A new study from the University of Chicago Medicine challenges the conventional wisdom that heavy drinking is primarily a way for people with depression to self-medicate. Instead, the research finds that individuals with both alcohol use disorder (AUD) and depression experience the same levels of pleasure and stimulation from drinking as those without depression, contradicting long-held beliefs and theories about addiction and treatment.
“We have this folklore that people drink excessively when they’re feeling depressed and that it’s really about self-medicating,” said lead author Andrea King, Professor of Psychiatry and Behavioral Neuroscience at the University of Chicago. “But our findings show that individuals with both AUD and depression report feeling positive, rewarding effects from alcohol—just like their non-depressed counterparts.”
The study followed 232 participants between the ages of 21 and 35, a phase when heavy drinking is most common. Half of the participants met the criteria for AUD, and among them, half had also experienced major depressive disorder in the past year. However, those with suicidal ideation or severe alcohol withdrawal symptoms were excluded for safety reasons.
To track real-time responses, participants used smartphones to log their experiences during one drinking session and one non-drinking session. The researchers found that while alcohol slightly reduced negative emotions, the effect was minimal and not specific to depression or AUD status. More strikingly, the study found that those with AUD reported significantly higher levels of pleasure and stimulation from drinking—regardless of whether they had depression or not.
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These findings contradict the widely accepted “dark side of addiction” theory, which suggests that as addiction progresses, people drink not for pleasure but to avoid withdrawal syndrome and stress. King believes this explanation overlooks a crucial factor: “From our study, it seems that people with AUD are experiencing strong pleasurable effects from alcohol, akin to pressing an accelerator pedal that fuels further dependency.”
Published in the American Journal of Psychiatry on February 1, the study‘s findings could reshape future treatment approaches. Currently, many treatments for AUD focus on alleviating stress and depressive symptoms but King argues that addressing alcohol’s pleasurable effects should be equally prioritized. “If we only focus on stress reduction, we’re missing half the picture. We need to also address the heightened stimulation, liking, and craving for alcohol,” she said.
Previous studies on alcohol and depression
However, the study is not the first of its kind. Past research has long linked heavy drinking to worsening symptoms of depression. Studies have shown that alcohol may temporarily improve mood, but over time, it can contribute to depressive symptoms and increase the risk of alcohol dependence. It’s still not clear whether depression drives one to drink or vice versa. In fact, research shows that alcohol is a depressant, as it depresses the central nervous system including brain and spinal cord, key players in processing sensory information.
Studies indicate a strong correlation between depression and alcohol use disorder, with nearly one-third of individuals diagnosed with depression also experienced alcohol-related issues. In most cases, depression precedes alcohol misuse, particularly among children. Longitudinal research suggests that children with depression have a higher likelihood of developing alcohol-related problems later in life.
Adolescents who have experienced major depression are twice as likely to initiate alcohol use compared to their peers. Furthermore, women with a history of depression are twice as likely to engage in heavy drinking, with evidence suggesting that they may be more prone to excessive alcohol consumption during depressive episodes.
A study published in JAMA Psychiatry found that individuals who reduced or stopped drinking for just four weeks reported significant improvements in mood and mental well-being. Similarly, research from the Royal College of Psychiatrists suggests that for those dealing with both alcohol dependence and depression, addressing alcohol use first often leads to better mental health outcomes.
Additionally, a 2019 study in The Lancet Psychiatry indicated that individuals with AUD who engaged in cognitive behavioral therapy (CBT) to reduce alcohol consumption saw notable reductions in depressive symptoms. The findings reinforce that heavy alcohol use can exacerbate depression, but cutting back or quitting can lead to significant improvements in terms of mental health.