ALCOHOLISM AND DEPRESSION Term paper II submitted as a partial fulfilment for the degree of B


ALCOHOLISM AND DEPRESSION

Term paper II submitted as a partial fulfilment for the degree of B.A.(H)Applied Psychology.

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Submitted by:Debarati Paul Supervisor:Ms Babita Prusty
B.A.(H)Applied Psychology Associate Professor
(Sem-3,Sec-A)
Enrollment No:A1506917085
AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES
AMITY UNIVERSITY UTTAR PRADESH,NOIDA
2018
ACKNOWLEDGEMENT
This research was supported by Ms Babita Prusty.I would like to thank my professors from Amity Institute of Psychology and Allied Sciences who provided me the insight and expertise that greatly assisted for the research.
I would like to thank Ms Babita Prusty for assistance with for supervision that greatly improved the manuscript.

I would also like to show my gratitude to the insights of my peers as well as my family. I was immensely grateful to for their comments on an earlier version of the manuscript.

INTRODUCTION
My topic for the Non-Teaching Credit Course based Research paper this semester is my findings on Alcoholism and its correlation to Depression. Before seeing the research evidence, it is important to have a brief idea about both the variables, that is, alcoholism and depression. Both of these topics are explained as the following:
Alcoholism:
Alcoholism, (also known as alcohol use disorder AUD) refers to over use of alcoholic substance which causes any sort of mental or physical health problems. There said to be two types of alcohol use disorder, which are- alcohol abuse and alcohol dependency.
A person can be classified as an alcoholic if he/she does the following activities or shows these symptoms:
Drinking way more alcohol than he/she intended to.
Spending a lot of time, energy and money on alcohol and treating the hangovers.
Craving alcohol while doing normal day-to-day activities.
Spoiling relationship with family members and close ones due to alcohol consumption.

Experience serious side effects of withdrawal symptoms when the person hasn’t had alcohol for a long time.
Alcohol usage doesn’t only affect our behavior temporarily but its usage also hampers various parts of our body. It affects the brain, heart, pancreas, liver and even the immune system. Drinking during pregnancy can cause severe harm to the child. It is researched and proven that women are likely to be more sensitive towards the mental effects of alcohol consumption.
There are mainly two factors which can cause a person to become an alcoholic. These factors are as the following:
Genetic factors:
If a person grows up in a family where one or more family member is an alcoholic, the person is more likely to become an alcoholic as well. The person learns alcoholic behaviors early on in life and also have the pre-disposed trait of alcoholism.

Environmental factors:
Environmental factors also take account for the social, cultural and behavioral situations that cause a person to drink. Sometimes people have to drink and it becomes a habit soon after that.
Curing alcoholism:
The following steps can be taken in account for preventing as well as curing alcoholism:
Limiting the sale of alcohol and increasing taxes on it to make it expensive.
The person who is an alcohol addict can be taken to a rehabilitation center, for proper treatment.

Various forms of alcohol detoxification can be done.
Awareness campaigns to prevent alcoholism.

Going to support groups, like Alcoholics Anonymous.
Depression:
Depression is a chronic mental illness. Here a person suffers from the feeling of sadness constantly. A person who has depression shows no interest in activities that they previously enjoyed. They feel completely unmotivated to get anything done.
There are various symptoms of depression. Some of them are as the following:
Being totally consumed by sadness
A person’s mood affecting his/her work and social life
A persistent state of lack of energy and feeling low
Loss of appetite and difficulty in eating
Thought of death and suicide.

The various causes of depression areas the following:
Genetics, people who have depression running in their family are more likely to get depression as well.

Psychological factors; such as mental trauma can cause depression
Loss of loved ones in a person’s life can lead to depression.
Social and environmental factors also contribute towards causing depression.
Depression, as mentioned earlier is a disease. It can be treated over time. The following are the ways to treat depression:
Various psychotherapy approaches are proven to cure depression.
Cognitive behavioral therapy can be used for this as well.

In some more serious, treatment-resistant cases other options such as ECT or rTMS can be used.
Various prescribed medications can also be used to treat depression.
AIM OF THE STUDY
To find how alcoholism leads to depression.

REVIEW OF LITERATURE
Sung YK, La Flair LN,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Mojtabai%20R%5BAuthor%5D&cauthor=true&cauthor_uid=25933091” Mojtabai R, Lee LC, Spivak S, Crum RM. (2016). The Association of Alcohol Use Disorders with Suicidal Ideation and Suicide Attempts in a Population-Based Sample with Depression. Found that there are associations between alcohol dependency, suicidality, and depression. Suicidality was assessed among current drinkers with 2-weeks of low mood.The number of suicide attempts and severity of depression was mediated by the drinking level.

HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Cheng%20HG%5bAuthor%5d&cauthor=true&cauthor_uid=26895091″Cheng HG, Chen S, McBride O, Phillips MR (2016) Prospective relationship of depressive symptoms, drinking, and tobacco smoking among middle-aged and elderly community-dwelling adults: Results from the China Health and Retirement Longitudinal Study (CHARLS). Found that people who showed initial symptoms of depression were not very likely to start drinking or smoking. Also it was found that, borderline drinking abuse was less likely to develop depressive symptoms. Though it was seen that in Males, who had never drank or smoked prior to the onset of depressive symptoms tended to have more rapid onset of tobacco and/or alcohol dependence compared to those without such symptoms.

Mentzakis E, Roberts B, Suhrcke M & McKee M (2016) Psychological Distress and Problem Drinking. Found that an individual with a drinking problem has an extremely detrimental effect on psychological distress, with problem drinkers exhibiting a 42% increase in the number of mental health problems, the most common problem reported was depression.
An R, Xiang X (2015) Smoking, heavy drinking, and depression among U.S. middle-aged and older adults. Found that non-smoking and non-heavy drinking depressed participants were more likely to engage in heaving drinking and smoking after a period of time. It was also found that, heavy smokers who didn’t have depression or alcohol addiction were more likely to develop depression and engage in heavy drinking after some duration.
Gigantesco A,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Ferrante%20G%5BAuthor%5D&cauthor=true&cauthor_uid=26513439” Ferrante G,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Baldissera%20S%5BAuthor%5D&cauthor=true&cauthor_uid=26513439” Baldissera S,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Masocco%20M%5BAuthor%5D&cauthor=true&cauthor_uid=26513439” Masocco M (2015) Depressive Symptoms and Behavior-Related Risk Factors, Italian Population-Based Surveillance System. Found that people who showed depressive symptoms are more likely to be consuming excessive amounts of alcohol, smoking cigarettes, being physically inactive and being obese, in comparison to those who aren’t showing depressive symptoms.
Hooker SA, MacGregor KL, Funderburk JS,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Maisto%20SA%5BAuthor%5D&cauthor=true&cauthor_uid=25425129” Maisto SA. (2014) Body mass index and depressive symptoms in primary care settings: examining the moderating roles of smoking status, alcohol consumption and vigorous exercise. Found that, depressive symptoms aren’t related to alcohol consumption, but on the other hand, Body mass index positively correlated with depression, so did people who were regular smokers. It also showed that people who engaged in vigorous exercise showed less depressive symptoms.

Hall, Mellisa (2012) Alcoholism and Depression. found that depression and alcoholism often need to be treated simultaneously, as a high percentage of depressed individuals engage in alcohol abuse. Before treating depression, alcoholism needs to be treated. Older adults are at a greater risk to have depression and alcoholism occur together, when compared to other age groups, though all age groups are at such a risk.

Bobo JK, Greek AA. (2011) Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval. Found that in older women depressive symptoms are closely linked with heavy drinking and smoking cigarettes, a link is also seen with education and retirement status. Hence it is important to periodically counsel women who are depressed on the risks of substance abuse, especially alcohol abuse.

Lejoyeux M,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Lehert%20P%5BAuthor%5D&cauthor=true&cauthor_uid=21118900” Lehert P. (2011) Alcohol-use disorders and depression: results from individual patient data meta-analysis of the acamprosate-controlled studies. Found that alcoholics, with depression can be defined by these 5 predictors: being female, younger, unemployed and living alone and being an episodic drinker. Depressed individuals had lower motivation to start and continue with the treatment, also in achieving abstinence. Depressed patients were more likely to become non-depressed if they quit drinking. Hence, it is important to identify depressive symptoms among alcoholics, but to treat the alcohol dependence first, as abstinence helps in treating depression.
Kertes, D. A., Kramer, J., Edenberg, H. J., Nurnberger, J. I., Hesselbrock, V, ; Schuckit, M. A. (2010). Gene variant linked to depression in alcohol-dependent individuals. Found that severity of alcohol dependence depends on the severity of the depressive symptoms including the duration of symptoms, number of episodes and extent of the symptoms.

Murphy, J. M., Gilman, S. E., Lesage, A., Horton, N. J., Rasic, D., Trinh, N.-H., …, Smoller, J. W. (2010). Time trends in mortality associated with depression: Findings from the Stirling COUNTY study. Found that in men alcoholism and heavy smoking doesn’t increase the risks associated with depression. Depressed men experienced a significant mortality risk that was not due to alcoholism and heavy smoking but due to external causes. These signs weren’t seen in depressed women.
Kelly JF, Stout RL, Magill M J, Tonigan S ; Pagano ME (2010) Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms? Found that an individual with heavier and frequent drinking had a greater association with depression. However greater AA attendance was linked with decrease in alcohol use and depression. The effects of AA on alcohol use was mediated partially by reductions in depression symptoms.
Benton, S. A. (2009). Understanding the high-functioning alcoholic and depression” The average age for first-time alcohol use in high-functioning alcoholics who show depressive symptoms is reported to be between the ages of 13 and 15 years. Children who begin drinking before the age 15 are five times more likely to become alcohol-dependent and show depressive symptoms than those who wait until age 21.

