Is Alcoholism a Mental Illness?

brain made up of alcohol

Mental illness is defined as a health condition that affects “mood, thinking, and behavior”. Mental health disorders include such conditions as depression, eating disorders, and addictive behaviors.

The latest statistics from the National Alliance on Mental Illness (NAMI) find about “1 in 5 adults in the U.S. experiences mental illness.” NAMI also reports a troubling increase in mental disorders among teenagers.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used by physicians to diagnose mental illnesses. In 1980, the third edition of the Manual, DSM-3, identified alcoholism as a subset of a mental health disorder. The current edition, DSM-5, classifies alcoholism, now referred to as Alcohol Use Disorder (AUD) or Substance Use Disorder (SUD), as a mental disorder presenting both physical and mental symptoms.

Alcohol Use Disorder

In 1992, the American Medical Association defined alcoholism as “a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.” Alcohol abuse, alcohol addiction, and alcoholism are now classified under the umbrella of Alcohol Use Disorder (AUD) and diagnosed as mild, moderate, or severe disorders.

AUD is commonly characterized as the inability to control alcohol use even in the face of negative consequences. Those with an alcohol use disorder often center activities around alcohol, need to consume increasingly greater amounts of alcohol to achieve the desired effect and have withdrawal symptoms when drinking stops.

Physicians use criteria outlined in the DSM-5 to diagnose AUD, by asking patients a series of questions relative to their behavior in the past year. These include questions about behavior such as:

  • Drinking more than you want
  • Trying to quit drinking but being unable to stop
  • Spending more time than you want drinking
  • Neglecting family, friends, or job responsibilities in order to drink
  • Making risky choices thanks to drinking, including drinking or having unsafe sex

Patients who respond yes to at least 2 questions may have an AUD. Those who respond yes to 2-3 questions, may have a mild AUD; yes to 4-5, may have a moderate AUD; and yes to 6 or more, may have a severe AUD.

How Alcohol Affects the Brain

Recent scientific studies have confirmed that continuing alcohol use causes changes to the brain and that those changes may be permanent.

Alcohol is a depressant, signaling the central nervous system to slow down motor, cognitive, and other vital functions. As a result, the body’s reaction time is slower, and balance, judgment and coordination decline. Alcohol can dangerously suppress life-sustaining functions, like breathing and body temperature, which can be fatal.

Addictive substances like alcohol affect the pleasure and reward center of the brain, triggering an increase in dopamine levels. Dopamine, known as the “happy” chemical, is naturally released by the brain in reaction to a pleasurable experience, reinforcing that experience as “good.” Alcohol causes unnaturally high levels of dopamine to be released, delivering an intense response and strongly ingraining the desire to repeat the experience.

When an individual consumes high amounts of alcohol regularly, their neural pathways adapt to the steady influx of the drug, remaining in a high state of overstimulation. This results in tolerance, which means an increasingly higher level of alcohol is needed to achieve the desired effect.

Research has shown that permanent overstimulation of the brain leads to habitual behavior, making the habit difficult to break. This state of overstimulation also results in withdrawal symptoms if an individual cuts back on their alcohol intake as the body struggles to regain its natural balance.

The Relationship Between Alcohol and Other Mental Disorders

man with depression drinking alcoholIt is common for an individual to have both an AUD and another mental disorder at the same time. This is known as a co-occurring disorder, dual diagnosis, or comorbidity. National Survey on Drug Use and Health statistics reflect that 9.2 million U.S. adults experienced both mental illness and a substance use disorder in 2018.

Sometimes one disorder precedes the other, but the presence of both tends to worsen the symptoms of each. Mental disorders that most commonly co-occur with an AUD or SUD include depression, eating disorders, and anxiety disorders, especially post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).

Studies show that undiagnosed or untreated mental disorders present a greater risk for the development of an alcohol or substance use disorder. Individuals suffering from depression, anger, or other negative emotions associated with their mental health disorder may seek to “self-medicate” with alcohol or drugs.

Likewise, excessive alcohol use can precipitate mental illness. Alcohol use increases depression, anxiety, and stress, which can trigger depressive and other mental disorders. Presence of both disorders reinforce one another.

A Hazelden Betty Ford Foundation publication discusses the prevalence of co-occurring alcohol or substance use disorders with other mental disorders, and which are most commonly comorbid.

  • Depression: As many as 80 percent of alcoholics experience depressive symptoms at some time in their lives, and 30 percent meet diagnostic criteria for major depression.
  • PTSD: There is a strong correlation between substance use disorders and PTSD, with as many as one-third of patients meeting criteria for PTSD when they enter treatment for their alcohol/drug problems.
  • Anxiety disorders: Rates of other anxiety disorders, such as agoraphobia, panic disorder, social phobias, and general anxiety disorder, are high in treatment populations, ranging from 10 to 60 percent.
  • Eating disorders: Most studies find that between 15 and 32 percent of women with alcohol/drug disorders meet diagnostic criteria for an eating disorder at some time in their life.

The Dartmouth Psychiatric Research Center theorizes that co-occurrence of these disorders may be triggered by various factors, which may include the attempt to self-medicate, an earlier onset of mental illness due to alcohol or drug use, genetic or environmental factors, like poverty or social isolation, and susceptibility, meaning those with a mental illness may be more susceptible to alcohol or drugs.

Treatment for Co-Occurring Disorders

Effective therapeutic approaches are similar to the treatment of AUD and other mental health disorders. Because of the high prevalence of co-occurring disorders, many addiction and mental health professionals are highly trained in all aspects of substance abuse and mental health treatment modalities.

BlueCrest Recovery Center offers a unique treatment approach that integrates evidence-based practice with 12-step principles to heal the physical, mental and spiritual components of addiction and co-occurring disorders.

Contact BlueCrest Recovery Center today to learn more and to see how we can help you or a loved one succeed in recovery.

Medically Reviewed By Dr. Thomaso Skorupski, D.O.

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