Dual Diagnosis: Alcoholism & Depression

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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Dual Diagnosis: Alcoholism and Depression

Psychiatric problems like depression and anxiety frequently coincide with alcohol use disorder (AUD). Individuals with AUD are more likely to suffer from depression than any other mental illness. Having both conditions at once increases the likelihood of suicidal thoughts and actions compared to having either one alone. The good news is that those who suffer from both alcoholism and depression can obtain help through dual-diagnosis programs. 

What Is Alcoholism?

Alcoholism is a chronic, progressive illness that manifests as harmful and compulsive alcohol use. It goes beyond social drinking to a reliance on alcohol as a means of coping with or escaping difficult feelings. This condition arises from a combination of genetic predisposition, the external environment, and the individual’s own psychology. Alcohol abuse may result in physical and psychological dependency, which can have far-reaching negative consequences in your personal, professional, and social lives.

Damage to the liver, heart problems, and an increased chance of developing mental health problems are just some of the consequences of heavy, persistent alcohol use. It causes problems in interpersonal relationships, slows cognitive processes, and clouds judgment, raising your risk of encountering legal and financial problems. Alcoholism is a complex disease with wide-ranging effects that impact not only the alcoholic but also their loved ones and the larger community.

Symptoms of AUD

The symptoms of excessive alcohol use become worse over time. The short-term symptoms of problem drinking are:

  • Poor nutritional habits
  • Poor hygiene
  • Stuffy nose 
  • Fluctuations in weight
  • Slurred speech
  • Mental impairment
  • Slow response times

The long-term effects of alcoholism may include:

  • Performance issues at work or school
  • Broken relationships
  • Lack of interest in healthy activities
  • High tolerance for alcohol
  • Inability to quit drinking
  • Financial losses
  • Legal issues
  • Health problems

What Is Depression?

In the United States, 8.3% of adults reported having a depressive episode in 2021. The majority of these people were young adults (18–25 years old), with women making up a larger proportion of the total than men.

Types of Depression

Depression is actually an umbrella term for many forms of depressive disorders. Psychotic depression impacts about 0.4% of adults, including as many as 3% of those over 60. Alternatively, 2.5% of the population has a persistent depressive disorder at some point. Experts estimate that seasonal affective disorder affects millions of Americans, but many people are unaware they have it. 

Psychotic Depression

Having psychotic symptoms is an indicator of psychotic depression, a severe form of major depression. Individuals with this illness suffer from symptoms of depression mixed with altered views of reality. Delusions and hallucinations are prevalent, and they often center on ideas of guilt, worthlessness, or a lack of self-sufficiency.

These psychotic symptoms carry grave implications for everyday life and make it hard to tell reality from fiction. Prompt and thorough treatment is necessary for psychotic depression, which often includes a mix of psychotherapy, medication, and emotional assistance to alleviate both the depressive symptoms and the psychotic aspects.

Persistent Depressive Disorder

Persistent depressive disorder (PDD), formerly known as dysthymia, is a prolonged type of depression that  lasts for at least two years. Unlike psychotic depression, PDD presents a milder but ongoing low mood, along with other symptoms such as changes in food choices, insomnia, low levels of energy, and despair. 

PDD’s persistent nature can affect a person’s everyday functioning and general quality of life, even if the symptoms aren’t as severe as those of major depressive episodes. To reduce symptoms and improve long-term health, treatment generally involves psychotherapy and sometimes medication. Research shows that a combination of medicine and psychotherapy is more effective than either one alone.

Seasonal Affective Disorder

Seasonal affective disorder (SAD) is a kind of depression that strikes during the autumn and winter months when daylight hours are shorter. Symptoms include persistent fatigue and low energy, oversleeping and insomnia, changes in appetite, and increased irritability. 

SAD differs from PDD in that it is episodic rather than persistent and does not involve psychosis. When comparing SAD with PDD, it’s important to note that although both entail depression, SAD is seasonal and improves as the weather becomes warmer and the days longer. There are more severe symptoms associated with psychotic depression, such as hallucinations and delusions. To effectively manage each illness, unique therapies are necessary.

Causes of Depression

The various causes of depression usually include biological, psychological, environmental, medical, and genetic factors. Biological factors include genetic predisposition, neurotransmitter imbalances, and abnormalities in brain structure. Psychological factors include negative thought patterns, trauma, and prolonged stress. Environmental variables that can lead to depression include chronic exposure to violence, childhood abuse, poverty, and more. Certain illnesses may result in depressive symptoms, as can hormonal imbalances and some medications. Genetic influences include a family history of depression. Considering these underlying reasons during diagnosis and therapy ensures the client receives custom-tailored care, which leads to more effective treatment and interventions. 

