Alcohol Use and Mental Illness

However, for individuals navigating mental health conditions, alcohol can pose serious risks. Instead of helping symptoms, alcohol exacerbates them. It also interacts with psychiatric medications and complicates recovery. Understanding these relationships is key to making informed decisions about alcohol consumption.

Research has consistently shown a strong bidirectional relationship between alcohol use and mental disorders. People with mental illness are more likely to misuse alcohol, and chronic alcohol contributes to the onset of psychiatric symptoms (Jané-Llopis & Matytsina, 2006). For instance, depression and anxiety frequently co-occur with alcohol use disorder, forming a feedback loop: individuals may drink to cope with emotional pain, but alcohol’s depressant effects can ultimately worsen mood and anxiety symptoms.

Alcohol enhances the inhibitory effects of the GABA neurotransmitter. This neurotransmitter plays a role in schizophrenia, autism spectrum disorder, bipolar disorder, panic disorder, post traumatic stress disorder (PTSD), and attention deficit/hyperactivity disorder (ADHD) (Schür et al., 2016). Furthermore, its general depressive effects are coupled with depressive disorders, such as depression or bipolar depression.

In a study of college students, those with poor mental health or depression were significantly more likely to engage in hazardous drinking, experience alcohol-related harm, and screen positive for alcohol abuse (Weitzman, 2004). Notably, this pattern was most pronounced in women, who reported higher psychological distress and vulnerability to alcohol’s negative impacts.

Depression and Anxiety:
While alcohol may initially seem to alleviate distress, it disrupts the brain’s neurochemical balance. It depresses central nervous system activity and impairs serotonin and dopamine transmission—neurotransmitters vital for emotional regulation. Over time, this can lead to or worsen depression and anxiety disorders (Jané-Llopis & Matytsina, 2006).

Bipolar Disorder:
Alcohol is especially risky for individuals with bipolar disorder. It can trigger mood episodes and interfere with mood stabilizing medications like lithium or valproate. Alcohol’s disinhibitory effects can also worsen impulsivity and increase risk-taking behavior during manic or hypomanic phases.

Schizophrenia and Psychotic Disorders:
Patients with schizophrenia are more likely to misuse substances, including alcohol, which can exacerbate hallucinations, delusions, and medication noncompliance (Jané-Llopis & Matytsina, 2006). Alcohol can also interfere with antipsychotic medications, potentially reducing their effectiveness or increasing side effects.

Combining alcohol with psychiatric medications can lead to unpredictable—and often dangerous—interactions.

Benzodiazepines and alcohol both depress the central nervous system, increasing the risk of respiratory depression, blackouts, and overdose.

Antidepressants (like SSRIs or MAOIs) may be less effective when alcohol is regularly consumed and can cause heightened sedation or, in some cases, serious hypertensive reactions. Stimulants used for ADHD may mask the sedative effects of alcohol, leading to greater consumption and increased cardiovascular strain.

As a result, many psychiatrists advise avoiding alcohol entirely while taking psychiatric medications, especially during dose adjustments or symptom instability.

From a broader perspective, the high comorbidity of mental illness and alcohol misuse has major public health implications. According to Jané-Llopis & Matytsina (2006), the burden of disease attributable to alcohol is significantly higher among those with mental disorders. Preventative strategies and early screening for dual diagnoses are crucial, particularly in young adults and vulnerable populations.

One promising approach is the integration of behavioral health into primary care settings, which allows for earlier identification of risky drinking patterns in patients with depression or anxiety (Saitz et al., 2014). Screening tools like the AUDIT-C or PHQ-9 can help clinicians track both substance use and mental health symptoms over time.

 

reviewed by Nicolas Sikaczowski, DO Board Certified Adult & Child Psychiatrist

 

References
1. Jané-Llopis, E., & Matytsina, I. (2006). Mental health and alcohol, drugs and tobacco: A
review of the comorbidity between mental disorders and the use of alcohol, tobacco and
illicit drugs. Drug and Alcohol Review, 25(6), 515–536.
https://doi.org/10.1080/09595230600944461
2. Weitzman, E. R. (2004). Poor Mental Health, Depression, and Associations With Alcohol
Consumption, Harm, and Abuse in a National Sample of Young Adults in College. The
Journal of Nervous and Mental Disease, 192(4), 269–277.
https://journals.lww.com/jonmd/abstract/2004/04000/
3. Saitz, R., Cheng, D. M., Winter, M., Kim, T. W., Meli, S. M., Allensworth-Davies, D., &
Samet, J. H. (2014). Chronic care management for dependence on alcohol and other
drugs: The AHEAD randomized trial. Journal of the American Medical Association
(JAMA) Psychiatry, 71(10), 1231–1239. https://doi.org/10.1186/1741-7015-12-91
4. Schür RR, Draisma LW, Wijnen JP, Boks MP, Koevoets MG, Joëls M, Klomp DW, Kahn
RS, Vinkers CH. Brain (2016) GABA levels across psychiatric disorders: A systematic
literature review and meta-analysis of (1) H-MRS studies. Hum Brain Mapp.
37(9):3337-52. https://pmc.ncbi.nlm.nih.gov/articles/PMC6867515/