As a former nurse and recovering alcoholic, I’ve experienced first hand how alcohol abuse can truly mess with mental health. I have seen this with patients as well as myself. And the most bizarre part of this is that you’d think I’d know how alcohol impacts mental health given that I practiced mental health nursing for decades. The truth is, there hasn’t been a ton of research on this topic, or if there is, the findings are not readily shared with the general public.
What follows is a comprehensive analysis of how alcohol abuse, particularly alcohol withdrawal impacts mental health. This is both from my personal story as well as research I have done to shed more light on this important topic.
Years ago, I went to several doctors and natural health specialists to seek help for depression. Out of all the doctors I saw, only one or two actually asked about how much I drank. I usually replied with a small lie and said I drank one or two per day throughout the week and a few more on the weekends. Although I drank more than that, the amount that I disclosed was still concerning. The doctors who asked me about my drinking only told me to cut back.
If you’re lucky enough to get this education from your doctor, then great. But unfortunately, many people never receive this information. Some doctors may not have expertise in this area. Also, modern health care systems are too pressured around time and money, which means that doctors and nurses can’t always provide education.
The Effect of Alcohol on the Nervous System
First, let’s talk about the nervous system. It’s a very complicated body system. And that may explain why health care professionals don’t provide education as some people may feel more confused than educated. But I believe this education can be simplified.
The nervous system relies on neurotransmitters to bring info from one neuron to the other. Each neurotransmitter has a different job, but we’ll talk mainly about the role of two neurotransmitters called GABA and glutamate. GABA has an inhibitory effect on neurons, whereas glutamate has an excitatory effect. To clarify, GABA helps slow down messages to the neuron, whereas glutamate helps speed it up (1).
A delicate balance has to be maintained between these opposing neurotransmitters for the nervous system to function correctly (1). It’s like the pistons in a car engine; too much inhibition slows the pistons down, and too much excitement makes the pistons go too fast. Either way, the car will crash. Likewise, if a balance weren’t maintained in our nervous system, the whole thing would malfunction.
Now, let’s look at what happens to your nervous system when you drink. The effects begin even with the first drink. The “high” that people feel from alcohol is due to the enhancing effects of GABA. Alcohol increases GABA’s inhibitory effect, which makes us feel slower and less responsive (2,3).
However, over time, the receptors that receive GABA become less responsive, which means the inhibition doesn’t happen as freely as before. Therefore, a person needs more alcohol to continue inhibiting the neuron (2,3). Also, the GABA receptors decrease in numbers as well so help balance things out.
At the same time, to maintain balance, the numbers of glutamate receptors increase. Remember that glutamate is the excitatory neurotransmitter that helps keep things moving. So to maintain that delicate balance, the nervous system adapts by increasing its excitatory functions as it tries to fight through the constant inhibition that alcohol creates (2,3).
In chronic alcoholism, the nervous system is continuously adapting, which means that a person has to drink more and more to get the “high” they seek. Many times, a person needs to drink just to feel normal. What that really means is that alcohol is now part of keeping the nervous system balanced. Without it, the balance is thrown off — and this is what happens in alcohol withdrawal (2,3).
What Happens to the Nervous System in Alcohol Withdrawal
Now that we know the effect that alcohol has on the nervous system, we can see how messed up it gets when alcohol is removed. In chronic alcoholism, the nervous system is tightly bound to the alcohol dose to stay balanced. However, you should know that even moderate drinking can also cause an imbalance when alcohol is removed (2,4).
There are many reasons why people have “hangovers” after drinking (dehydration, increased gastric acid, electrolyte imbalance, etc.). However, the GABA and glutamate balance is a big part of the hangover experience. By removing alcohol, the balance gets thrown off, which causes a commotion in the nervous system. The result is withdrawal symptoms like anxiety, nausea, tremors, and insomnia (2).
However, for chronic heavy drinkers, their nervous system’s balance becomes heavily dependent on alcohol to keep it steady. Therefore, when alcohol is removed, the nervous system goes through a kind of crash. In this case, the withdrawal symptoms become more severe and can progress to hallucinations, seizures, heart arrhythmias, and psychosis (2,3,4,5).
Unfortunately, even for moderate or binge drinkers, research shows that going through small and frequent withdrawal processes can negatively affect the nervous system (4,5,6). In my case, I used to drink heavily and then take a break for a day or two in between. Each time I drank, my body would go through a mild withdrawal. Then I’d go back to heavy drinking again. No doubt, this would send my nervous system into a tailspin each time.
The result was a nervous system that was always confused and out of whack. And guess what a huge component in the maintenance of our mental health is? — our nervous system and the delicate balance of neurotransmitters (7,8). Once our neurotransmitters go out of balance, it has an enormous effect on our mental health.
