Alcohol and Mental Health Issues - Should One be Treated Before the Other?

by Xanthippe
(Portland, ORE, US)

I have had issues with depression, anxiety, severe shyness, abuse, and poor self-esteem all my life. By compounding this with a problem drinking, I find myself in a desperate situation. I pour four to six (sometimes more) double shots of hard liquor, five to seven nights a week, into a ninety-seven pound petite female body. I never leave the house except with my boyfriend, and that's only once every couple of weeks or so. The depression and anxiety seem only to have worsened, I'm a fully-fledged agoraphobic, and my work (at home, of course, writing and illustration) has faded nearly into oblivion. My boyfriend is 100% supportive and non-judgmental, I'm grateful to say, but he can’t fix my problems.

When alcohol is involved with other mental problems such as those listed, is there a benefit to treating the addiction first or the other way round? Our financial standing is not ideal. I'm pretty much metaphorically paralyzed. I’m afraid for my health, my sanity, and future.


Reply



Many people with addictions also suffer from mental health disorders. The unfortunate cycle that you have touched on is a complication that many people go through and become distraught over as they self-medicate their mental health with the alcohol, thus worsening the mental health and leading to more self-medication. You have already conquered an important part of treating co-occurring disorders (both alcohol use disorder and mental health disorder) by simply being aware of it. Strong self-awareness is key to any treatment.

In terms of treating the alcohol abuse and your mental health, the two should not be thought of as separate. They are both negatively impacting your ability to thrive and the best approach is an integrated treatment method to address both sides of the same coin. When treating both alcohol and depression/anxiety, two things could possibly occur: sobriety from alcohol could lead to increased depression/anxiety since it was used as self-medication OR sobriety could lead to decreased depression/anxiety if the alcohol was the source of the mental health concerns. Because of this, treatment providers will look into your history of depression, anxiety, and other mental health concerns, as well as your history of alcohol use. In this specific case, it sounds like the depression and anxiety was present before the alcohol abuse since you acknowledged it’s been present ‘all your life’.

In situations where the alcohol abuse was present later in life, the main focus would be on the mental health itself. A treatment professional would evaluate your history and symptoms and provide an appropriate diagnosis, as there are many forms of depression and anxiety such as major depression, bipolar depression, subsyndromal mood disturbance, etc. This is vital to provide appropriate intervention and treatment. They will also evaluate your level of abuse, and dependence, on alcohol to have a successful approach to sobriety tailored to you. Your treatment provider will create a treatment plan specifically for you addressing both your mental health and alcohol use together, to best benefit your wellbeing.

With the agoraphobia (fear of certain situations and places) you described, it can be very overwhelming to find treatment. However, there are many options tailored specifically to your situation of agoraphobia and addiction in modern times, as the two do often go together. Integrated treatment for agoraphobia and addiction can include psychotherapy, medication if deemed appropriate (many found positive responses through evidence based research), holistic stress management, and learning coping skills.

Overall, your mental health concerns and alcohol use should be viewed and treated together, as they are intertwined through a cycle. Having the self-awareness to seek treatment and be accepting of help and support is the first step towards thriving in your journey in recovery.

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I drink too much, and suffer from depression. How do you treat two issues?

Should one issue be treated first, or are they both treated at the same time?

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