Alcohol and Mental Health

Many people enjoy drinking alcohol; it can positively impact the drinker’s mood and make them feel confident and more relaxed, even if it's only for a short while.1 However, despite its temporary feel-good benefits, it can adversely affect a person’s mental health in the long run, such as by making depression symptoms worse.2

From memory loss and learning difficulties to anxiety and even suicide, heavy and frequent alcohol drinking has been linked to numerous mental health problems.3 This is because drinking alcohol can interfere with the normal workings of the brain, altering the chemicals (neurotransmitters) that help us maintain optimal mental health.4 So, the more a person drinks alcohol, the less able they may be to deal with stress, anxiety, and other mental health conditions.

With about 63% of Americans partaking in this popular substance, alcohol’s effects are an important topic to cover.5 In this guide, we delve into all the information you need to know about how alcohol can affect your mental health.

You may have heard that alcohol is a depressant, and that's true.6 Like every other depressant, alcohol can disrupt your brain's delicate chemical balance and alter what you feel, how you think, and what you do — potentially affecting your overall mental wellness in the long term. However, that's only one part of the explanation as to how alcohol can affect the brain's chemistry. To get the full picture, we'll need to discuss neurotransmitters.

Neurotransmitters are chemical messengers that are responsible for transmitting signals among brain nerves (neurons) that control behavior, emotion, and processes.7 When you feel good after a drink or two, that’s because the alcohol has suppressed the release of certain neurotransmitters. For example, glutamate is an excitatory neurotransmitter that triggers brain activity and increases energy levels.8 The effect of alcohol inhibiting glutamate release is altered synaptic plasticity, affecting your memory and ability to learn.9

Alcohol can also increase the brain's production of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that reduces energy levels and increases sedation.10 11 The effects alcohol has on both glutamate and GABA are what lead to common signs of intoxication — and the more alcohol in your system, the more symptoms emerge.12

Dopamine is a "feel good" neurotransmitter that increases as you drink more alcohol.13 14 As your dopamine levels rise, your brain’s hormones signal feelings of pleasure and enjoyment. However, with more drinks, dopamine levels will reach an all-time high and start diminishing. Over time, and with continued drinking, this can make you require more and more to feel as good — this leads to further tolerance, depression, and, potentially, dependence as your brain expects to experience that higher level of dopamine.15

Anxiety is a normal reaction to stress, and many people experience it at some point in their lives.16 (External triggers often cause stress, and anxiety is defined as persistent worry even when there isn’t a stressor.)40 For example, it's okay to feel anxious as you step on the stage to speak to a crowd or as you await your laboratory results. Usually, anxiety goes away after the stressor has been removed, but, for some people, anxiety may also linger for so long that it causes you distress and affects your daily life. This is when normal anxiety becomes an anxiety disorder.17

If you're experiencing persistent anxiety or stress, a glass of wine might seem tempting to calm your nerves. However, alcohol can’t fix emotional problems or mental health concerns; it’s only acting as a temporary fix, not a treatment of the root cause of your anxiety.

Since the effects of alcohol wear off quickly, you may be tempted to continue drinking to mask your stress and anxiety. As you increase your alcohol intake and become more reliant on it for relief, your tolerance levels also increase. With time, you'll need larger amounts of alcohol to get the feeling you desire. This is often the blueprint for alcohol dependency, which further worsens your anxiety.

Excessive use of alcohol affects the amygdala, the area of your brain responsible for managing negative emotions. Amygdala functional anomalies have been discovered in brain imaging investigations of people with alcohol use disorders.18 Too much alcohol can make you less capable of handling stress healthily, thereby triggering anxiety. And hangovers can also trigger or worsen anxiety.

Just like anxiety, people experiencing depressive episodes often find them overwhelming and unmanageable. To quell these feelings, some people drink alcohol to make them feel better, but, as with anxiety, this doesn’t get to the root of the problem and only acts as a temporary band-aid with the potential to make things worse.

Studies have shown that people with alcohol dependence are 3.7 times more likely to also have major depressive disorders.19 In fact, depressive disorders are among the common mental disorders discovered in people with alcohol use disorders.20 Seeing as alcohol directly affects the areas of the brain that manage emotions, this makes a lot of sense.

Drinking and depression is a vicious cycle, as heavy drinking can lead to depression, and depression can trigger alcoholism. First, alcohol lowers serotonin levels in your brain (serotonin is a neurotransmitter that regulates your mood). Since drinking too much decreases its ability to balance your mood, your chance of developing depression significantly increases.21

On the other hand, people with depressive disorders have a higher likelihood of self-soothing with alcohol. This harms the brain by worsening depression, which can trigger people to drink more. In other words, depression and alcohol use disorder often coexist, with one worsening the other.

It’s worth noting that most physicians advise against drinking when taking antidepressants. This is because some regularly prescribed antidepressants appear to raise the risk of relapsing into heavy drinking if taken by someone trying to withdraw from the substance.22

In the chart below, we cover three other mental health concerns that have links with alcohol use disorder — psychosis, self-harm, and suicide.

