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Exploring Perceptions of Alcohol Use as Self-Medication for Depression Among Women Receiving Community-Based Treatment for Alcohol Problems

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Abstract

Although epidemiological literature reports a significant overlap between depression and alcoholism among women, the dynamics of this relationship requires further exploration. The present paper documents significant lifetime histories of depression among women in treatment for alcohol problems, and presents findings on these women's experiences of the relationship between depression and alcohol use problems. In this community-based treatment sample, 18 out of 18 women participating in qualitative interviews reported histories of depression and almost 80% were currently using anti-depressant medication. The use of alcohol as an attempt to escape difficult emotions or alternatively to produce positive emotional experiences is discussed within the gendered context of the stories women tell about their depression and alcohol use.
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... Previous research has explored experiences of people living with cooccurring heavy alcohol use and depression in different countries and settings [31,[37][38][39][40][41][42]. These studies show how socio-cultural factors, such as the dual stigma attached to both dependent drinking and mental ill-health, compound the challenge of seeking and receiving appropriate support in these disconnected health and social care systems [37,40,42]. ...
... These studies show how socio-cultural factors, such as the dual stigma attached to both dependent drinking and mental ill-health, compound the challenge of seeking and receiving appropriate support in these disconnected health and social care systems [37,40,42]. Findings also indicate that while people commonly perceive their drinking and mental ill-health as connected, this association is seldom recognized within formal care provision [38,39,42]. ...
... Importantly, however, evidence suggests that therapeutic relationships in which people feel their experiences are listened to and acknowledged appear most conducive to recovery [37][38][39]. For example, a recent Australian study about help-seeking for suicidal people with heavy drinking and depression found that provision of positive support throughout the care system was critical to their decision not to die by suicide [40]. ...
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Background and Aims Heavy alcohol use and depression commonly co‐occur. However, health and social care services rarely provide coordinated support for these conditions. Using relational autonomy, which recognizes how social and economic contexts and relational support alter people's capacity for agency, this study aimed to (1) explore how people experience formal care provision for co‐occurring alcohol use and depression, (2) consider how this context could lead to adverse outcomes for individuals and (3) understand the implications of these experiences for future policy and practice. Design Semi‐structured qualitative interviews underpinned by the methodology of interpretive description. Setting North East and North Cumbria, UK. Participants Thirty‐nine people (21 men and 18 women) with current or recent experience of co‐occurring heavy alcohol use ([Alcohol Use Disorders Identification Test [AUDIT] score ≥ 8]) and depression ([Patient Health Questionnaire test ≥ 5] screening tools to give an indication of their current levels of alcohol use and mental score). Measurements Semi‐structured interview guide supported in‐depth exploration of the treatment and care people had sought and received for heavy alcohol use and depression. Findings Most participants perceived depression as a key factor contributing to their heavy alcohol use. Three key themes were identified: (1) ‘lack of recognition’ of a relationship between alcohol use and depression and/or contexts that limit people's capacity to access help, (2) having ‘nowhere to go’ to access relevant treatment and care and (3) ‘supporting relational autonomy’ as opposed to assuming that individuals can organize their own care and recovery. Lack of access to appropriate treatment and provision that disregards individuals’ differential capacity for agency may contribute to delays in help‐seeking, increased distress and suicidal ideation. Conclusions Among people with co‐occurring heavy alcohol use and depression, lack of recognition of a relationship between alcohol use and depression and formal care provision that does not acknowledge people's social and economic context, including their intrinsic need for relational support, may contribute to distress and limit their capacity to get well.
... 17 However, this can result in a vicious cycle, as excessive alcohol consumption can further disrupt the brain's neurotransmitter balance and exacerbate depressive symptoms. 18 Similarly, individuals with depression may turn to smoking as a coping mechanism given the temporary mood-enhancing effects of nicotine. 19 By exploring the effect of depression on alcohol intake and smoking within the context of the risk of coronary artery disease, we aim to improve the understanding of these complex interactions, which would inform targeted interventions and preventive strategies. ...
... Depression was categorized based on the BDI scores. Participants were classified into 4 categories: no or slight depression (0-13), mild depression (14)(15)(16)(17)(18)(19), moderate depression (20)(21)(22)(23)(24)(25)(26)(27)(28), and severe depression (29-63). 23,24 At the time of the survey, alcohol intake was assessed by determining whether participants were drinkers or non-drinkers. ...