Conner KR,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Pinquart%20M%5BAuthor%5D;cauthor=true;cauthor_uid=19150207” Pinquart M, Gamble SA.(2009) Meta-analysis of depression and substance use among individuals with alcohol use disorders. Found that depression is linked to regular alcohol and drug abuse. Depression is also linked to future alcohol abuse and onset alcohol use disorder at an earlier age, though a stronger association was seen between depression and accohol abuse among older people.

Epstein JF,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Induni%20M%5BAuthor%5D;cauthor=true;cauthor_uid=19080015” Induni M, Wilson T. (2009) Patterns of clinically significant symptoms of depression among heavy users of alcohol and cigarettes. Found that heavy drinkers and daily smokers were 3 times more likely to show depressive symptoms than non-drinkers and non-smokers respectively. The people who engage in both the activities may be at an even greater risk for depression.
Centers for Disease Control and Prevention. (2009). Alcohol and risk of suicide: Suicide and alcohol among racial/ethnic populations. Found that people who engage in alcohol abuse with clinically significant depression have an increased risk of lifetime suicide, which is approximately 15%. This was visible in all the types of ethic populations to some extent.
Davis L,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Uezato%20A%5BAuthor%5D;cauthor=true;cauthor_uid=18281835” Uezato A, Newell JM, Frazier E. (2008) Major depression and comorbid substance use disorders. Found that almost one-third people with major depressive disorder also have some form of substance use disorders, with an increased risk of suicide. Differential treatment should be used for people with both depressive and substance abuse disorders instead of the standard treatments which are used for either.

.
Massak A, Graham K. (2008) Is the smoking-depression relationship confounded by drinking? An analysis by gender. Found that the link between depression and smoking was slightly reduced but remained significant when the drinking status and pattern were controlled for. The relationship between drinking and depression was stronger for women when depression was measured as meeting clinical criteria for depression at all levels of drinking, but in men only significant drinking related to depression along with regular smoking.

Horwitz AV (2008) Comfortably Numb: How Psychiatry Is Medicating a Nation. Found that even before medicines were developed for depressive disorders alcohol was used as a substitute, which is in practice till date.

Graham K,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Massak%20A%5BAuthor%5D;cauthor=true;cauthor_uid=17207105” Massak A, Demers A, Rehm J. (2007) Does the association between alcohol consumption and depression depend on how they are measured? Found that depression is mainly related to drinking bigger quantities per instance, the volume isn’t related as much, and it is completely unrelated to the frequency, also women are more strongly affected by this than men. When the depression is measured as meeting a clinical diagnosis, the overall relationship between the two is more significant in women. Finally, it is seen that former heavy drinker showed slightly higher rates of major depression than former light drinkers.
Schuckit MA, Smith TL,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Chacko%20Y%5BAuthor%5D;cauthor=true;cauthor_uid=16257139” Chacko Y. (2006) Evaluation of a depression-related model of alcohol problems in 430 probands from the San Diego prospective study. Found that people with depressive symptoms are more prone to development of alcohol problems both directly and through drinking to cope with the depression. A major reason why people with depression drank was to cope with the low mood and to get better sleep.

Manninen L, Poikolainen K, Vartiainen E, & Laatikainen T. (2006). Heavy drinking occasions and depression. Found that when compared to lifelong abstainers and people with no episodes of heavy drinking, ex-drinkers and subjects with heavy drinking occasions had more often clinically significant depression. It is also seen that men aged between 45–64 years with heavy drinking had 2.3 times higher risk for depression as compared with young men (aged 25–34 years) without any heavy drinking occasions. The respective risk for old women was 2.2 times higher.

Sullivan LE,  HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Fiellin%20DA%5BAuthor%5D;cauthor=true;cauthor_uid=15808128” Fiellin DA, O’Connor PG. (2005) The prevalence and impact of alcohol problems in major depression: a systematic review. Found that antidepressants prove to be more beneficial in people with depression and alcohol dependency. Alcohol problems are linked with worse outcomes with respect to depression course and suicide/death risk. It is seen that alcohol abuse is more common in depression than in the general population.

