Self-medication is not a concept that can only be applied to people with diagnosed mental health problems, and is in fact a useful way to describe many of the reasons we drink.

Little has been said in public policy documents about the way the general population relies on alcohol - a legally available drug - as a mood-altering substance that is used to mask other problems, or to deal with emotions.

Alcohol is a toxic substance in terms of its direct and indirect effects on the chemistry of the brain and other body organs and systems.

The initial impact of a drink - that "winding down" or relaxing feeling - is a reflection of almost immediate chemical changes occurring in the brain's nerve cells (neurons) in response to alcohol.

As more alcohol is consumed, increasingly sensitive parts of the brain become affected and behaviour changes accordingly.

The first drink for many people (although not all) depresses the parts of the brain that are associated with inhibition, increasing talking and self-confidence and reducing social anxiety.

As more alcohol enters the bloodstream, the areas of the brain associated with emotions and movement are affected, often resulting in exaggerated states of emotion (anger, withdrawal, depression or aggressiveness) and uncoordinated muscle movements.

Alcohol then depresses the nerve centres in the area that controls sexual arousal (which increases) and performance (which doesn't).

Drinking to relieve anxiety and depression

There is much evidence to show that many people drink to help deal with anxiety and depressive thoughts. It reveals that alcohol can be a favourite coping mechanism.

When the results of a recent survey were extrapolated to the general population, researchers found that up to 12 million adults in the UK drink to help them relax or overcome feelings of depression.

There are two potential problems in using this coping mechanism.

Firstly, self-medicating with alcohol can become self-perpetuating. Underlying anxiety leads to increased alcohol use, which changes the physiology of the brain and leads to a depletion of the neurotransmitters (the brain's 'messengers') that it needs to reduce anxiety naturally.

Therefore, the individual feels more anxious and needs more alcohol to 'numb' their anxiety.

In the long term, this can lead to an individual becoming tolerant of alcohol - that is, they need increasingly large amounts of drink to experience the same reduction in their anxiety.

The second problem with using alcohol to self-medicate is that it is difficult to maintain exactly the amount of alcohol needed to reduce the negative feelings.

Keeping the optimum balance of alcohol to reduce anxiety is almost impossible because the effect of alcohol on the brain is such that after the initial 'euphoria' or stimulation from the first drink, alcohol acts as a depressant and the feelings of anxiety may rapidly return.

Increased drinking to cope with those feelings leads to a rapid increase in the levels of alcohol in the blood and may become counter-productive.

The problem with drinking to relieve depression is similar to the problems described above with anxiety.

Regular drinking changes the chemistry of the brain and, of particular relevance here, depletes the levels of the neurotransmitter serotonin.

This is a brain chemical implicated in depression. This leads to the cyclical process of drinking to relieve depression, becoming more depressed as levels of serotonin become more depleted, thus needing more alcohol to medicate the depression.

Increased alcohol consumption can also affect social relationships and work life, which in turn can contribute to depression 3.

Alcohol depresses the Central Nervous System, and this can have a disinhibiting effect which can reveal or amplify our underlying feelings.

This is one of the reasons that many people become angry or aggressive when drinking. If our underlying feelings are of anxiety and low mood then alcohol can also exaggerate them.

Executive Summary

In short, drinking to mask anxiety, depressed mood or general unease has the opposite effect either when blood alcohol levels increase or once the drink wears off.

This is why a physical hangover is very often accompanied by anxiety or low mood.

"I don't really know when I started drinking. I should say I have had various breakdowns due to depression and with those I have always tended to drink alcohol. I was drinking enough to stay numb."
Susan, 53, retired nurse


What the evidence shows

Evidence outlined in this report has shown that:

there are significant connections between reported alcohol use and depressive symptoms

people report using alcohol to help them sleep

people drink more when experiencing moderate to high levels of shyness or fear
anxious people use drinking 'to cope' and are more likely to avoid social situations where alcohol is not available

as many as 65% of suicides have been linked to excessive drinking

70% of men who kill themselves have drunk alcohol before doing so

almost a third of suicides amongst young people are committed while the person is intoxicated

anxiety and depressive symptoms are more common in heavy drinkers

heavy drinking is more common in those with anxiety and depression

there is a significant relationship between job stress and alcohol consumption

Many GPs believe that alcohol is a cause of mental health problems.

Implications

The consumption of alcohol can have positive as well as negative effects. There is some evidence associating light drinking with improved emotional, mental and physical health.

But there is an emerging picture of alcohol use as a way of masking problems, and helping us cope with emotions we would otherwise find it too difficult to deal with.

Many of the personal stories outlined in this report paint a picture of loss caused by over-consumption of alcohol - from the loss of important memories linked with important occasions; to the loss of work, relationships and self-esteem.

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Excerpted from Mental Health Foundation [UK] Report on the effects of Alcohol on Mental Health [pdf]