Alcohol Withdrawal and Mental Health
There are, of course, many factors involved in how and why people become depressed and anxious. There’s childhood conditioning, socio-economic factors, trauma, nutrition, physical illness, etc (9,10). But the most crucial factor is our nervous system (7,8). And when you add in alcohol, the risks increase big time.
Even though alcohol affects two neurotransmitters, the truth is that all neurotransmitters work together to create a well-functioning nervous system. As living beings, we rely on our capacity to maintain homeostasis in every organ of our body. When you mess with one small part, the whole thing can be thrown off. And this is quite true of our nervous system.
The most frequent symptom of any degree of alcohol withdrawal is anxiety (2,3,4). Whether we drink a few one night or many drinks each day, we get anxious once we stop drinking. So it’s not a stretch to say that repeated alcohol use most definitely causes anxiety.
But you can be sure that alcohol also affects many other psychiatric illnesses such as depression, bipolar disorder, obsessive-compulsive disorder, etc. All mental health issues have an unbalanced nervous system at their core (9,10,11). So it makes sense that the addition of alcohol will cause further imbalance.
We can conclude that if one is prone to having depression and anxiety (as I was), then adding alcohol to the mix is akin to throwing gas on the fire (12). In my case, alcohol seemed like nice self-medication at first. I suspect this is true for others as well. That initial calm we feel from inhibiting our nervous system may seem like we’re getting a break. But once we remove alcohol, that self-medication turns into poison. This is why alcohol withdrawal treatment is so critically important for chronic drinkers.
Alcohol and Mental Health Medications
If you take medications for a mental health issue, you should know some essential facts. First, combining alcohol and mental health medications can be toxic to your organs (12,13) . But for certain mental health medications, alcohol also may increase sedation, which can cause respiratory depression and death (12,13). This is especially true for benzodiazepines (12).
Secondly, alcohol can render certain medications less effective. Many medicines used to treat depression won’t work as well if you combine them with alcohol (13). Dr. Mark Rego, a psychiatrist and health writer, reports many cases of patients who’s medications stopped working during increased alcohol use. However, once he advised his patients to reduce or quit drinking, their mental health symptoms improved.
Unfortunately, Dr. Rego says that for some patients, alcohol abuse leads to depression that doesn’t respond to medication and only gets worse. Considering that medications had worked for many of his patients prior to engaging in increased drinking shows that alcohol may be decreasing the effect of the medication. This was certainly true in my case.
I took an antidepressant for many years and found that it didn’t work that well for me. Unfortunately, my heavy drinking wasn’t helping the matter. Later, I also found out that certain antidepressants may even contribute to a worsening alcohol problem (14).
Long Term Mental Health Effects of Alcohol Abuse
The good news is that we can give our nervous systems a chance to repair and find balance again once we detox safely from alcohol. This takes time, and each person’s road to recovery will look different. Those who drank mild to moderate amounts before getting sober may achieve full nervous system recovery (2,6).
For chronic drinkers, however, repairing the nervous system may take a long time. Many people in recovery have noted that they have long-lasting anxiety or depression. Some note that they have less capacity to feel pleasure, while others have ongoing mood swings or just feel down a lot (2,3,6). Rest assured that this is likely normal, and all we need is a little patience and perseverance.
Conclusion
As I said, some of you may have received this education from your doctor. But it’s also likely that many of you have not. When it comes to family doctors, they probably don’t have the specialized training to offer education about addiction and mental illness. For this reason, it’s wise to consult a psychiatrist if you suffer from addiction and mental illness. As they are specialists in this area, they are more likely to ask the right questions and provide proper education and treatment.
However, it’s important to tell your doctor exactly the amount that you drink daily. Disclosing this info may cause some embarrassment and stress, but in the end, your health depends on your honesty.
Hopefully, this info will help people understand the crucial link between alcohol use and mental health issues. Knowledge is power in this case. The more we know, the more we can make informed choices about our health.
References
- Neurotransmitters, Synapses, and Impulse Transmission
- Introduction to Alcohol Withdrawal
- Neurotransmitters in alcoholism: A review of neurobiological and genetic studies
- Withdrawal Management
- Withdrawal Syndromes
- Neuroplasticity and Predictors of Alcohol Recovery
- Neurotransmitters and Depression
- Classical Neurotransmitters and Neuropeptides Involved in Major Depression: a Review
- Mental illness and the economy
- WHO: Mental Health
- Information about Mental Illness and the Brain
- Concurrent substance-related disorders and mental illness: the North American experience
- Alcohol and Medication Interactions
- Ninety-three cases of alcohol dependence following SSRI treatment
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