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Objective Our study hypothesizes that the interaction between depression, alcohol intake, and smoking status can significantly influence the risk of acute coronary syndrome (ACS). We aim to investigate the magnitude of the association between depression and ACS risk and explore how alcohol intake and smoking status affect this association.Methods We used data from the Korean Genome and Epidemiology Study. The primary exposure of interest was the presence of depression, as measured using the Beck Depression Inventory score at baseline. The primary outcome was the occurrence of ACS observed in the biennial follow-up surveys. We used Cox proportional regression analysis to estimate the effect of depression on ACS incidence. We conducted interaction and joint effect analyses to explore the interactions between depression and health-related habits including alcohol intake and smoking with regard to ACS incidence.Results During 16 years of follow-up among 3,254 individuals, we documented 88 cases of new-onset ACS (2.2 cases per 1,000 personyears). We found no association between depression and ACS risk; furthermore, the effect of depression on ACS risk by alcohol intake and smoking status did not differ significantly. In the analysis to observe the joint effect of smoking and depression, the multivariate hazard ratios of ACS were 1.26 (95% confidence interval [CI], 0.67–2.36) for non-smoking and depression, 1.52 (95% CI, 0.83–2.82) for smoking and non-depression, and 2.79 (95% CI, 1.21–6.41) for smoking and depression compared with non-smoking and non-depression.Conclusion Our study reveals the combined effect of depression and smoking on ACS risk, highlighting the potential benefits of concurrent interventions for both depression and smoking for cardiovascular health.
... Feminist research and practice led the way in recognizing the serious impacts of sexual assault, domestic violence, and childhood physical and sexual abuse that are associated with a loss of confidence, depression, anxiety, and substance use which are then often pathologized (Brown & Stewart, 2008;Burstow, 2003;Butler, 1978;Herman 1992Herman , 2015Herman et al., 1989;McKenzie-Mohr & Lafrance, 2011;Ross & Morrison, 2020). Nowhere has this process been established as clearly as in the growth of individuals diagnosed with "borderline personality disorder" a diagnosis overwhelmingly applied to women with a history of trauma and abuse (Becker & Lamb, 1994;Brown, 1992Brown, , 2020Cermele et al., 2001;Herman, 1992;Marecek & Gavey, 2013;Tseris, 2013). ...
... Empowerment, a central theme of trauma and violence-informed care incorporates a social justice framework that recognizes individuals who have experienced trauma can feel powerless and that this is compounded by social inequity. Brown and Stewart (2008) argue that trauma often precedes the development of anxiety and/or depression, which is often addressed through substance use. For example, among girls and women, the links between substance use and sexual victimization are profound (Poole & Greaves, 2012;Ross et al., 2015). ...
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Social workers are positioned to respond to clients with a history of trauma by practicing bio-psycho-social, trauma, and violence-informed care but frequently encounter systemic barriers to providing holistic care. The research presented in this article was initiated by a College of Social Work in Canada in response to concerns raised by social work providers that their practice was constrained by ideological, structural, and system limitations within publicly funded mental health and addiction services. Ideologically trauma-based social work care is defined by five principles of safety, trust, collaboration, choice, and empowerment and recognizes that what has happened to individuals, including early adversity, can influence their bio-psycho-social functioning across the lifespan. Structurally, trauma-based care recognizes the corrosive impact of poverty, systemic discrimination, and exclusion. Findings Our research included a literature review, an online survey (n = 115 completed surveys), individual interviews (n = 50), and three focus groups (n = 15). The findings consistently highlighted a dissonance between dominant bio-medical approaches and reliance on the Diagnostic Statistical Manual of Disorders and social justice–based practice. Primary themes included a recognition by social workers of the pervasive presence of trauma and its effects, including mental health and addiction challenges; intergenerational impacts of trauma; the limitations of the medical model; and the need to reposition social work practice. Applications Repositioning the role of social work within mental health and addiction settings to center social justice responses to trauma presents transformative opportunities to better meet the needs of service users and increase workplace satisfaction.
... One plausible explanation for the strong relation between severe anxiety and severe depression symptoms and AUD is that alcohol provides temporary (and desired) relief for a wide range of symptoms that are otherwise associated with significant psychological distress. There are sufficient data that support the instant numbing effect of alcohol on emotional distress (Brown & Stewart, 2008;Stewart et al., 2006;Stewart & Conrod, 2003). In the long term, such alcohol use is associated with the maintenance or even worsening of depression symptoms (Brown & Stewart, 2008). ...
