Moderate Drinking and Mental Illness Don't Mix

Moderate Drinking and Mental Illness Don’t Mix

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This post was originally published on September 9, 2015.

When it comes to drinking, 100 percent abstinence is, for me, an absolute imperative. But there are many people who believe in, or even advocate for, moderation as a legitimate treatment. They include researchers like David Sinclair, who created the Sinclair Method that aims to circumvent alcohol addiction through the use of a little “magic pill” called Naltrexone.

Naltrexone is supposed to cut off the effect of booze in the pleasure center of the brain, so a person primed for excessive drinking wouldn’t want to go back for several more rounds after pounding a pint of beer. Instead, they’d just relax with that one glass, watch sports, eat a burger, laugh with their friends, maybe order one more cold one over the course of four hours, then call it a night and go to bed without ever experiencing anything more than a very nice dose of relaxation.

I can’t say what’s best or what’s safe for anyone else, or whether someone who once had a gnarly drinking problem can successfully moderate after getting some sober time under their belt.

But for me, drinking is a total liability, not only because I have little control once I start, but also because I have a serious mood disorder.

Even if I could successfully master the art of moderation, the reality is even the smallest amount of alcohol can screw up my brain chemistry in a big way. This is something moderation advocates don’t write about, and it’s irresponsible given so many alcoholics have co-occurring disorders.

Drinking is very bad news for the mentally ill. No, I’m not a doctor, but I’ve heard this from every psychiatrist (and medical doctor) that I’ve ever had.

If you hang out with enough sober alcoholics, you’ll find plenty of them are taking psychotropic meds, be they for depression, anxiety, bipolar disorder, OCD, schizophrenia or ADHD.

The most common diagnosis seems to be depression, so let’s break down the science.

Depression and booze don’t mix well. Remember the catchphrase from college? “Beer then liquor, never been sicker?” There should also be one that says, “Prozac then liquor, never been sicker in the head.”

Alcohol is, of course, a depressant. It’s easy to overlook this since for many people (yours truly), the first few sips of booze act like crack—we get energized, talkative and extremely euphoric.

(Interestingly, the people I know who don’t like to drink a lot often report that they do not experience this pleasurable reaction to alcohol, like my roommate who insists drinking makes her feel sluggish, sleepy and stupid.)

The last thing you want to do is pour a depressant into a brain that’s prone to depression because, well, doing so will make someone more depressed. Shocker, I know. Even if the depressed individual gets a euphoric high from booze, they’ll often crash hard after multiple drinks, perhaps bursting into tears. That, or they may get angry and start a bar brawl. (This was sort of my M.O. toward the final days of my drinking career, although the first time I got drunk I went from elated giggling to hysterical sobs after eight or so drinks.)

If you’re on meds for depression and you drink, it seriously destabilizes your brain and can send you spiraling down past what’s safe. Major depression can also make it near-impossible to function at work or school or even to keep your clothes clean, your hair washed and your body nourished.

But these days, many people (especially women) seek treatment for depression. As anyone who’s ever taken any psych med will tell you, you’re not supposed to drink when you’re popping the Celexa, the Zoloft, the Cymbalta, the Adderall, the Paxil, the Abilify, the lithium or the Depakote.

You’re not supposed to drink when you’re on psych meds because alcohol blocks the efficacy of the drugs. 

Trust me. I’ve taken psych meds for 15 years and, after going through at least five or six psychiatrists over the years, I haven’t had one tell me it’s safe to drink. Every time a new doc filled out a prescription, they said the same thing, “Don’t drink while taking these. They won’t work if you do.”

And then I’d need to clarify the statement.

“You mean no alcohol?” I’d ask. Surely, they just meant don’t drink 12 beers every day.

“Don’t drink anything while on the drugs,” they’d insist.

I remember my disbelief and, of course, I didn’t listen to them.

Then the pharmacists who counseled me at Walgreens, Costco, Target or Kaiser reiterated that I should not be drinking on those drugs. After I got home and put the pills in the medicine cabinet, I’d see the labels on the bottles that read, “DO NOT DRINK ALCOHOL WHILE TAKING THIS MEDICATION”.

You don’t have to be a doctor to conclude that maybe it’s not the best idea to drink while taking antidepressants. And if you’re bipolar, the situation is perhaps slightly worse because booze sends you up and then down, exacerbating the mood swings inherent in bipolar disorder.

The moderation conversation has heated up in recent months, especially with the release of the movie One Little Pill and Gabrielle Glaser‘s article in The Atlantic that criticized AA and questioned the efficacy of abstinence, while talking about the safety of the Sinclair Method. All sorts of doctors, scientists and researchers have gone on record to promote Naltrexone.

