Alcohol and mental health - Alcohol Action Ireland

Alcohol is a depressant

Alcohol is no ordinary commodity; it is a depressant drug with significant health implications for those who use it, and it is a significant risk factor for suicide, as recognised by the World Health Organisation.[1] Research on alcohol has shown how its consumption can play a variety of negative roles in relation to mental health difficulties. Not least, alcohol can be a contributory factor to mental health distress, it can be an exacerbator of existing mental health difficulties, while mental health difficulties can be a maintaining factor for alcohol consumption.

Research shows that many people drink alcohol in a belief that it may help them overcome difficult emotions or situations.[2] However, using alcohol to cope[3] with trauma[4] or feelings of loneliness, depression, and anxiety may increase a person’s risk of developing alcohol dependence, as well as other long-term health and social harms associated with heavy alcohol consumption.

Trauma

According to the US organisation SAMSHA, trauma is an almost universal experience of people with mental and substance use disorders. Early traumatic experience may increase risk of substance use disorders because of attempts to self-medicate or to dampen mood symptoms associated with a dysregulated biological stress response.

A growing body of evidence now makes clear that it is critical to address trauma as part of substance abuse treatment and that “misidentified or misdiagnosed trauma-related symptoms interfere with help seeking, hamper engagement in treatment, leads to early dropout, and make relapse more likely.”

Dual diagnosis

Dual Diagnosis (DD) is defined by the HSE as ‘the co-morbid disorders due to substance use and/ or addictive behaviours along with the presence of mental disorder(s)’.[5] The disorders of substance use include disorders of alcohol use.

It is clear from research that many people seeking help for addiction problems also present with complex needs and are struggling with anxiety and/ or depression or other serious mental health problems.[6] Evidence indicates that 30-50% of people with severe mental illness have co-existing substance misuse problems, and the same study outlined that 85% of those attending an alcohol service had reported suffering from a psychiatric disorder in the previous year.[7] Indeed, those with DD are at increased risk of suicide compared to those with only substance-use or mental disorders.[8]

Dual Diagnosis is well known to be associated with poor outcomes due to the absence of, or limited level of services to cater to the complex needs of those with DD.[9] However, it is hoped this will now change following the publication of the HSE Model of Care for Dual Diagnosis developed by the National Working Group under the National Clinical Programme for Dual Diagnosis and endorsed by the College of Psychiatrists of Ireland.

While these are very welcome developments, concern remains that people with both problems will be excluded from getting an integrated service. This is because, depending on their location in the country, people who need both interventions still will not have access to the new service. Work in the area of dual diagnosis now needs to move towards the practical delivery of comprehensive services and a rapid extension of HSE work in this area.

Alcohol, suicide and self-harm

Alcohol is significant risk factor for suicide, as recognised by the World Health Organisation.[10] Globally, alcohol was associated with 27% of suicides and self-harm incidents in 2019, while in Ireland, alcohol was found to be associated with one-third of self-harm hospital presentations in 2020.[11] Research by Larkin et al., which analysed suicide cases in Cork from September 2008 to June 2012, found that alcohol was detected in the toxicology of 44% out of 307 suicide cases.[12]

If the percentage from the Larkin study is applied to 436 recorded suicides in 2021,[13] it could be estimated that alcohol may have played a part in almost 192 of these tragic deaths. The same study also found alcohol was noted in the case notes in 21% out of 8,145 self-harm presentations.

Furthermore, a significant meta-analysis which examined the alcohol-suicide link in over 10 million people found that alcohol use was associated with a 94% increase in the risk of completed suicide.[14] The meta-analysis also found that a key risk factor for suicide was being a younger drinker, and the most consistent risk factor was a heavier pattern of drinking.

Therefore, it is little wonder that the World Health Organisation (WHO) advocates for governments to use the full suite of policy tools available to implement alcohol reduction strategies as a suicide prevention measure.[15]