Is Alcoholism a Mental Illness?

Medically reviewed by

Dr. Richard Foster, LICDC-CS

March 20, 2019

Within the Diagnostic and Statistical Manual of Mental Disorders (DSM), alcoholism – or alcohol use disorder – is classified as a substance abuse disorder featuring both physical and mental symptoms.

Alcoholism may also be referred to by doctors, addiction specialists, and the general population alike as a mental disorder, or mental illness.

Alcoholism As A Mental Illness

The first mentions of diagnostic criteria for alcoholism as a mental disorder were made within the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which is no longer used by doctors as an accurate tool for diagnosis but remains important to some researchers.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a renowned and comprehensive resource used nationwide by mental health professionals to help diagnose and treat mental disorders. It has been revised several times since its initial publication in 1952 to add, edit, or retract mental disorder diagnoses and their symptoms.

In 2013, the release of the fifth edition of the DSM referred to as the DSM-5, changed the previously listed diagnoses of ‘alcohol abuse’ and ‘alcohol dependence’ by merging them into one diagnosis of alcohol use disorder.

That his, while doctors who previously used the DSM-IV may have provided diagnoses of either ‘alcohol abuse’ or ‘alcohol dependence’ to individuals who showcased symptoms of an alcohol-related problem, a person is now more likely to be given the diagnosis of alcohol use disorder (AUD).

Is Alcoholism The Same As Alcohol Use Disorder (AUD)?

Alcohol use disorder (AUD) is the clinical term to describe excessive alcohol use and may be used interchangeably with the term ‘alcoholism’ in non-medical settings. In 2015, a reported 6.2% of adults in the United States – approximately 15.1 million adults – were found to have AUD.

The diagnosis for AUD is separated into three different levels of severity: mild, moderate, and severe.

The diagnostic criteria for AUD as defined within the DSM-IV includes eleven symptoms:

• Preoccupation with drinking
• Spending a lot of time drinking/experiencing hangover effects
• Feels unable to stop or cut down on alcohol use
• Physical tolerance (i.e. need to drink more to feel the same effect)
• Problems with family and social relationships due to drinking
• Decreased interest in activities other than drinking
• Drinks more frequently or for longer periods of time than intended
• Interference of alcohol use with family, home, or work life
• Participation in risky, and potentially harmful, behaviors or activities due to drinking
• Experiences withdrawal symptoms after stopped use
• Memory blackouts or changes in mental health (i.e. depression, anxiety) due to alcohol use

Someone who has 2 to 3 of these symptoms may be diagnosed with ‘mild’ AUD. Moderate alcohol use disorder requires the presence of 4 to 5 symptoms, and severe AUD requires the presence of 6 or more.

In addition to the signs formally listed in the DSM criteria, people who struggle with alcoholism, or alcohol use disorder, may also experience a number of physical, mental, and psychological symptoms as a result of their heavy drinking.

Some of these symptoms of alcoholism include:

• aggression
• agitation
• being in denial about their problem with alcohol
• trouble with motor coordination
• sleeping problems
• financial troubles as a result of alcohol use

Alcohol Abuse And Co-occurring Mental Disorders

As many as half of those who have a psychiatric disorder, such as anxiety or bipolar disorder, may also end up struggling with a substance abuse disorder like alcoholism, and vice versa.

Struggling with more than one mental disorder is referred to as dual-diagnosis, or having co-occurring mental and substance abuse problems. Another term that may be used by clinicians is ‘comorbidity’ or comorbid disorders.

Many of the symptoms of alcoholism – such as increased anxiety, risky behavior, and hopelessness – overlap with those of other mental illnesses including anxiety, depression, and bipolar disorder.

This overlap can sometimes make determining accurate diagnoses difficult, as a mental health professional may be unsure of whether or not a person’s alcohol use is, in fact, causing the symptoms affecting their mental health. In some cases, a clinician may not be willing to diagnose someone with an additional mental illness until they have stopped their substance use.

Dual-Diagnosis Conditions Common With Alcohol

There are some mental conditions that have been associated with alcohol-related issues and are found in higher rates among those who struggle with alcohol abuse.

These include:

Anxiety Disorders

According to the National Institutes of Health, those who struggle with alcohol abuse maybe three to four times more likely than the general population to be diagnosed with an anxiety disorder at some point in their life. Some of these anxiety disorders include panic disorder, post-traumatic stress disorder (PTSD), and social phobia.

While heavy alcohol use may cause symptoms of anxiety in people without an anxiety disorder, the experience may not entirely be the same. Those who do not have an anxiety disorder independent of their alcohol use, for instance, will likely experience lessened symptoms sometime after they have stopped drinking.

Major Depression

Feelings of depression are common in those who struggle with alcoholism, affecting about 80 percent of alcoholics at some point during their experience of addiction. People who abuse alcohol, or have a history of previous alcohol dependence, may also be four times more likely to experience a major depressive episode than those who do not abuse alcohol.

When the more common mood disturbances that are experienced by those with alcohol dependence are accounted for, the number of individuals with a dual diagnosis of depression and alcohol use disorder is closer to 30 to 40 percent.

Bipolar Disorder

Bipolar disorder is another common comorbid disorder experienced by those who abuse alcohol. One estimate suggests that up to 50 to 60 percent of those who experience mania are likely to abuse alcohol at some point in their lifetime.

However, it is acknowledged that diagnosing bipolar disorder in those with substance abuse can be tricky. This is due to the effects alcohol can have on the brain, the fact that some symptoms of bipolar disorder often go under-reported, and the complicating factor that both illnesses share similar features (e.g. engaging in high-risk behaviors).

Attention-Deficit Hyperactivity Disorder (ADHD)

Attention-deficit hyperactivity disorder has also been associated with alcohol-related issues. Some studies show that individuals who are untreated for their ADHD as children may be more likely to develop problems with substance abuse.

Symptoms of ADHD like impulsive behavior and poor judgment in social settings may put someone at greater risk for abusing substances like alcohol or nicotine.

Other Comorbid Illnesses

In addition to the conditions listed above, there have also been reported rates of alcohol abuse in people with schizophrenia, borderline personality disorder, and other personality disorders.

How Dual-Diagnosis Impacts The Treatment Process

It is important that someone who struggles with alcoholism and one or more other mental disorders receives care that takes into account the presence of all their conditions.

Failing to treat all disorders through comprehensive treatment by instead treating only alcohol abuse can lead to a higher risk for substance abuse relapse. It can also be very invalidating for the person who is struggling to not have their psychiatric issues taken seriously and adequately treated.

Behavioral therapies, including Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), are often used in the treatment of comorbid illnesses. Some medications may also be used to help treat comorbid alcohol and psychiatric issues.

Factors such as age and the specific substance a person misuses may also be considered when figuring out what course of treatment may be most appropriate for the person struggling.

What’s most important is to recognize that both the substance abuse and other comorbid mental conditions deserve attention in the treatment process, as they can be important factors in determining what treatment may be most helpful for the individual person.

If you or a loved one is struggling with alcoholism, contact one of our specialists today to learn more about seeking treatment for a sober and more hopeful future.