Therapists Explain The Link Between Alcoholism and Depression

Learn about the relationship between alcoholism and depression — and how to treat both.

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Alcohol misuse can bring challenging emotions and experiences for the individual and those around them. It can also heighten or cause depressive symptoms, requiring care for multiple conditions at once.

The relationship between alcoholism and depression is a challenging one. “Alcohol may start as a way to unwind, numb stress, or escape painful emotions, but over time it directly disrupts brain chemistry and emotional stability,” says Charlie Health Group Facilitator Bree Williams, LPCA. “Regular alcohol use depresses the central nervous system, leading to increased irritability, brain fog, low motivation, emotional numbness, and disrupted sleep.”

But there are treatment options available, from medication to support groups. As Charlie Health Licensed Creative Arts Therapist Courtney Way, MA, LCAT, says, “Recovery isn’t linear, and doesn’t look the same for everyone.” Here’s what you need to know about alcoholism and depression, including how to treat them.

What is alcohol use disorder?

Alcoholism, formally known as alcohol use disorder (AUD), is a type of substance use disorder. The 2022 revision of the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) defines alcohol use disorder as “a problematic pattern of alcohol use leading to clinically significant impairment or distress.” Medical professionals can diagnose it as mild, moderate, or severe, depending on how many symptoms a person exhibits during a 12-month period.

A 2023 survey from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that about one in seven men, one in 11 women, and one in 33 people aged 12 to 17 who participated met the criteria for AUD.

AUD and depression

A person living with a substance use disorder like AUD can experience a co-occurring mental health condition, such as an anxiety disorder, depressive disorder, borderline personality disorder, or post-traumatic stress disorder (PTSD). According to SAMHSA’s 2023 survey, 35% of US adults live with a mental health disorder and a substance use disorder.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA, individuals living with major depressive disorder have a 27% to 40% lifetime prevalence of co-occurring AUD. A variety of factors can cause AUD and depression to co-occur. The two can enter a chicken-and-egg scenario, fueling each other in a challenging cycle, says Williams. A person living with AUD might experience negative effects such as broken relationships, dependence, and financial strain, leaving them mentally drained and feeling a sense of isolation, says Williams.

Williams explains that some people living with depression might turn to drinking alcohol as an unhealthy coping tool, allowing them temporarily to feel confident, escape their thoughts, or sleep. “But alcohol is a depressant, so after temporary relief, mood drops even lower,” she says. “For others, long-term drinking changes brain functioning, leading to new or intensified depression, especially when alcohol becomes the only way to feel regulated.” A person might experience a depressive episode or find themselves developing depression.

Way adds that excessive drinking can end up disrupting a person’s sleep and increasing their stress. Both conditions also have similar risk factors, including genetic vulnerability and chronic stress, says Way.

Alcohol withdrawal can worsen depressive symptoms

A significant part of treating AUD is the withdrawal process. According to the DSM-5-TR, a person living with alcohol use disorder might experience withdrawal symptoms such as:

• Tremors
• Sweating
• Elevated pulse and blood pressure
• Insomnia
• Anxiety
• Nausea or vomiting
• Seizures
• Delirium tremens

Williams explains that some individuals also experience accentuated anxiety or depression symptoms while in withdrawal, potentially “reinforcing the belief that they ‘need it’ to function socially or emotionally.”

AUD and depression treatment

Yes, as Way says, AUD and depression “can intensify each other,” making treatment and recovery more complicated. But, concurrent, holistic treatment can help people manage the symptoms of both. 

Williams stresses that AUD “is often misunderstood as a self-control issue, but it is deeply tied to pain, coping, and nervous system dysregulation. Quitting is not just about willpower — it’s about healing what made drinking feel necessary.” Treating the depression aspect is just as critical.

Treatment for someone living with AUD and depression can often be “strongest” when it involves structured sobriety tools, medication support, and therapy, says Williams. “It is also important to monitor for risks during this time, as treatment can bring up a wide range of thoughts and feelings,” she adds.

1. Go to support groups

Way and Williams both emphasize the power of support groups, such as Alcoholics Anonymous (AA), SMART Recovery, or sober communities, to curb heavy drinking and cope with a co-occurring disorder like clinical depression or an anxiety disorder. They bring “accountability and connection, which is deeply protective against isolation-based relapse,” says Williams.

2. Take medication

Some individuals benefit from taking medications for mood stabilization, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin–norepinephrine reuptake inhibitors (SNRIs), says Williams. She adds that some people might take naltrexone or acamprosate to limit cravings.

Way emphasizes that a medical professional should be monitoring medications at all times.

3. Attend therapy

Techniques such as cognitive behavioral therapy (CBT) and trauma-informed therapy can get to the root of emotional triggers and “help disrupt the pattern of drinking,” says Williams.

4. Start intensive treatment

A person living with AUD and depression, especially in severe cases, might need the safety and security of a structured program, explains Williams. They might explore an intensive outpatient program (IOP), partial hospitalization, residential treatment, rehabilitation, or a medically supported detox, says Way.

How to help someone living with depression and AUD

In addition to substance use and mental health treatment, loved ones can make a big difference for a person’s well-being. The key is kindness and understanding. “If you or someone you love is experiencing both conditions, approach it with compassion rather than shame,” says Williams. “Sobriety and healing come more easily when the person feels supported, seen, and not judged for how they coped.”

Way adds that “It is also important to monitor for risks during this time, as treatment can bring up a wide range of thoughts and feelings.” A mental health professional can provide guidance on what signs to look out for and communicate any concerns.

How Charlie Health can help

If you or a loved one are struggling with a serious mental health condition or developing depression, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions, including mood disorders. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing your well-being is possible. Fill out the form below or give us a call to start healing today.