I’ve read a lot of this discussion and have yet to see any sort of disclaimer about the dangers of moderation for those with mental illness. True, there are those who develop mental illness symptoms as a result of drinking and using, but there are plenty of us who had these problems before we started our partying.

Should I reiterate that every psychiatrist I have ever visited has always advised me to stay off booze entirely?

I don’t have a moral problem with anyone drinking, and I don’t believe all problem drinkers necessarily have to abstain for life because what the hell do I know? But when I asked a new psychiatrist about this whole moderation thing, her eyes boggled in shock.

“One glass of wine, or even a half a glass of wine, can greatly destabilize the brain of someone with a mood disorder,” she told me. “Anyone with a mood disorder should stay away from alcohol. The goal is total sobriety, at least if you want to be stable. Otherwise, you’re constantly trying to get those chemicals to balance out.”

I’m just not interested in tempting fate anymore than I already have, so I’m taking my doc’s word for it.

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7 Comments

  1. Kenneth Anderson on

    Can any of you cite even one peer reviewed journal article saying that alcohol prevents antidepressants from working? Not a Psychology Today blog–I have one of those myself. I mean a genuine placebo controlled double blind trial published in a peer reviewed medical journal.

    BTW I am happy if abstinence is the solution for you. About half of people with alcohol dependence find that abstinence works better than controlled drinking.
    http://www.spectrum.niaaa.nih.gov/archives/v1i1Sept2009/features/Alcoholism.html

  2. Kenneth Anderson on

    Articles which relate only anecdote instead of peer reviewed scientific studies are worthless. Peer reviewed scientific studies have found that antidepressants are effective even when mixed with alcohol.
    http://www.ncbi.nlm.nih.gov/pubmed/8611060
    By the way, the name of the inventor of the Sinclair Method is David Sinclair, not John. Clearly the only research the author of this article did was listening to gossip in AA meetings.

    • Yikes! Well, if you’ve followed my writing, you’ll see I constantly question AA (and have actually left), and I also don’t assume that just because people once had an alcohol problem they can’t successfully moderate. But to me any camp that is too one-sided, reductive, absolutist, and polemical isn’t realistic. This article is my own *personal essay*–not a research piece–on what does and does not work for me, as well as an articulation of a premise that is never addressed by those against AA or by advocates of harm reduction or moderation or the Sinclair Method. I am not attacking those folks. I am simply presenting a caveat. Now anecdotal evidence, which is constantly used in court, is also the subject of memoir, personal essay, and testimony on the witness stand. Surely we cannot discount all anecdotal evidence? Blaming anecdotal evidence in the addiction conversation makes one sound like a parrot. Parroting Glasner and Dodes. And what, pray tell, fuels this desperation to incite ex-problem drinkers to start drinking again? I get to do what I want with my body, thank you very much. I’m not missing out by being sober; instead I save money. It’s no one’s business whether I do or do not drink. If someone else who’s bipolar wants to drink on top of that faulty brain chemistry, fine. But just because I write on and explore the subject of moderation and mental illness doesn’t mean I discount the Sinclair method entirely or am a blinded AA member. There are grey areas and nuances in the world. Why is it so hard for people to get with that? Oh. Peer-reviewed. If you read enough “peer-reviewed” studies, you see there are tons on any given subject and many contradict each other.

      • Kenneth Anderson on

        Actually I am parroting Galileo, Francis Bacon, Isaac Newton and Immanuel Kant. If you wish to return to the Dark Ages when we treated diseases by exorcising demons based on the anecdotal evidence that it worked for someone, then go right ahead. The entire recovery movement has been one giant paradigm shift to lead us away from science and reason back into anecdotal evidence and superstition.

        Frankly, I will stick with randomized controlled trials rather than testimonials when I make my decisions

        • Well, I don’t know what else to say except I’ve never felt more stable in my life thanks to taking my meds and staying off the booze. I don’t care what anyone else does. Not all of us are the same for sure. But I’m excited at how healthy and happy I feel, which is hilarious, seeing as how I was so unstable for so many years. I know this anecdotal evidence means nothing to you, but, as I’ve stated in previous essays, it means the world to people around me. So, that’s enough for me. I don’t need to convince anyone else.

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About Author

Tracy Chabala is a freelance writer for many publications including the LA Times, LA Weekly, Smashd, VICE and Salon. She writes mostly about food, technology and culture, in addition to addiction and mental health. She holds a Master's in Professional Writing from USC and is finishing up her novel.