As a former mental health nurse and recovering alcoholic, I write a lot about alcohol use and mental health. To my mind, not enough has been done to educate the general public about the dangers of alcohol use combined with mental illness. I have witnessed many people fall through the cracks in the health care system and I myself have struggled with severe depression and anxiety that resolved when I quit drinking.
Experts have found that mental health disorders (particularly anxiety) are exacerbated by alcohol use. This is because the same symptom of alcohol withdrawal is anxiety, and this symptom can occur after only one episode of heavy drinking (defined by more than one drink for a woman and two drinks for a man on one occasion). Anxiety is a symptom that is often at the root of many mental health disorders. Research is beginning to show that anxiety may even plague those who drink moderately. However, when alcohol use turns to binge drinking (defined by more than four drinks for a woman and five for a man in one episode), anxiety symptoms become even more pronounced.
The effect of alcohol on the brain and nervous system can be severe. Alcohol withdrawal causes the nerves to be extra excitable, which can trigger anxiety, insomnia, paranoia, hallucinations, and even seizures. To mitigate these effects, one has to continue drinking to keep the nervous system somewhat in balance. Every time a person drinks heavily and then stops, their body goes into withdrawal. So we don’t have to be alcoholics to experience the adverse effects of withdrawal.
Unfortunately, mental illness also can harm our brains and nervous systems. Psychotic disorders alone can cause anxiety, paranoia, hallucinations, etc. When you mix in alcohol, the result is devastating.
By 2017, over 792 million people worldwide were diagnosed with mental illness, and 107 million had an alcohol use disorder. Women, in particular, are more vulnerable to the effects of alcohol. Psychotic disorders such as bipolar illness are especially affected by alcohol. What many may not realize is that the symptoms of bipolar also match those of severe alcohol withdrawal. These include extreme anxiety, paranoia, hallucinations, mania, depression, hearing voices, and disruptions in sleep and eating patterns. As of 2017, 46 million people worldwide were diagnosed with bipolar disorder.
Glenna Gill, 52, has been coping with bipolar illness and alcohol use disorder for approximately 16 years, with the worst of her drinking beginning in 2020 at the start of the pandemic. However, she has been sober from alcohol for about seven months, and she says, “the results have been dramatic.” She agreed to tell me her story in hopes of helping others struggling with these two conditions.
Bipolar illness consists of type one, type two, and cyclothymic disorder. Episodes of cycling hypomania and depression characterize type two bipolar (which is what Glenna has). Hypomania has similar symptoms as type one but not as severe, however, the depressive episodes are more severe than those of type one. Glenna’s hypomania symptoms consist of impulsivity, severe anxiety, and excessive spending of money. But when her depression cycle shows up, she says “it can be very severe and I’ll be crying for days and unable to get out of bed.”
For a time, Glenna would use alcohol to help calm her anxiety and hypomania, and she says that it had a good effect in the beginning. However, she noticed that her anxiety would be more severe the day after drinking, which led her to drink more. Over time, this pattern started to wear her down, and her bipolar symptoms became worse.
She explained, “I noticed that my medications didn’t seem to work as well and my decision-making, which was already impaired from my bipolar illness, became much worse with alcohol.” When she would stop drinking, she said “I would experience extreme anxiety, depression, racing thoughts, and an inability to properly care for myself.”
At the height of her drinking, Glenna would consume about 10 shots of vodka per day and would have to start in the morning to quell her anxiety. This is a typical pattern for alcohol abuse as the withdrawal symptoms can be so severe that one needs to drink consistently throughout the day just to feel normal. However, Glenna didn’t feel normal. She says that her “anxiety was so high that alcohol couldn’t even touch it.”
On top of that, she told me that “my illness often gave me the shakes, and I thought I had to drink to stop them.” This is how she ended up consuming more and more alcohol. But with heavier alcohol use, she said “the shaking became worse.” Indeed, the “shakes” are a sign of alcohol withdrawal.
Many of Glenna’s symptoms are typical of alcohol abuse. The more alcohol one consumes, the more it “stretches” out the nervous system — creating serious withdrawal symptoms and prompting heavier and heavier drinking. It becomes a race against withdrawal to stay afloat.
However, for those with illnesses like bipolar, alcohol use can create a double effect. This is particularly problematic for women with both bipolar and alcohol use disorders. Not only do the symptoms of the disease get worse, but they also combine with the symptoms of alcohol withdrawal and hormonal changes, creating even worse outcomes than those from alcohol withdrawal alone.
Also, the combined effect of alcohol use and bipolar illness on the brain may increase severe withdrawal symptoms such as delirium tremens (DTs), a serious and life-threatening symptom of alcohol withdrawal. Delirium tremens causes high blood pressure, severe tremors, hallucinations, psychosis, and seizures. It’s important to note that some of these symptoms are also present in psychotic disorders.
The other critical issue is what alcohol does to mental health medications, particularly those prescribed for depressive episodes. Often, alcohol decreases the effectiveness of psychotropic medications. Indeed, Glenna says that her “medications didn’t seem to work during my drinking.” In her confusion, she would work with her doctor to experiment with several drugs but none of them seemed to work correctly. However, when she quit drinking, she said her medications were “finally able to do their intended job.”
Glenna’s story highlights an important issue in mental health: Alcohol combined with mental illness, particularly with a psychotic disorder like bipolar, can be serious and sometimes life-threatening. Conditions like bipolar already carry a risk of suicide and severe detriments to quality of life. Adding alcohol to the picture is like pouring gas on an out-of-control fire. For those with psychotic disorders like bipolar, medication may be their only saving grace. But with heavy alcohol use, these medications may be rendered useless, setting people up for a severe downturn in their illness.
Because women are more vulnerable to alcohol use than men, they are much more likely to have serious cognitive deficiencies and worse withdrawal symptoms from alcohol than men. And since bipolar and other psychotic disorders already degrade cognition, alcohol can speed up this process. And unfortunately, women are more likely to self-medicate with alcohol as their hormonal composition makes alcohol use more enjoyable and soothing. They are also more likely to crave alcohol when estrogen levels drop. Indeed, Glenna says that she “noticed a shift towards more depressive symptoms” during her periods — which prompted her to drink more. She would notice much worse withdrawal symptoms then as well.
Glenna says “I barely remember the woman I was when I was drinking and if I can quit, anyone can.” Her decision to stop drinking came from “wanting to live more than wanting to die.” Layered on to mental illness, alcohol use has the potential to seriously destabilize lives.