... There are sufficient data that support the instant numbing effect of alcohol on emotional distress (Brown & Stewart, 2008;Stewart et al., 2006;Stewart & Conrod, 2003). In the long term, such alcohol use is associated with the maintenance or even worsening of depression symptoms (Brown & Stewart, 2008). Similarly, use of alcohol to self-medicate anxiety, especially generalized anxiety disorder, is common and effective despite increasing one's risk of mood or substance use disorders over time (Bolton et al., 2006). ...
Article
Objective: The high prevalence of alcohol/substance use among individuals with psychiatric disorders elucidates the import of investigations into associations between types and severity of psychiatric symptoms and alcohol/substance use. This study examined the likelihood of alcohol use disorder and substance use among individuals with varying depression and anxiety symptoms and severity thereof. Differences across sex were also examined. Methods: Using data from the National Epidemiological Survey on Alcohol and Related Conditions, a nationally representative sample from the United States (N = 43,093), separate logistic regressions estimated the odds of lifetime alcohol use disorder, depressant, stimulant, hallucinogen, and comorbid substance use across psychiatric symptom clusters controlling for age, sex, and ethnicity. Results: Symptom severity was a more important correlate of alcohol use disorder and substance use than symptom type. In particular, the odds ratio of lifetime use of depressants, stimulants, hallucinogens, or any combination of these types of substances were higher for individuals with either severe depression or severe depression and anxiety relative to a healthy control. Moreover, the odds of having a diagnosis of lifetime alcohol use disorder were higher for individuals with severe symptoms of depression, anxiety, and both depression and anxiety, relative to healthy individuals. Those with mild depression were more likely to engage in substance use than individuals with anxiety alone. Patterns of association among males and females were highly consistent. Conclusions: The findings highlight an enhanced risk of alcohol and substance use among individuals with severe depression and/or anxiety symptoms above what is seen among individuals with less severe symptomatology. In addition, this study shows a unique risk posed by the presence of depression on substance use. This study offers a framework for future studies to examine the causal mechanisms explaining the connection between psychiatric symptoms and alcohol/substance use.
... Indeed, studies indicate that alcohol-use disorders increase the risk of depression [3,[16][17][18][19] and manic episodes [20]. However, it has also been suggested that alcohol abuse may result from depressive symptoms as a form of selfmedication [21,22] or from the more intense mood during hypomanic/manic episodes [23]. ...
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Clinical and epidemiological studies have demonstrated a relationship between alcohol addiction and mood disorders. Alcohol-dependent patients with depression tend to demonstrate clinically more severe manic symptoms, which complicates the process of diagnosis and therapy. However, the predictors indicating the risk of mood disorders in addicted patients remain unclear. The aim of the study was to examine the relationship between personal dispositions, bipolar traits, depth of addiction, quality of sleep, and depressive symptoms in alcohol-dependent men. The study group comprised 70 men (age M = 46.06, SD = 11.29) diagnosed with alcohol addiction. The participants completed a battery of questionnaires: BDI, HCL-32, PSQI, EPQ-R and MAST. The results were tested using Pearson’s correlation quotient and general linear model. The findings indicate that some of the studied patients are likely to have mood disorders of clinically significant severity. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in alcohol-dependent patients. Among the components of sleep quality, problems with falling asleep and waking up at night appear to be most strongly associated with depressive symptoms. The intensity of depressive symptoms may relate to the intensity of certain bipolar features, such as risk-taking activity and irritability. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in the studied group.
... Mental health literature has aptly identified that alcohol should not be used as a means for coping and that the stigma and shame associated with alcohol use may result in more selfmedication and drinking to self-soothe, as well as an avoidance tactic for accessing appropriate supports that may be helpful for both women and their children. 50,51 As others have drawn attention to in popular media (eg, parent magazines), the problem with the cultural perception of the wine mom is that it hides or masks problematic drinking. 52 These perceptions remains embedded in traditional, stereotypical and stigmatizing views about which 'types' of women drink at risky levels, posing a threat to their children, community and society, 53,54 and prevent women from accessing the needed supports to address these concerns. ...
