Alcohol and depression: Study challenges self-medication theory

The relationship between alcohol and mental health is complex. Alcohol can contribute to mental health disorders like depression and anxiety, and people with these conditions are also more likely to misuse alcohol.

For decades, the prevailing belief was that individuals with depression and alcohol use disorder (AUD) drank primarily to self-medicate, seeking relief from negative emotions rather than pursuing pleasure.

However, a recent study from the University of Chicago Medicine is challenging this assumption. The research reveals that people with AUD and depression experience significant stimulation and pleasure when intoxicated, much like those without depression.

These findings not only reshape our understanding of alcohol’s effects but also open new doors for treatment strategies.

Tracking responses to alcohol

The study, led by Dr. Andrea King, professor of psychiatry and behavioral neuroscience at UChicago, used innovative methods to track real-time responses to alcohol in natural settings.

With the help of smartphone technology, the researchers were able to capture how participants felt during drinking episodes, providing a more accurate picture than traditional lab-based studies.

“We have this folklore that people drink excessively when they’re feeling depressed and that it’s really about self-medicating,” said King.

“In this study of natural environment drinking and smartphone-based reports of the effects of alcohol in real-time, participants with AUD and a depressive disorder reported feeling acute, sustained positive and rewarding alcohol effects – just like their non-depressed counterparts.”

Redefining alcohol addiction

The researchers followed 232 participants between the ages of 21 and 35 – a demographic known for higher rates of heavy drinking.

Half of the group met the criteria for AUD in the past year, and these individuals were evenly divided into those who had experienced major depressive disorder and those who had not.

Participants were excluded if they had suicidal ideations or severe withdrawal symptoms, ensuring safety while maintaining a diverse sample.

Using their smartphones, participants answered questions every half hour during a typical drinking episode and a non-drinking episode. The data revealed that alcohol consumption reduced negative feelings, but the effect was small and not specific to depression or AUD status.

On the other hand, the positive effects of alcohol were significantly higher in individuals with AUD compared to those without AUD.

Pleasure plays a key role

Surprisingly, the pleasurable effects were similar in both depressed and non-depressed individuals with AUD. This challenges the notion that alcohol addiction is solely driven by an attempt to alleviate distress.

“For nearly a decade, our group has been improving methods to use mobile technologies to measure real-time clinically meaningful outcomes in people with AUD and those at risk for alcohol-related problems,” said study co-author Dr. Daniel Fridberg.

“These approaches allow us to bridge the gap between the lab and real life and have led to new insights that could one day result in better treatments.”

Rethinking treatment for alcohol addiction

The implications of these findings are profound, particularly for how AUD and co-occurring depression are treated. Current treatment strategies often focus on reducing stress and alleviating depressive symptoms, assuming that these factors drive excessive drinking.

However, King argues that this approach addresses only part of the issue. According to her, treatments must also target the heightened feelings of stimulation and reward that both depressed and non-depressed individuals with AUD experience.

“Currently, the focus of treatment is often on resolving stress and symptoms of depression, but that is only addressing one side of the coin if we don’t also address the heightened stimulation, liking and wanting more alcohol that occur in both depressed and non-depressed people with AUD,” said King.

Her extensive research on human responses to alcohol underscores the importance of understanding how pleasure and reward pathways contribute to addiction. By broadening the scope of treatment to include these factors, clinicians may develop more effective interventions.

Challenging the “dark side of addiction”

The study also calls into question a widely accepted theory about the progression of addiction.

This theory proposes that repeated heavy drinking leads to changes in the brain’s stress and reward systems, causing individuals to shift from drinking for pleasure to drinking to avoid withdrawal and stress.

While this model has been influential, it does not fully account for the high levels of stimulation and pleasure observed in King’s research.

“As treatment providers, we’re taught people with AUD are drinking to self-medicate and feel better,” said King. “But what exactly are they feeling? From our study, it seems to be high levels of stimulation and pleasurable effects, with a modest decrease in negative states.”

King compared these heightened feelings to an accelerator pedal, fueling dependency rather than merely easing discomfort. This perspective suggests that addiction is not solely about escaping pain but also about pursuing intense positive experiences.

Long-term sensitivity to alcohol

King’s next project aims to extend these findings to older adults with long-term AUD. Specifically, she plans to examine whether individuals aged 40 to 65 who have struggled with AUD for decades still experience heightened pleasure when drinking.

The prevailing theory would predict blunted positive responses and increased tolerance in these individuals, as prolonged exposure to alcohol is thought to dull its enjoyable effects.

However, King’s previous research raises the possibility that some individuals retain sensitivity to alcohol’s pleasurable effects even after years of heavy drinking.

This upcoming study could provide critical insights into the long-term dynamics of AUD and its interaction with aging. If older drinkers with AUD exhibit sustained sensitivity to alcohol’s rewarding effects, it would challenge existing assumptions about tolerance and addiction.

Moreover, it could inform the development of age-specific treatments that address the unique needs of older individuals with AUD.

New insights for better treatments

One of the most innovative aspects of this research is its use of mobile technology to gather real-time data in natural environments.

Traditional lab studies often fail to capture the nuances of alcohol consumption in everyday life, where social, emotional, and environmental factors play a significant role.

By using smartphones to track participants’ experiences, King and her team have created a more comprehensive and accurate picture of how alcohol affects individuals with AUD and depression.

“For nearly a decade, our group has been improving methods to use mobile technologies to measure real-time clinically meaningful outcomes in people with AUD and those at risk for alcohol-related problems,” said Fridberg.

“These approaches allow us to bridge the gap between the lab and real life and have led to new insights that could one day result in better treatments.”

This methodology not only enhances the validity of the findings but also sets a precedent for future research in addiction science.

Broader view of alcohol addiction

The University of Chicago Medicine study represents a significant step forward in understanding the complex interplay between alcohol, mental health, and addiction.

By challenging long-held beliefs and offering new perspectives, the research paves the way for more effective treatment approaches. It highlights the need to consider both the pleasurable and negative effects of alcohol when addressing AUD, particularly in individuals with co-occurring depression.

As scientists continue to explore these dynamics, the hope is that treatments will become more personalized and effective. Whether through medication, behavioral therapy, or a combination of approaches, the ultimate goal is to help individuals achieve lasting recovery.

By focusing on the full spectrum of alcohol’s effects, researchers and clinicians can work together to create a brighter future for those struggling with addiction.

The study is published in the American Journal of Psychiatry.

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