Alcohol and Mental Health

The World Health Organization (WHO) estimates that 5.1% of the global burden of disease and injury is attributable to alcohol.[1] In China, WHO data from 2010 estimates that 9.3% of adult men have alcohol use disorders and that 24% of men over the age of 15 that drink alcohol participate in heavy episodic drinking.[2] These numbers are comparable to data from the United States.[3]

Alcohol can have profound effects on mental health.[4] This article is meant to discuss some of the common clinical issues that arise regarding alcohol and mental health.

Working definition of alcohol misuse

There are many terms used to talk about problematic alcohol consumption, some of them more clinical (such as an alcohol use disorder[5]), others more colloquial (such as alcoholism). For the purposes of this article, the general concept is that problematic alcohol use (also called alcohol misuse) generally involves problems controlling your drinking, preoccupation with alcohol, use of alcohol despite its causing problems in your life (relationships, legal, medical problems, etc.), and distortions in thinking (denial being the most common).[6]

Effects of alcohol on sleep

Many people think that drinking helps sleep. However, the medical literature is clear that alcohol in the long term definitely makes sleep worse even if it helps you get to sleep faster. Drinking causes sleep to be less restful (i.e., low sleep quality), causes frequent awakenings (often called fragmented sleep), and lessens REM sleep.[7] Also, if you already have a sleep disorder (such as obstructive sleep apnea), alcohol can worsen your sleep disorder.[8]^,[9] One trustworthy source for sleep tips that I recommend is the Mayo Clinic, which provides advice found in the below footnote that is in line with this message.[10]

Alcohol and depression

Depression can be caused by both intoxication and withdrawal from alcohol (sometimes called “secondary depression”).[11] Self-harm and suicide are also much more common in people with alcohol problems.[12] In fact, nearly one-third of people with major depression also have an alcohol problem.[13] Therefore, the bottom line is that you are more likely to drink alcohol excessively if you have depression and more likely to have depression if you have an alcohol problem.

Alcohol and anxiety disorders

Substance abuse is more common in almost every type of anxiety disorder. The relationship between anxiety and alcohol is complex. For some people, anxiety greatly increases their risk of misusing drugs or alcohol. For other people, it is the substance abuse that magnifies and causes their anxiety symptoms. The rates of co-occurring substance abuse and generalized anxiety disorder are staggering, with numbers in some samples over 50%.[14] High rates of alcohol misuse have also been established for panic disorder[15] and post-traumatic stress disorder, or PTSD, (both in the general population[16] and among military personnel[17]).

Alcohol and nutrition

Excessive alcohol is “wasted calories,” meaning, even if your total caloric intake remains normal, your body may not be getting the vitamins and nutrition it needs to stay healthy. This is particularly true for people with liver disease.[18] In adults with heavy alcohol use, the most common nutrient deficiencies are thiamine (vitamin B1), pyridoxine (vitamin B6), and folate.[19] Malnutrition is associated with significant morbidity and mortality.

Alcohol-related medical conditions

Alcohol can contribute to many serious health problems, including hepatitis, high blood pressure, pancreatitis, and cardiomyopathy.[20] Though there is some evidence that moderate alcohol consumption may be cardioprotective, heavy alcohol consumption is associated with increased mortality from all causes, particularly among adults under the age of 60 years with lower risks of cardiovascular disease.[21]

Take-home message

If you or a loved one has a problem with alcohol misuse, you should contact your doctor about treatment options that are right for you and your family.