Mental health and alcohol
By Kerry Hudson
A large number of people in the UK, after a stressful day at work or with pre date jitters, head to the bar, fridge, anywhere they can get their hands on a swift tipple to calm their nerves or loosen up. Drinking to 'feel better' has sadly become quite a normal part of our 'boozy' British culture and I would even go as far to say drinking is expected to be part of a normal 'social' life; I've heard of employers turning down applicants who don't drink as their job entails socializing and entertaining clients.
But this can be quite a dangerous game, and for the whopping one in four of us with mental health issues, drinking to "take the edge off" or "self medicating" can make things worse rather than better.
I don't think it's any coincidence that the majority of people I know from the mental health services (clients) are or have been problem drinkers.
As a bipolar sufferer I have noticed that I use alcohol to echo my moods. For example when I'm feeling manic I tend to drink more, periodically telling myself that it will slow me down but it in fact magnifies my highs. When I'm feeling low I swap wine for tea and lots of it. The majority of other bipolar sufferers I know either drink a lot or not at all which in itself seems reflective of the conditions black and white extremities.
It is not just us bipolar sufferers who tend to reach for a bottle; people with all sorts of mental health issues seek a "quick fix" in alcohol.
The psychopharmacological elements of alcohol that relax the muscles, lift our mood and esteem, have a short-term effect in some, that reduces some of the negative symptoms - depression, loneliness, anxiety, frustration etc. However, ironically, continued drinking will enhance these negative symptoms, and this continued pattern can become alcohol dependancy.
"Dual Diagnosis" is the name given to people with a mental health condition and a secondary diagnosis of addiction.
- The psychiatric condition most often linked with problem drinking is Anti-social Personality Disorder (ASPD) where it's sufferers are reportedly 21 times more likely to to have a drink problem then the average UK population.
- Personality disorder sufferers of any type, are more likely to be addicts and addicts are more likely to be diagnosed with a mental health condition.
- People with Schizophrenia are reportedly 3 times more likely to be a problem drinker.
- Depressive and affective disorder (such as Bipolar) sufferers are reportedly 1.9 times more likely to be problem drinkers,
- People with Anxiety disorders such as Obsessive Compulsive Disorders (OCD) are reportedly 1.5 times more likely.
It is, therefore, so important that psychiatric services recognise these statistics and work with alcohol related issues in treatment packages.
One of the biggest problems I have seen with people who have a Dual Diagnosis is obtaining treatment. This is because some services cannot decide between themselves whether it is the clients mental health or dependancy that needs addressing first, and clients often cannot engage in both services at the same time. I've seen clients being tennis balled from service to service, both refusing treatment because both believe the other should be intervening. In the meantime the perceived rejection has made the clients more vulnerable.
Fortunately there are some services that offer combination support, called Specialist Alcohol Team (SAT) which is accessed through the NHS.
So what came first? Problem drinking or mental illness?
This chicken and egg scenario is often questioned by friends and relatives of people with the conditions. Depression, for example, has been linked as both cause and effect of heavy drinking.
While mental health conditions such as Bipolar Disorder and Schizophrenia are often present long before problem drinking, points to a causary link.
Personality disorders such as Borderline and Anti-Social are quite often linked to childhood trauma, so addiction could be seen as the secondary condition, however there is also the view that the root cause to these issues is quite often the same.
Diagnosis and treatment
In an idea world, the most accurate diagnosis would be made if the patient abstained from all substances (even caffeine) for a period of time. People with bipolar can display excitable behaviour with zero inhibitions whilst sober. In fact after nine months with no alcohol I was sent for a psychiatric assessment because I was "acting drunk" thus my bipolar diagnosis was made. But hangovers, withdrawal, caffeine rushes etc.. can all play a part on our mood.
In psychological assessments it can be noted that the patient is "fidgety" or "hyper" or "withdrawn" so it is important that the psychiatrist know if alcohol or other stimulant is playing its part, when a life changing diagnosis is about to be made.
If your drinking is starting to impact upon your life or condition it is important you seek help. Please see our alcoholism and addiction sections for more or contact a specialist counsellor, or see Dual Recovery Anonymous.
To know more about Kerry Hudson please visit her blog seesaw-seatingplan