How Does Alcoholism Affect Depression?

Depression and alcoholism have a complicated connection. People with depression may use alcohol as a coping method, but this just makes their situation worse in the long run. Alcohol is a central nervous system depressant that worsens depressive disorders by upsetting the balance of neurotransmitters in the brain. 

Because of their cyclical nature, alcohol abuse and depression may encourage one another and lead to a vicious cycle. And because alcohol consumption coincides with impaired judgment and an increased likelihood of impulsive behavior, dealing with depression becomes much more difficult. For optimal healing and psychological health, it is essential to address both disorders simultaneously via integrated care.

How Does Depression Affect AUD?

Individuals with depression may resort to alcohol to self-medicate, seeking temporary escape from emotional agony. However, this method of coping worsens depressive symptoms. Anxiety and depression are both risk factors for developing an alcohol use problem. Because of how various illnesses interact with one another, therapy must take into account the complexities that arise throughout the healing process. For effective and long-term treatment of mental health and drug use disorders, it is essential to get to the root causes of issues like depression and alcoholism.

How Does Dual Diagnosis Treatment Help With AUD and Depression?

Because of the intrinsic relationship between alcoholism and depression, dual diagnosis therapy provides extensive, all-encompassing treatments for both conditions at the same time. This integrated strategy improves outcomes by zeroing in on and eliminating the underlying causes of both illnesses. 

Experts in dual diagnosis work with clients to help them learn coping mechanisms, control their reactions to triggers, and overcome the obstacles presented by their conditions. The individualized nature of dual diagnosis therapy increases the likelihood of intervention adherence. This, in turn, promotes long-term sobriety and better mental health by breaking the reinforcing loop of alcoholism and depression.

Medication Management

The overall effectiveness of dual diagnosis therapy for depression and alcoholism benefits significantly from medication management, which helps clients on their recovery path by stabilizing their mood, lowering cravings, and treating underlying problems. Medication management is an integral part of a holistic treatment plan that includes psychotherapy.

It is important to take a cautious and personalized approach to medication management in dual-diagnosis therapy for depression and alcoholism. When diagnosing and treating clients, psychiatrists must take into account the individual’s history of substance abuse and mental health status. Doctors often prescribe medications like acamprosate and naltrexone to help with alcoholism while administering antidepressants to treat depression. Dual-diagnosis therapy allows for regular monitoring, which enables dose modifications for maximum efficacy. 


Several different types of counseling are used in dual-diagnosis therapy for alcoholism and depression. Cognitive behavioral therapy (CBT) can help clients identify and alter destructive ways of thinking that contribute to their depression and anxiety. 

Dialectical behavioral therapy helps people learn to better manage their emotions and cope with stressful situations.  Alternatively, motivating people to overcome doubts and take action is a goal of the counseling technique known as motivational interviewing

Counseling methods that take into consideration the intricate connection between alcoholism and depression are synergistic. They can help clients achieve a sober lifestyle and cope with co-occurring mental health disorders.

Support Groups

Support groups can complement dual-diagnosis therapy for alcoholism and depression. By bringing together people who are recovering from addiction, groups like Alcoholics Anonymous (AA) help everyone involved. 

The Depression and Bipolar Support Alliance (DBSA) is another helpful organization for those dealing with depression and alcoholism. Self-efficacy and mental strategies are at the heart of the SMART Recovery framework. These groups, led by knowledgeable facilitators, help people struggling with alcoholism and depression by fostering a sense of belonging, encouraging the exchange of personal experiences and providing insightful advice.

Mindfulness Interventions

When a person is dealing with a dual condition such as alcoholism and depression, mindfulness techniques may be helpful. Mindfulness-based cognitive therapy (MBCT) helps people break destructive patterns of thinking related to depression and anxiety by training them to pay attention to the here and now. The goal of mindfulness-based relapse prevention (MBRP) is to reduce the likelihood of a relapse into depression and alcohol consumption by helping people develop more insight about themselves, which helps them be more resilient. 

Practicing mindfulness meditation techniques like deep breathing or body scans might help you become more in tune with your emotions without attaching any judgment to them. These programs aid in the treatment of depression and alcoholism by encouraging introspection, stress reduction, and a heightened awareness of triggers. 

The Alcohol Awareness Hotline Can Help You Find Resources

If you or someone you love is struggling with alcoholism and depression, help is available. Here at Alcohol Awareness, we spend every day helping people connect with resources. Contact us today by calling (885) 955-0771 to learn more about the support services available in your area.