become the problem as tolerance develops and we need to drink more to have the same effect. Once that happens alcohol starts to cause or add to the problems we were trying to solve (feeling anxious, low mood, poor sleep etc).

So, the same symptom may be either a cause or a consequence. For instance, symptoms of depression or anxiety may increase our alcohol use, which then is likely to worsen our mental state, worsening anxiety and depression symptoms, and fuelling further alcohol use which people may regard as treating their anxiety or depression.

Similar vulnerability factors (genetics, adverse childhood experience, social inequalities, stress, life events and personality traits) may be common to both mental ill-health and alcohol use disorders. For example, higher levels of impulsivity are seen both in alcohol use disorder and bipolar disorder and likely contribute to their high co-occurrence.

But while stigma around mental ill-health is thankfully starting to reduce, the same cannot be said for people with alcohol use disorders, where it remains frequently dismissed as a ‘lifestyle choice’, a ‘lack of willpower’ or a form of ‘moral weakness’.

People who become physically or psychologically dependent on alcohol often feel a huge sense of shame, and self-stigma, which adds to their already low mood, and sense of hopelessness, and is a significant barrier to seeking appropriate help.

Sadly, most health professionals are not trained in what should be the simple act of assessing levels of alcohol consumption or offering brief interventions, which have a strong evidence base for effectiveness.  

Other factors also have an impact: confusion over alcohol units; the increase in alcohol strength and portion size in recent years; the alcohol industry’s sub-standard labelling; and advertising which implies that no event is complete without alcohol (have you tried finding a birthday card without an alcohol reference of late?). All this results in a potent cocktail of social norms of high alcohol consumption combined with ignorance of its harms, which can drive people further down the road to mental ill-health and risk of suicide.

The health and social care act changes of 2012, resulted in addiction services taken out of NHS commissioning, and subject to frequent re-tendering and budget cuts. This has disproportionally affected people with co-occurring alcohol dependence and a mental health disorder.

Many addiction services no longer have competencies in-house to deal with co-morbid mental ill-health, and mental health services frequently refuse to work with people who have a comorbid alcohol use disorder, such that patients wanting help with the depression that they see as causing them to use alcohol, are often told they can’t be helped until they are alcohol-free. People in truly desperate states are bounced between addiction and mental health services, with many often falling through the gap.

 So what can be done?

  1. We all need to be more aware of what we drink, and why, and at a population level increase our alcohol health literacy
  2. We need to be aware and challenge the alcohol and advertising industries’ attempts to encourage alcohol as the only narrative in our social world
  3. We need to encourage conversations about alcohol use as we now seem better able to do about mental ill-health
  4. We need health professionals to recognise alcohol as a modifiable risk factor for so many mental (and physical) health disorders and have the competence to manage it
  5. We need mental health services to reclaim alcohol use disorders as primarily a disease of the mind, and genuinely embrace person centred care
  6. We need government to commit to the resources required to redress the balance of 10 years of funding cuts

This may seem like a lot that needs to be done, which it is, but the most effective thing we can all do is make small but sustained changes to our own alcohol awareness and behaviours.

Written by Julia Sinclair

This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.