It usually starts as a question you might not yet want to ask or answer.
Perhaps it’s the anxiety that arrives in the morning before anything in the day has gone awry. Maybe it’s a low mood that has been sitting heavier than it used to, both on the days you’re drinking and on those you aren’t. It could be that you have been watching these things manifest in someone else, and the worry has been sitting with you longer than you’d like to admit.
Alcohol and mental health are closely tied – usually seen first in how you feel. Understanding why is when things begin making more sense.
Alcohol and mental health: what is happening in the brain
The reason that alcohol and mental health are so closely linked is because of how drinking changes the chemistry of your brain. The change is measurable, and doesn’t stop when the glass is empty.
Alcohol is a depressant, despite the talkative and disinhibited feeling early in a drinking session. This is because it’s a drug that impacts two opposing systems:
- It boosts a brain chemical called ‘GABA’, which acts like the brain’s brake pedal. That is the bit that feels good … the slight loosening after the first drink.
- At the same time, it suppresses ‘glutamate’ – the accelerator. That is why thinking and reactions slow down.
- When the alcohol leaves your system, your brain rebounds. Glutamate floods back and GABA drops. That’s what drives the next-day anxiety, the racing heart and the sense of dread that has nothing obvious behind it.
- It also kicks the stress system into a higher gear, raising the stress hormone, cortisol. This response is your nervous system overcorrecting.
Drinking also disrupts dopamine and serotonin, the brain chemistry controlling motivation and mood. Over a heavy month, that disruption can flatten how you feel even on the days you’re not drinking.
The patterns you may be recognising
Some of what follows might already sound familiar. These are common patterns in people whose mental health and alcohol use have started to impact each other:
- The overnight wake-up with a thumping heart and no obvious reason is the glutamate rebound and the cortisol spike hitting as your blood alcohol drops in the second half of the night.
- The Sunday mood crash after a heavy weekend is the dopamine and serotonin disruption catching up after the brain has had to work hard to rebalance.
- Sleep that looks like sleep but is not – you fall asleep faster, but sleep becomes fragmented, and the deep restorative stages are suppressed.
- The diminishing return on the first drink. The pleasant edge it used to take off is shorter and shallower, and you may be drinking more to chase it.
- The reasons – work stress, a difficult relationship, a bad week, the weather. Mood symptoms get attributed to everything except the drinking, until a sober few weeks make the pattern visible.
Alcohol and mental health conditions
The relationship between alcohol and mental health runs in both directions. Drinking can drive symptoms, and pre-existing symptoms can drive drinking. What looks like one condition on its own may be partly shaped by alcohol use:
Alcohol and anxiety
Alcohol works as a short-term sedative because of the boost it gives to GABA. That is why a drink can feel like it ‘takes the edge off’. But as the alcohol leaves your system, anxiety rebounds, often higher than where it started. The relationship runs both ways: drinking can drive anxiety, and anxiety can drive drinking.
Anxiety often gets worse before it gets better in the early stages of cutting down. The brain is readjusting, and most people see it settle within a few weeks.
Alcohol and depression
Alcohol is a depressant, and over time it disrupts the systems that hold mood steady. The pattern repeats over weeks: sadness while drinking, anxiety during the hangover and withdrawal, then back round again. The relationship is bidirectional: low mood can drive drinking, and drinking deepens low mood. In most cases, depressive symptoms improve in the weeks after stopping drinking, often without separate antidepressant treatment.
Alcohol and sleep
Alcohol and sleep have a bi-directional relationship. Alcohol shortens the time it takes to fall asleep. That is part of why people reach for it on a difficult night. But it suppresses Rapid Eye Movement (REM) sleep and fragments the second half of the night, especially as your blood alcohol falls.
Poor-quality sleep affects emotional regulation, mood and concentration. So, next-day low mood and anxiety is partly a sleep-deprivation problem in disguise.
Alcohol, suicidal thinking and psychosis
Alcohol lowers inhibition and lowers mood. Both effects raise the risk of suicidal thinking during heavy intoxication. The risk is higher where low mood is already present. Worldwide, alcohol use disorder is the second most common mental health condition among people who die by suicide. The risk rises sharply at high levels of acute intoxication.
Alcohol-induced psychosis is rare, but it can happen, and it usually shows up in long-term heavy drinking or during withdrawal.
If you are experiencing thoughts of suicide or seeing or hearing things that are not there, please get medical help today. In the UK and Ireland, you can call Samaritans on 116 123 at any time, or your Doctor. In an emergency, call your national emergency services number.
It’s time to leave addiction behind
Alcohol and mental health medication
Alcohol does not mix well with most mental health medications. The risk is highest with benzodiazepines and other medication that depresses the central nervous system, and the combination can be dangerous even at low doses. There is also a meaningful interaction between alcohol and mental health medication like antipsychotics and mood stabilisers.
