Depression and alcohol

Through the years I’ve dealt with many alcoholics who complained primarily of depression. These clients were convinced that the drinking problem was a direct result of depression, and, if they dealt with the depression, they could drink moderately in the future. In the great majority of cases, this has not been true. The opposite was true — the depression was caused by the progression of alcoholism. Never did I see it become true that an alcoholic, depressed or not, returned to trouble-free moderate drinking.

Our medical staff at the various places I worked, trained in addictionology, had seen this condition many times before, so they didn’t treat the depression as a primary problem until the person had been abstinent from alcohol for a period of time. Experienced distinguishing between primary depression or primary addiction, and understanding which likely caused what, if our medical staff admitted someone to treatment in an addiction facility, we would obviously see more primary addiction cases. If a person was evaluated and depression was the primary diagnosis, and there was no convincing evidence of alcoholic progression, then the person would be referred to a specialist to treat the depression, or we’d provide education on alcohol abuse, but not treatment for addiction.

For those admitted to addiction treatment, who were also depressed, the medical staff would provide detox medication that helped with the depression, but what really alleviated the depression was abstinence from alcohol, individual counseling, group therapy and AA/support group attendance. This holds true today, too, working in outpatient treatment — however, with outpatient, we have to use different tools to help with the initial timespan of recovery that’s so difficult. When an alcoholic is not physically separated from access to alcohol, many things can throw the person off and cause a lapse in the initial treatment process. Vivitrol is a medication that blocks the effect of alcohol and is used when possible in early recovery. This allows a client in outpatient treatment the time to reap the rewards of treatment without the complications of lapsing back to drinking.

We have to remember, though, when dealing with depression and alcohol, alcohol is a depressant. With an alcoholic, alcohol works as both a stimulant and a depression. Alcoholics build tolerance to alcohol, so the pleasant stimulating effect of alcohol can last a good while, then the depressant qualities of alcohol take over. As alcoholism progresses, so does the depression, so that at the end stage of alcoholism the alcoholic lives in a depressed state and drinking merely gets the alcoholic to a less depressed state of mind. The magic is gone and likely has been absent for a long time.

This is not to say that an alcoholic can’t experience a dual problem of alcoholism and depression that’s, say, caused by a lack of certain brain chemicals. In this case the depression is usually treated long term along with the alcoholism. Medication is often used to alleviate the depression, and then the treatment is similar to alcoholism, counseling, group therapy and support, along with nutrition therapy, meditation and exercise.

Also, if a depressed person, even if the alcohol and the consequences of alcoholism caused the depression, doesn’t deal with the depressive thought patterns it can cause a return to that first drink seeking relief from the negativity and mental pain, then the person is back on the addiction roller coaster.

Addiction treatment requires a holistic approach, dealing with mental, physical, emotional and spiritual complications. we aren’t neatly segmented into different aspects of being human. We can damage certain human aspects, and this throws us off balance and creates problems. In order to recover from alcoholism, which is difficult under the best of circumstances, an ongoing management of recovery is necessary, paying attention to our mental, physical, emotional and spiritual health long term. It does no good to get better for a short period then let it all deteriorate until life is so meaningless, boring and confusing that drinking seems like a good idea again.

It takes what it takes to recover, and a good addiction professional will suggest a path and tools to work with, but recovery must be managed wisely over the long term — recovery management is not a burden, it’s a life changing process that improves the mind, body and spirit. Believe me, recovery becomes much more than staying away from alcohol — it becomes a smart and inspiring journey that opens up many doors that alcohol closed.