The relationship between mental health, alcohol and illicit drugs
The relationship between mental health, and alcohol and other drugs, is complex. People who experience mental health issues and conditions are more likely to use alcohol and other drugs and visa versa.12
Experiencing alcohol or other drug issues and one or more diagnosed mental health conditions is common in the community.2 It has been estimated that at least 30 to 50 percent of people with an alcohol and/or other drug issue also have a mental health condition.3
Whilst people may feel alcohol and other drugs help with feelings of stress, anger, worry and sadness, they are not an effective solution and can actually negatively affect our mental health and wellbeing both in the short-term and long-term.
How alcohol affects our mood and mental health
Alcohol is a drug that has a depressant effect on the body and can negatively affect thoughts, feelings and actions. Alcohol, can cause agitation, lack of motivation, large changes in mood,4 and increased stress and anxiety.5 Over time, alcohol can contribute to the development of, or worsen existing mental health issues.6
The most immediate effects of alcohol are on the brain.5 Alcohol slows down the central nervous system (your brain and spinal cord), which controls the way your brain communicates with your body, affecting the way you think, feel and act.
Because alcohol causes changes in the brain, leading to the depletion of chemicals that naturally help to reduce anxiety. As a result, we can be left feeling even more stressed, anxious or depressed, and then feel we need more alcohol to help cope with these feelings.7 This is why when people use alcohol to relax or cope with stress, in the long-term, it can contribute to increased stress, anxiety and depression, and increase overall alcohol use. Research has found that those who reported ‘self-medicating’ their mood by drinking alcohol have a greater likelihood of developing alcohol dependence.89
Alcohol use and mental health conditions
Alcohol use can play a role in the development and progression of mental health conditions.
The relationship between alcohol and mental health conditions, such as depression and anxiety, has been summarised below:
A person who is dependent on alcohol is more likely to develop a mental health condition and having a mental health condition can also increase the likelihood of developing alcohol dependence.28
For example, for those who experience alcohol dependence, the risk of depression doubles.10 Similarly, people with diagnosed anxiety and depression are more than four times more likely to experience alcohol dependence, compared to the general population.11
Impact of alcohol on sleep
Getting a good night’s sleep is important in maintaining your mental health and wellbeing.7 While alcohol may help you to fall asleep and stay asleep for the first half of the night, it is likely to disturb your sleep in the second half of the night, which is the more important part of our sleep cycle.5 The lack of quality sleep not only affects your mental health and wellbeing, but it can also affect your ability to function during the day and your overall quality of life.13
Post alcohol anxiety
It is also not uncommon for people to report increased feelings of anxiety following alcohol use. This can be known as ‘hangxiety’ and occurs during the ‘hangover’ period. Alcohol stimulates the production of GABA, a chemical that helps calm down the brain. After a few drinks, the brain also starts to increase glutamate, a receptor which helps further increase feelings of calmness.14 The combination of these chemicals and receptors can briefly decrease anxiety and worry, however, once this has worn off the next day you can experience increased levels of worry, agitation and anxiety.6
Wanting to reduce your drinking?
To stay at low-risk of alcohol-related harm, including mental health issues, the National Health and Medical Research Council (NHMRC) recommended for healthy men and women drink no more than two standard drinks on any day.
The NHMRC recommends for anyone who is receiving treatment for a mental health condition to discuss their alcohol use with a healthcare professional. If you are taking prescribed medication for a mental health condition, it’s also important to remember that alcohol and other drugs interact with your medications and can reduce their effectiveness or increase the chances of side effects.
For more information about the health effects of alcohol and ways to prevent and reduce alcohol related harm, visit the Alcohol.Think Again website.
