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Alcohol Worsens Depression; Depression Worsens Alcohol Abuse

In the United States, more than 140,000 people die each year from alcohol-related causes. Primary care physicians are often the only medical professionals that an at-risk drinker will encounter, placing them in a prime position to help reduce premature morbidity and mortality from alcohol use. Incorporating annual screenings for alcohol misuse into primary care practices will aid in detecting risky or hazardous alcohol use before the onset of abuse, dependency, and physical and social injury.

First, the Facts

About a third of American adults drink too much. "Too much" means they consume enough alcohol to increase their risk of long-term health problems, disability, accident, injury, social disruption, violence, and death. Continuous alcohol use also increases an individual's risk for the following:

  • Unintentional injuries from car accidents, falls, drownings, burns, and firearms
  • Violence, including child abuse and intimate partner abuse, homicide, and suicide
  • Harm to a developing fetus if a woman drinks while pregnant called fetal alcohol spectrum disorder (FASD)
  • Unexplained death of a seemingly healthy baby under the age of one called sudden infant death syndrome
  • Creating Adverse Childhood Experiences (ACEs) for their child
  • Lost productivity/unemployment
  • Financial problems or inability to support family
  • Deteriorating family and personal relationships

According to the National Institute on Alcohol Abuse and Alcoholism, approximately 97,000 men and 43,000 women die each year from excessive alcohol use,making it the fourth-leading preventable cause of death. Every day, 32 people (1 every 45 minutes) are killed in a motor vehicle accident involving and alcohol-impaired driver. In Arkansas, about 1,407 deaths are attributable to excessive alcohol use. From 2015–2019, the 5-year average annual rate of excessive alcohol deaths per capita in Arkansas increased by as much as 52.1%. As a provider, it's important to stay aware of trends and current statistics regarding alcohol misuse so that you can enhance your practice to help those who struggle with binge drinking and alcoholism.

Alcohol and depression

Does alcohol lead to depression, or are patients who are diagnosed with depression more prone to alcohol use? Research shows that there is a biconditional relationship between alcohol use disorder (AUD) and depressive disorders. While both disorders exist together, each increases the risk of the other, and each worsens the other. Some people are genetically susceptible to both, and others have symptoms of depression that can lead to the development of AUD. 63.8% of people who drink excessively have depression. Drinking alcohol also makes antidepressant medications less effective.

According to a recent Centers for Disease Control and Prevention study, high opioid overdose mortality rates, depression rates, ACEs, and stressful life events were associated with higher substance and alcohol use among postpartum women. The study noted that substance use prevalence was higher among women who experienced six or more stressful life events during the year preceding birth or four ACEs related to household dysfunction. Compared to substance use among those who reported no stressful life events in the year prior to giving birth, the prevalence of substance use was 3.6 times as high, and polysubstance use was 9.1 times as high among those who reported six or more stressful life events.

This study emphasizes the importance of identifying factors that lead to substance use (including high-risk alcohol use). Once providers learn the factors that may be leading to increased depression and substance use, they can then work with the patient to take steps to address the underlying issues. Through clinical and community-level interventions, providers can access substance use and mental health conditions and lessen the harm associated with ACEs (particularly among postpartum women).

Strategies for Success

Besides informing patients about resources they can use to learn more about alcohol and its effects on health, providers can make easy changes to their practice to ensure they are providing the best care for recovering patients.

One easy step is to manage patients' high risk for AUD by keeping accurate records and utilizing in-depth screening tools. Screen for alcohol use annually through single-question screenings or utilize formal tools, such as AUDIT, AUDIT-C, CRAFFT, and several National Institute on Alcohol Abuse and Alcoholism tools. For patients whom you have identified as having high-risk alcohol use or AUD, provide brief intervention counseling (15 – 30 minutes or more if needed). You can also refer these patients to other care providers and treatment centers as needed. However you decide to assess and refer patients, it's important that providers commend patients who are successful in efforts to reduce or stop alcohol consumption and continue to support those who are not successful.

Providers can also improve office systems by using electronic medical records (EMRs) when screening to organize and manage records for patients with AUD. Patients with AUD or high-risk alcohol use benefit from a medical home where a primary care provider directs care and coordinates consults with other providers as needed. Educate your staff on AUD, high-risk alcohol use, and parameters for men and women who are heavy drinkers. It's also important to educate non-medical staff on screening as part of an office visit intake. You can also familiarize yourself with AFMC's Arkansas Substance Abuse Resource Guide and use it to help patients identify resources available in their county. The guide provides contact information, including addresses, emails, and phone numbers of local recovery centers.

Primary care providers are uniquely positioned to educate patients and families on risk factors, warning signs, and prevention techniques. Ask patients who struggle with AUD and high-risk alcohol use questions like "What counts as a drink?" or "What's your drinking pattern?" so taht they can begin thinking about their own personal consumption levels. You can also talk about when to avoid alcohol, the harm associated with drinking too much, and how many drinks are in common containers (e.g., wine glasses and shot glasses). Once you have a better understanding of their current alcohol consumption levels, create a written or electronic plan for change. Help them set goals and create steps they can follow to reach those goals. If they elect to use an electronic plan, ensure that they receive automated reminders and motivating messages as they start their journey to recovery. Those with paper plans can also receive frequent check-ups and motivational messages encouraging them to keep going. Because recovery is often a team effort, you may also consider involving patients' families in goal-setting activities. Encourage the family not to drink around the recovering patient and to offer support whenever needed on the journey.

Resources

AFMC's Alcohol Use Disorder page offers free informative, educational, and strategic resources for patients and providers. Most of these resources come from organizations dedicated to helping individuals recovery from alcohol and substance misuse. If you, your patient, or a loved one is struggling with depression or overuse of alcohol, there is hope. You can get the help you need. Please call these free helpines — a name is not required:

  • Arkansas Crisis Hotline (1-888-274-7472)
  • National Suicide Prevention Lifeline (988)
  • National Drug and Alcohol Treatment Referral Routing Service (1-800-662-HELP) can provide information about local treatment programs and let you speak to someone about alcohol problems
  • National Institute on Alcohol and Alcoholism

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