Why Drinking Alcohol with a Mental Illness is Unsafe
I was rereading a favorite childhood book a few weeks ago and realized that my attitudes toward alcohol might be a little out of step with wider 21st American culture. The book was “Jack and Jill” by Louisa May Alcott and one of the chapters feature two of the main characters leading activities in their Temperance Lodge. I found this charming, but as I thought about it I realized that for most people this would be a very strange concept. I am not actually a teetotaler (someone who practices and advocates total abstinence from alcohol). I will have a mixed drink if out with friends or a glass of wine during a nice meal with family. I do, however, have deep concerns about the idea that drinking alcohol to excess is a normal and enjoyable activity. While many people can consume alcohol safely my work as a mental health provider gives me a frontline look at the negative effects of alcohol.
I see alcohol as one of the major negative factors in my patients’ lives, but this isn’t a view shared by most people. To be honest many of my patients laugh when I advise them to eliminate alcohol consumption. Of those that don’t laugh many are being polite and giving lip service to my advice. They continue to drink and don’t tell me about it until they experience a negative alcohol related event. I don’t enjoy preaching to people and I believe in an individual’s freedom to make choices, even bad choices. However I think those choices should be well informed. Therefore in this article I would like to discuss the chemical effects alcohol has on the brain and link this to why alcohol is particularly dangerous to people coping with mental illness.
Neurochemistry of Ethyl Alcohol
Ethyl alcohol (the alcohol found in beer, wine, and hard liquor) is an interesting substance from a neurochemical standpoint. It affects several receptor systems in the brain because it is a small molecule that is able to dissolve in both water and fats. These properties allow alcohol to easily enter the blood and the brain and get into the actual membranes of the nerve cells. By getting into the nerve cell membranes alcohol is able to alter the activity of multiple receptors for neurotransmitters (which are the chemicals that neurons, or nerve cells, use to communicate with each other) at the same time. How much a particular neurotransmitter system is affected by a given amount of alcohol in a particular person is probably determined by genetics. These differences as well as genetic differences in the body’s ability to break down and get rid of alcohol explain why different people respond differently to the same amount of alcohol.
Overall alcohol produces a sedating effect within the nervous system by increasing the activity of receptors for inhibitory neurotransmitters such as GABA (gamma amino butyric acid), glycine and adenosine. Alcohol also decreases the activity of receptors for excitatory neurotransmitters like glutamate and aspartate. The combined effect of these changes is that alcohol slows down the activity and communication of the neurons in the brain. This is the likely cause of the calming effect some people experience from alcohol, as well as for bad effects like diminished coordination, impaired decision making ability, memory problems, and slowed reaction time. On the extreme side, enough alcohol can also slow or even stop your breathing because of this slow down in brain activity.
Alcohol also interacts with the dopamine and endorphin receptor systems in the brain, increasing their activity. Dopamine is a major neurotransmitter involved in many brain processes, including the experience of pleasure. Endorphins are the body’s natural pain-killing chemicals and are also involved in the experience of pleasure and sense of well-being. Alcohol’s effect on these systems is the likely cause of the pleasure many people experience from drinking alcohol. Dopamine can also be an excitatory neurotransmitter, which explains why some people respond to alcohol initially by becoming more active instead of sedated. Eventually the inhibitory effects of alcohol on the brain will predominate and overcome the excitement; that is why even initially happy and active drunks pass out after enough alcohol.
Effects on Behavior and Mental Illness
Alcohol is well known for decreasing social inhibition, which may seem strange when you think that it enhances a chemical that inhibits nerve cell activity. The explanation for this is that social inhibitions are actual the result of activity in parts of the brain. When those parts of the brain become less active under the influence of alcohol their ability to inhibit behavior decreases. Some people drink alcohol specifically to obtain this effect, but in general our social inhibitions are there for good reasons. They help us harness our impulses so that our behavior serves our long-term goals. Under the influence of alcohol the brain’s ability to monitor and control what a person does and says decreases, which can lead to embarrassing, painful and even dangerous situations. Alcohol is estimated to be involved in about 30% of suicides, with about 25% of people who commit suicide being legally intoxicated at the time of death. Alcohol is also involved in the majority of intimate violence and child abuse crimes.
Many anxious patients tell me that they drink because it relieves their anxiety and depressed patients tell me they drink because it makes them feel better. Unfortunately, the relaxing and euphoric effects of alcohol wear off over time. With chronic alcohol use the brain adapts and changes the amounts of receptors present in nerve cells in order to counteract the effect of alcohol. Excitatory receptors are increased while inhibitory receptors, dopamine receptors, and the amount of endorphins in the brain are decreased. This is why someone who has been drinking regularly begins to need more alcohol to obtain the same effect. It also means that once a person stops drinking the brain is in a state of increased excitatory activity, which will usually be experienced as increased anxiety, and will have less ability to experience pleasure. The increased excitatory activity is also what causes symptoms of alcohol withdrawal (which includes anxiety, tremor, elevated blood pressure, seizures, and death among other symptoms). So alcohol is not an effective treatment for anxiety problems or for depression.
Research shows that even moderate alcohol interferes with the ability of a person to recover from anxiety or depression. There are multiple reasons for this. As above, alcohol directly affects the brain as discussed above and tends to directly worsen both anxiety and depression. Alcohol’s effects on the brain also interfere with the ability of medication to act beneficially on the brain. Alcohol interacts dangerously with many medications used to treat anxiety and depression, to the extent that some combinations can cause death. Alcohol impairs memory formation and learning, which makes psychotherapy less effective. In addition to its biological effects alcohol use can increase social stress due when the removal of inhibitions leads to ill-judged or dangerous behaviors.
The published safe alcohol limits in the United States are one drink (meaning one 12 ounce beer (5% ethyl alcohol), a 5 ounce glass of wine (12% ethyl alcohol), or 1.5 ounces of hard liquor (40% ethyl alcohol) per day for an adult non-pregnant woman and two drinks per day for an adult man. However these guidelines are for an “average” person. If you are currently suffering from any type of mental illness I strongly recommend not drinking any alcohol at all. The potential negative consequences are too severe. I encourage you to ask yourself: is this drink worth my health, my happiness, or my life?