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Alcohol and Mental Illness

[Download the NAMI alcohol and mental illness fact sheet.]

Alcohol is legal for adults over the age of 21 in most states, and the majority of people who drink alcohol do so responsibly and without experiencing significant adverse effects. Yet, alcohol is one of the most commonly abused substances in America—nearly one in five people will experience problematic alcohol abuse at some point in their lifetime. People who abuse alcohol experience consequences of their excessive alcohol use. Someone who gets sick, injured or arrested due to their drinking—or who experiences problems at work, school or home due to being intoxicated or hung-over—likely has a problem with alcohol.

What happens when a person abuses alcohol?

After using alcohol, a person may begin to feel “drunk.” This can involve peaceful feelings, such as being happy, silly or confident, which are most likely related to alcohol’s interactions with certain chemicals in the brain (e.g., the neurotransmitter GABA [gamma-aminobutyric acid]). People with mental illness are more likely to also experience negative emotions such as depressed mood or anxiety.

People who regularly abuse alcohol may become addicted (e.g., their body becomes physically dependent on the substance). An addicted person who abruptly stops drinking alcohol may experience alcohol withdrawal, a medical emergency requiring immediate treatment. Alcohol withdrawal can result in heart problems (e.g., arrhythmias), seizures or delirium tremens (an acute delirious state), all which can be fatal.

Therefore, many people seek assistance in going through the process of stopping their alcohol abuse. This can include inpatient detoxification, which can involve admission to a hospital—either a general hospital or a detoxification facility—and treatment with the appropriate medications to help avoid serious complications of alcohol withdrawal.

What is the relationship between alcohol and mental illness?

The relationship between alcohol abuse and mental illness is complex, and the treatment of both together is more complicated than the treatment of either condition alone. Certain groups of people with mental illness—including males, individuals of lower socioeconomic status, military veterans and people with other medical illnesses—are at increased risk of abusing alcohol. Recent scientific studies have suggested that nearly one-third of people with mental illness experience alcohol abuse. Conversely, more than one-third of all alcohol abusers are also battling mental illness.

Scientific data is clear that regular alcohol abuse is linked with increased risk of legal troubles and jail time, difficulties at school and at work, as well as abuse of other drugs.

Alcohol abuse results in a worse prognosis for a person with mental illness. People who are actively using are less likely to follow through with the treatment plans they created with their mental health professionals. They are less likely to adhere to their medication regimens and more likely to miss appointments, which leads to more psychiatric hospitalizations and other adverse outcomes. Active users are also less likely to receive adequate medical care for similar reasons and are more likely to experience severe medical complications and early death. People with mental illness who abuse alcohol are also at increased risk of impulsive and potentially violent acts. Perhaps most concerning is that people who abuse alcohol are more likely to both attempt suicide and to die from their suicide attempts.

People with mental illness and active alcohol abuse are less likely to achieve lasting sobriety. They may be more likely to experience severe complications of their substance abuse, to end up in legal trouble from their substance use and to become physically dependent on alcohol.

What is the relationship between alcohol and medical illness?

The potential health benefits of controlled alcohol use are largely beyond the scope of this review. However, it should be noted that while limited quantities of alcohol have been shown to be helpful in certain medical illnesses (e.g., cardiovascular disease), it is by no means a first-line treatment for these conditions. In fact, the majority of people who abuse alcohol are at risk of significant side effects. Heavy alcohol abuse remains the number one cause of liver cirrhosis in America. Cirrhosis can lead to the need for liver transplantation or death. Alcohol abuse is also associated with heart disease, diabetes and certain types of cancer.

In younger people, alcohol can also be associated with sexual dysfunction and infertility. Women who abuse alcohol while pregnant are more likely to experience complications during their pregnancies and to deliver babies with birth defects (including but not limited to fetal alcohol syndrome).

What treatments are available for people with alcohol abuse and dependency?

For people with severe alcohol abuse, the first step is to ensure a safe detoxification. After this is achieved, many options exist for people who are newly sober or who are trying to avoid relapse on alcohol. These can include inpatient rehabilitation centers or supportive housing (e.g., sober houses, group homes or residential treatment facilities). Others may choose to return home to their friends and family who can be helpful in encouraging the newly-sober individuals to continue their efforts.

Some people find therapy to be a helpful part of maintaining their sobriety. This can include self-help groups such as Alcoholics Anonymous or SMART Recovery. Individual therapy can also be useful and some people will find that cognitive behavioral therapy is an important part of their treatment plan. Another form of therapy called “motivational interviewing”—an interactive, patient-centered model of treatment focused on finding inspiration for behavioral change—has been found to be effective in helping people to stop abusing alcohol. These and other tools can be useful, as a significant majority of people will relapse at some point in their lives, even if they are eventually able to achieve long-lasting sobriety.

There is no medication that can cure alcoholism . A number of different medications have been studied in the treatment of alcohol abuse and dependency. Disulfiram (Antabuse), acamprosate (Campral) and naltrexone (Revia, Vivitrol) have all been approved by the US-FDA for the treatment of alcohol abuse and dependency.

Family, friends and others can be most helpful in providing empathic and non-judgmental support of their loved ones. With this support and effective psychiatric treatment, many people with alcohol abuse and mental illness will be able to actively participate in their recovery journey.

Reviewed by Jacob L. Freedman, M.D., and Ken Duckworth, M.D., February 2013

[Download the NAMI alcohol and mental illness fact sheet.]

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