Mental health and illicit drug use
There is a strong association between illicit drug use and mental health issues and conditions.15 Like alcohol, people who use drugs may also experience mental health issues or conditions but it’s hard to tell which came first. Experiencing a mental health issue or condition can make a person more likely to use drugs and other people may use drugs which contribute to the development of a mental health issue or condition.16 There are also instances where a person may experience both issues without one causing or contributing to the other.17
In 2019, people with a diagnosed or treated mental health condition in the past 12 months were almost twice as likely (1.7 times) to have used any illicit drug in the last 12 months in comparison to people who did not have a mental health condition. Additionally, 26% of people who had recently used any illicit drug reported experiencing high or very high psychological distress.18
Co-occurring mental health issues and drug use problems
A mental health condition does not always cause drug use problems and vice versa. This is because both mental health conditions and drug use problems can be caused by the same risk factors such as genetics, changes in similar areas of the brain, and environmental factors:19
- There is a complex interaction among genes (DNA) and the environment that can increase the risk of the person experiencing both a mental health condition and drug use problems.2021 For example, frequent and heavy cannabis use during adolescence is associated with increased risk of psychosis in adulthood, specifically among individuals who have a specific gene.22
- Many of the same areas of the brain are affected by drug use problems and mental health conditions. For example, parts of the brain that control reward, decision making, impulse control and emotions are affected by both drug use and some mental health conditions.19 Further, the brain messengers (neurotransmitters) have also been shown to be affected by both drug use and mental health conditions.19
- Environmental factors such as chronic stress, trauma and negative childhood experiences are associated with an increased risk of developing drug use problems and mental health conditions.25
In some cases of illicit drug use in individuals with mental health issues, the illicit drug use use occurs in an attempt to relieve mental health symptoms. If this happens repeatedly, over time a substance use issue is likely to develop.16
How illicit drugs affect mental health
Different types of illicit drugs can have varying side effects and impacts on mental health as they affect the body in different ways and can vary from person to person. It is difficult to predict how someone will react to a specific drug. Drugs interfere with the chemicals in the brain and can affect the brains messaging and function. This can impact on your mood contributing to the onset or worsening of mental health issues.19
Drug use can also lead to changes in some of the same areas of the brain that other mental health conditions such as schizophrenia, anxiety, mood, or impulse-control conditions also change. 2627
Therefore drug use, that happens before the first symptoms of a mental health issue or condition appear, can contribute to changing brain structure and function that may increase the risk of developing a certain mental health condition.
How mental health issues and conditions contribute to drug use
Evidence shows that some mental health conditions increase the risk for developing a drug use problem.28 Some people may use drugs to ‘self-medicate’ or reduce physical or emotional pain.17 Although this may temporarily reduce symptoms they can also worsen mental health issues or conditions both in the short, and long-term. For example, evidence suggests that cocaine use may worsen the symptoms of bipolar disorder and contribute to its progression.29
For more information on the effects of specific illicit drugs on mental health head to the Drug Aware website.
Do you or someone you know need help?
Call 000 in an emergency if you or someone you know is in a life threatening situation, or is at-risk of harm to themselves or others.
Alcohol and other drug support
If you or someone you know you know needs help in for their alcohol or drug use, the Alcohol and Drug Support Line is a confidential, non-judgemental telephone counselling, information and referral service. The phone service is free of charge and available 24/7 by calling (08) 9442 5000 or 1800 198 024 (toll-free for country callers).
Live Chat is also free of charge and available for Western Australian residents. You can access the Live Chat here.
Mental health support
The Mental Health Emergency Response Line is available 24/7 for anyone in the community experiencing a mental health emergency. This includes support for individuals, families/carers, members of the general public or health professionals.
For other mental health support options, including how your GP can help, visit the Think Mental Health support services page.
Australian Institute of Health and Welfare (AIHW) 2017. National Drug Strategy Household Survey 2016: detailed findings. Drug statistics series no. 31.
Hall, W., Degenhardt, L., Teesson, M. (2009). Understanding the comorbidity between substance use, anxiety and affective disorders: broadening the research base. Addictive Behaviors, 34, 526-530.
Western Australian Mental Health Commission. (2015). Better Choices. Better Lives. Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025. Perth, WA: Mental Health Commission.
Beyondblue [Internet]. Victoria (Australia): Beyond Blue Limited; c2020. Alcohol and Drugs [cited 2020 July 17]. Available from: https://healthyfamilies.beyondblue.org.au/age-13/raising-resilient-young-people/alcohol-and-drugs
National Health and Medical Research Council. (2009). Australian Guidelines to reduce health risks from drinking alcohol. Canberra, ACT: Commonwealth of Australia.