Silberg J, Rutter M, D’Onofrio B, Eaves L. (2003) Effect of depressive risk factors in adolescent substance use. Found that even though depression was moderately associated with substance use, the pattern differed for males and females. It was noted that depression lead to smoking, drug use and, to a lesser extent, alcohol abuse in girls as compared to men. Men mostly indulged in these activities due to environmental factors and peer groups.

Preuss UW, Schuckit MA, Smith TL, Danko GP, Buckman K, Bierut L, Bucholz KK, Hesselbrock MN, Hesselbrock VM, Reich T (2002) Comparison of 3190 alcohol-dependent individuals with and without suicide attempts. Found that
alcohol-dependent individuals with a history of suicide attempts are found to have a significantly greater course of alcohol dependence. Hence treatment of alcohol use and substance use disorders among alcoholics is extremely important in preventing suicide attempts and completions.

Swendsen JD, Merikangas KR. (2000) The comorbidity of depression and substance use disorders. Found that the link between alcohol abuse and depression is more likely due to external or causal factors rather than a direct link between the two. The research shows that there are multiple mechanisms of comorbidity that are likely to be simultaneously active in this population.

Prescott CA, Aggen SH, Kendler KS. (2000) Sex-specific genetic influences on the comorbidity of alcoholism and major depression in a population-based sample of US twins. Found that individuals with Major Depression were at significantly increased risk for alcohol dependence and for a combined diagnosis of alcohol abuse and/or dependence. History of Major Depression in a twin significantly increased the risk of cotwin alcohol dependence and alcohol abuse and/or dependence among identical twins only, this was not observed in fraternal twins.

Baving L & Olbrich H. (1996) Alcoholism and Depression found that alcoholic individuals with depression, exhibited greater alcohol abuse, greater physical damage and higher liability to drug abuse and overdose, when compared to non-depressive alcoholics. The former are also at greater risk of suicide along with a higher risk of relapse. It is seen that depression may be a result of alcoholism: either induced by heavy alcohol consumption, as a consequence of alcohol withdrawal or as a psycho reactive phenomenon.
Pomerleau CS, Aubin HJ, Pomerleau OF. (1997) Self-reported alcohol use patterns in a sample of male and female heavy smokers. Found that drinkers with a history of alcohol dependence drank significantly more per week than drinkers with no history, it was more pronounced in men than in women. Though drinkers of both genders with a history of alcohol dependence highly linked with having clinical depression. It was also noted that presence of both depression and alcohol dependence, had a negative effect on the ability to stop smoking.
Robert A. Woodruff Jr.; Samuel B. Guze; Paula J. Clayton; et al (1973) Alcoholism and Depression found that the majority of patients with alcoholism and depression had a history of onset of alcoholism prior to that of depression. Patients with alcoholism plus depression more closely resembled those with alcoholism than those with depression. 
DISCUSSION AND CONCLUSION
Alcoholism can be seen as leading cause towards depression. Furthermore, people who already have depression, and tend to engage into alcoholism can see more damages happening to their physical and mental health.
After doing research on this topic and finding various primary researches, I have come to a conclusion that both alcoholism and depression aren’t only correlated but in many causes they stimulate one another. They are inter-connected like a never ending loop.
Alcohol has a sedative effect on the human brain. While having it in a small amount makes a person feel relaxed, consuming it in larger amounts enhances the depression symptoms a person may have. Alcoholism can make a person’s problems look bigger than they actually are. Alcohol contains depressants. It is capable worsening a person’s depression symptoms.
Many common depression symptoms include, fatigue, indecisiveness, irritability, insomnia, overeating etch.
Alcohol abuse and Depression
According to studies, 30-50% of people who abuse alcohol, have some kind of depressive symptoms at any given day. It’s also researched that children who show depressive symptoms are more likely to become alcoholic addicts when the reach adolescence.
WebMD says that nearly one-third of people with severe depression tend to abuse alcohol.

Effects of Alcohol on Depression
The effects of alcohol os given as the following:
Alcohol lowers serotonin and norepinephrine levels, which helps in regulating mood. Low levels of these chemicals can make a depressed person more depressed.

Alcohol temporarily cuts off the effects of stress hormones which can exaggerate your depression symptoms as it depresses the brain and nervous system.

Stress or drugs such as alcohol or cocaine can activate a gene that is linked to depression and other mental health problems. The gene can result in seizures, depression, manic-depressive episodes, and other mental problems, according to Robert Post, chief of the biological psychiatry branch of the National Institute of Health (NIH).

Folic acid deficiency contributes to aging brain processes and increased risk of Alzheimer’s disease and vascular dementia. Depression is also common in those with folate deficiency. Alcohol use can lower levels of folic acid.

Alcohol disrupts sleep and alters the thought process, which can increase depression symptoms.

Alcoholism and depression – A person suffering through both of these issues can seek dual-diagnosis treatment.

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