It’s worth noting that while alcohol misuse can cause or contribute to these concerns, they may also be symptoms of alcohol withdrawal in those who are dependent. This is because the body and mind can react strongly to suddenly cutting off the substance they’ve grown to rely on to adapt to stressors. Alcohol withdrawal symptoms can be life-threatening, and that's why rehab or professional assistance can be necessary for some people aiming to break the habit.29

If you’re concerned about alcohol use disorder, here are some telltale signs to look out for:30

• It’s difficult to limit or reduce the amount of alcohol you drink, even if you want to.
• You feel strong urges or cravings to drink alcohol.
• Even if you know your alcohol use is causing difficulties, it feels impossible to stop.
• Alcohol is leading to issues fulfilling your obligations at school, work, home, or with family and friends.
• You experience withdrawal symptoms like sweating, shaking, and nausea when you try to stop drinking.
• You drink in secret or downplay how much you drink in general.

According to the U.S. Dietary Guidelines, adults who drink should limit it as follows:

• Women and AFAB individuals should limit their drinking to one or less in a day.
• Men and AMAB people should try to keep their alcohol consumption to two or less in a day.

The National Institute on Alcohol Abuse and Alcoholism also clarifies that binge drinking should also be avoided; this is defined as drinking that brings your blood alcohol concentration to 0.08% or higher.31 32 On average, this happens after a woman has four or more drinks or a man has five or more drinks within roughly two hours.

And heavy drinking, or heavy alcohol use, includes binge drinking and is defined as:32

• For men, drinking five or more drinks in a given day or 15+ per week.
• For women, consumption of four or more drinks on any day or eight or more per week.
• In its definition of heavy alcohol use, SAMHSA includes the criterion of binge drinking on five or more days in the past month.

Many people struggle with alcohol dependence because they're looking for ways to deal with stress, anxiety, and depression. Unfortunately, alcohol is an unhealthy coping mechanism that's capable of worsening your problems. The good news, though, is that there are numerous effective and healthy ways to cope.

Exercise

More than just keeping your body in shape, exercise can also significantly improve your mental wellness by helping you fight depression and stress. When you partake in physical activity, your brain releases feel-good endorphins and other natural brain chemicals that lift your mood. Like alcohol, exercising takes your mind off your troubles and can provide you with a feeling of relaxation afterward.33

Fortunately, unlike alcohol, working out isn’t associated with an increase in depression. This makes it a healthy coping mechanism you can incorporate into your daily life. Another good thing about physical activity is that it doesn't have to be strenuous. Activities like gardening, taking a walk, and washing your car can still provide you with benefits.

Meditation

Meditation for depression and stress helps you relieve symptoms by altering the way you react to how you feel. It can help your brain to sustain its focus when negative emotions and thinking intrude. By helping your brain ignore negative stress sensations, your way of thinking can change over time, directing your mind to more positive thoughts and ensuring that your brain functions optimally under stress.34

Sleep

There is a strong connection between depression and sleep disorders. Like alcohol and depression, sleep and depression have a bidirectional relationship. Studies have shown that people with insomnia have a much higher risk of slipping into depression than others. In fact, almost 75% of depressed people also struggle with sleep. As such, the more you can get a good night's sleep, the better your chances of fighting depression and stress.35

According to the CDC, people 18 and older need to sleep for seven or more hours every night.36 When you sleep, various brain activities increase and decrease as you enter various sleep stages and complete your sleep cycle. These activities are known to improve mental and emotional health.37 If you have trouble sleeping, little lifestyle changes like exercise, maintaining a comfortable atmosphere, and avoiding large meals before bed can help.

Eat a healthy, balanced diet

Your mental health, to a large extent, is reflective of what goes into your body. Nutritional deficiencies can increase your risk of mental illnesses, especially depression and schizophrenia.38 As such, experts encourage people to ensure adequate intake of food items rich in selenium, vitamin D, omega-3s, zinc, proteins, probiotics, antioxidants, and B vitamins. Some healthy foods that can help with this include walnuts, oily fish, whole grains, milk, eggs, fruits, and dark leafy vegetables.

Besides nutritional deficiencies, eating more of certain kinds of food can also have a negative impact on your mental health. For example, an excess of processed foods has been associated with an increased risk of depression.39

Work around your triggers

Coping with anxiety and depression may be helped by understanding your body, recognizing what triggers you, and trying to avoid excessive stress. For example, if boredom triggers your anxiety, you can try to plan ahead to prevent it by scheduling activities or starting a new, engrossing hobby.

Other healthy activities that can help you cope with stress and depression include spending time with friends and family, engaging in entertainment, volunteering, and more.

If you or someone you know has alcohol use disorder (or you suspect it), there are many resources and support groups dedicated to helping you through the process. Below, we’ve compiled several resources that can help you or your loved one find assistance or more information on the recovery process.

Recovery

• Alcoholics Anonymous (a twelve-step program also commonly known as A.A.)
• Celebrate Recovery (recovery with a Christian focus)
• Recovery Dharma (a recovery program using non-theistic Buddhist practices)
• Women For Sobriety
• Inspire Recovery: LGBTQ+ Drug and Alcohol Rehab
• Al-Anon and Alateen
• USAGov: Find help for substance abuse

Hotlines

• SAMHSA National Helpline
• Partnership to End Addiction
• 988 Suicide and Crisis Lifeline

Additional information and other resources

• Hazelden Betty Ford Foundation: Facing Addiction as a Family
• SAMHSA Families: Resources for Families Coping with Mental and Substance Use Disorders
• The American Psychological Association: Understanding alcohol use disorders and their treatment
• American Academy of Addiction Psychiatry
• National Institute on Alcohol Abuse and Alcoholism