The American Mayo Clinic notes four common interactions when drinking alongside mental health medication: low mood and anxiety worsen, side effects intensify, thinking and alertness drop, and some combinations cause a harmful physical reaction.
A separate review of psychotropic medication and alcohol interactions found that nearly one in four people reported a serious adverse effect when drinking alongside their medication. The most common were a worsening of the underlying condition, hospital admission, and increased drowsiness.
If you are taking medication and drinking, talk to your prescribing clinician about it honestly before making any changes to either side.
When to seek help with alcohol and mental health
There is no single point at which drinking becomes a mental health concern. Often, those that seek help have identified recurring patterns:
- You are drinking to manage how you’re feeling, and the relief is getting shorter.
- Your low mood or anxiety is worsening, not improving, even though you have cut back.
- You are drinking earlier in the day or more than you intended to, more often than you used to.
- You notice withdrawal feelings, like shakiness, sweating or anxiety, between drinks.
- Your mental health symptoms are not improving on medication, and your drinking has stayed the same or increased.
- Friends, family or your GP have raised your drinking with you, and you have brushed it off.
Mild withdrawal symptoms like shakiness or sweating between drinks are a sign that your body has adapted to alcohol. If you have been drinking heavily for a long period, do not stop suddenly without medical input. Severe withdrawal can be dangerous and needs medical supervision. Your GP can advise, and our medically supervised alcohol detox is available where it is needed
How to get help with alcohol and mental health
You have options, and not all of them involve us. Your Doctor is a good first port of call, especially if you are taking medication for a mental health condition. In the UK, the NHS runs a free alcohol service which your GP can refer you in. If you need to talk to someone today, Samaritans are on 116 123, at any hour.
At Castle Health, we offer alcohol addiction treatment through residential and outpatient routes, with cognitive behavioural therapy for alcohol addiction used to address both the drinking and the mood underneath it. Where physical withdrawal is part of the picture, we provide medically supervised alcohol detox. Residential care happens in our inpatient treatment setting, with continuing care after you leave.
"I've been nearly three years without drinking. Life has become much more enjoyable, I mean life is much more exciting, it's much more liberating. I just feel complete freedom. I don't need to worry."
If someone you know is drinking and finding challenges with their mental health
The pattern you have been watching is likely their drinking, mood, temper, and sleep all moving in a worrying direction.
What you may be noticing
Alcohol and mental health are closely linked. Mood shifts that track drinking patterns are therefore common – more anxiety the morning after, or a flatter, harder-to-reach version of the person you know. Irritability that feels new or more broken sleep. And in you, alongside all of that, you might be noticing more worry, frustration, guilt, the doubting of your own perception that comes from being told it’s all in your head.
How to start the conversation
Pick a sober moment, not the aftermath of an argument or a bad night. Lead with what you have noticed in them, not what they are doing wrong. Be specific: “You’ve been waking up at 4am for a few weeks now” lands differently to “your drinking is too much now, it’s impacting your sleep.”
Try not to issue ultimatums in a first conversation. They tend to shut things down before anything has been said. Aim for a lot of ‘we’ statements instead of ‘you’ if possible.
- “I have noticed you have not been sleeping well, and I have been worried about you. Can we talk about it?”
- “Something feels different lately, and I do not want to ignore it. How are you actually doing?”
- “I am not asking you to do anything. I just wanted you to know I have been thinking about it and I want to see if we can work through it together.”
If they shut it down, see this as information over failure. Let it sit and try again, gently, on another day.
What comes next if they are ready to talk
A GP is a good first step. An honest conversation about treatment options is the next, with you in the room if they want you there. If they are not sure where to start, our addiction screening questionnaire is short and confidential. You can also find some information on the locations we serve.
Family therapy is part of our treatment offering, and it is available whether or not your loved one is ready for treatment themselves.
Frequently asked questions about alcohol and mental health
Will my mental health improve if I stop drinking?
In most cases, yes, particularly for low mood and anxiety that is being driven by your drinking. Improvements often begin within the first few weeks. Where mental health symptoms continue beyond about a month of sustained sobriety, a separate clinical assessment may be appropriate.
Is alcohol a depressant or a stimulant?
Alcohol is a depressant. The talkative, disinhibited feeling early in a drinking session is the brain’s brake pedal being eased. It is not stimulation, despite how it can feel. According to the Royal College of Psychiatrists, alcohol’s overall effect on the brain is depressant, despite that early reach.
How much alcohol affects mental health?
There is no completely safe level when it comes to mental health. Risk rises sharply above the UK Chief Medical Officers’ guidance of 14 units a week. They recommend spreading those units across several days, with drink-free days in between.