Jane‐Llopis, E. V. A., & Matytsina, I. (2006). Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug and alcohol review, 25(6), 515-536.
Mental Health Foundation. (2006). Cheers? Understanding the relationship between alcohol and mental health. Retrieved from: https://www.bl.uk/collection-items/cheers-understanding-the-relationship-between-alcohol-and-mental-health
Crum, R., Mojtabai, R., Lazareck, S., Bolton, J., Robinson, J., Sareen, J.,& Storr, C. (2013). A prospective assessment of reports of drinking to self-medicate mood symptoms with the inci-dence and persistence of alcohol dependence. JAMA Psychiatry, 70(7), 178-726.
Turner, S., Mota, N., Bolton, J., & Sareen, J. (2018). Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and Anxiety, 35, 851-860.
World Health Organization. (2018). Global status report on alcohol and health 2018. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf
Boschloo, L., Vogelzangs, N., Smit, J., can den Brink, W., Veltman, D., Beekman, A., Penninx, B. (2011). Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders. Findings from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Affective Disorders, 131, 233-242.
Mental Health Foundation. (2011). Sleep matters. The impact of sleep on health and wellbeing. Retrieved from: https://www.mentalhealth.org.uk/publications/sleep-report
Drake, C., Roehrs, T., & Roth, T. (2003). Insomnia causes, consequences and therapeutics: an overview. Depression and Anxiety, 18, 163-176.
Marsh, B., Carlyle, M., Carter, E., Hughes, P., McGahey, S., Lawn, W., Morgan, C. J. . (2019). Shyness, alcohol use disorders and “hangxiety”: A naturalistic study of social drinkers. Personality and Individual Differences, 139, 13–18. https://doi.org/10.1016/j.paid.2018.10.034
Australian Institute of Health and Welfare (2019). Alcohol, tobacco & other drugs in Australia - Mental health conditions.
Deady, M., Teesson, M., & Brady, K. T. (2013). Chapter 55 - Impact of Substance Use on the Course of Serious Mental Disorders. https://doi.org/10.1016/B978-0-12-398336-7.00055-3
Santucci K. Psychiatric disease and drug abuse. Curr Opin Pediatr. 2012;24(2):233-237. doi:10.1097/MOP.0b013e3283504fbf.
Australian Institute of Health and Welfare (2020). National Drug Strategy Household Survey. Retrieved from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data
National Institute on Drug Abuse. "Why is there comorbidity between substance use disorders and mental illnesses? ." National Institute on Drug Abuse, 25 Jun. 2020, https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/why-there-comorbidity-between-substance-use-disorders-mental-illnesses Accessed 16 Jul. 2020. P.6
Enoch M. A. (2012). The influence of gene-environment interactions on the development of alcoholism and drug dependence. Current psychiatry reports, 14(2), 150–158. https://doi.org/10.1007/s11920-011-0252-9
Cerdá, M., Sagdeo, A., Johnson, J., & Galea, S. (2010). Genetic and environmental influences on psychiatric comorbidity: a systematic review. Journal of affective disorders, 126(1-2), 14–38. https://doi.org/10.1016/j.jad.2009.11.006
Barkus, E., & Murray, R. M. (2010). Substance use in adolescence and psychosis: clarifying the relationship. Annual review of clinical psychology, 6, 365–389. https://doi.org/10.1146/annurev.clinpsy.121208.131220
Pelayo-Terán, J. M., Suárez-Pinilla, P., Chadi, N., & Crespo-Facorro, B. (2012). Gene-environment interactions underlying the effect of cannabis in first episode psychosis. Current pharmaceutical design, 18(32), 5024–5035. https://doi.org/10.2174/138161212802884609
Parakh, P., & Basu, D. (2013). Cannabis and psychosis: have we found the missing links?. Asian journal of psychiatry, 6(4), 281–287. https://doi.org/10.1016/j.ajp.2013.03.012
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
Ross S, Peselow E. Co-occurring psychotic and addictive disorders: neurobiology and diagnosis. Clin Neuropharmacol. 2012;35(5):235-243. doi:10.1097/WNF.0b013e318261e193.
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