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Popular culture has recently seen the emergence of the so-called comical wine mom persona, particularly on social media sites such as Instagram. Given the increasing use of alcohol amongst women, and the emergence of alcohol as a tool for women and mothers to assert agency and gender equity, a critical analysis of wine mom culture warrants attention. Forty Instagram posts associated with the #winemom hashtag were selected using theoretical sampling and analyzed using reflexive thematic analysis. The central objective was to use a postfeminist lens to critically explore how wine mom culture is part of the consumption, (re)production, and (re)configuration of the ideologies of ‘good’ and ‘bad’ motherhood occurring in online gendered spaces. The findings demonstrated the ubiquity of wine mom culture and its contribution to normalized images and meanings of ‘liberated motherhood’ that may have problematic sociocultural and health implications related to women’s alcohol consumption.
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Objectives The aim of the study was to develop a new self-report scale to explore the “fears, blocks and resistances of mindfulness”. Currently, there is no scale to identify individuals who may struggle with engaging in mindfulness. Method A total of 522 participants were invited to take part in the study from three countries: Australia ( n = 199), Portugal ( n = 160), and the UK ( n = 163). Participants completed a range of self-report scales including the newly developed Fears and Resistances to Mindfulness (FRM), Fears of Compassion, Depression, Anxiety and Stress Scales, Forms of Self-criticising/Attacking and Self-Reassuring, and the Five Facet Mindfulness Questionnaire. Results Factor analyses suggested the scale comprised 2 factors. One was related to fears of paying attention to what arises within one’s mind. The second factor was related to resistances, i.e. that mindfulness is a waste of time. Seven items were filler items, and 5 items were identified as problematic due to low communalities or cross-loading; therefore from the original 31 items, 19 were retained in the final scale, which demonstrated excellent internal consistency (McDonald’s Ω = 0.90 for both scales), good construct validity, and temporal stability. Blocks to mindfulness did not emerge as a separate factor. Conclusions This is the first study to specifically explore fears and resistances to mindfulness and their associations with fears of compassion, self-criticism, and mental health difficulties. Data suggested that fears and resistances are distinct constructs and should be measured independently. The new measure can offer insights in to fears and resistances to mindfulness, and future research can explore how to work with them. Preregistration This study was not preregistered.
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Introduction: Substance use is highly prevalent among people with mood disorders. Effective treatment for these people requires a better understanding of the relationship between both mood and substance use from the perspectives of those with lived experience. Question: What are the reasons those with lived experience of mood disorders give for substance use? Method: An integrative review was conducted. The Joanna Briggs Institute suite of critical appraisal tools was used to evaluate the quality of individual studies. Data relevant to the review question were extracted and the results were synthesised into themes. Results: Eighteen papers met the eligibility criteria. Three themes were identified across the included studies: Managing my mood, More Effective than prescribed medication, and Escape from trauma and hardship. Discussion: This integrative review identified that people with a mood disorder who use substances described choosing to take substances to manage their mood, as an alternative to prescribed medications, and to cope with trauma and social hardships. Implications for practice: Mental health nurses need to provide care that recognises why people use substances. They need to understand these reasons to provide a harm reduction and trauma-informed model of care. Evidence-based non-pharmacological interventions for mood disorders need to be available as an alternative to medications or as a supplement.
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Objective. The main goal of the research is to determine comorbidities in women addicted to alcohol who were treated at the Clinic for Addiction Diseases of the Institute of Mental Health Belgrade. Methods. The research was conducted in January 2018, a retrospective study collected data for research purposes by reviewing available medical documentation - discharge lists. The research sample consists of 136 women addicted to alcohol between the ages of 18 and 68 who were treated at the Clinic for Addiction Diseases in the period from 2007 to 2017. For the needs of the research, and starting from the research variables, a special matrix for content analysis was made and filled in for each patient included in the research sample. Results. Among alcohol addicts, 17.6% had depression as comorbidity, and 5.9% had suicidal ideations. and 11.8% anxiety disorder. Conclusion. The study of comorbidities has significant implications, primarily due to the possible modification of the treatment of the underlying disorder and the adjustment of the therapeutic procedure to the comorbid disorder. Accordingly, timely diagnosis and treatment of comorbid diseases affects the easier course and better prognosis of the underlying disease on the one hand, but also reduces the cost of treatment and relieves the burden on the health system, on the other hand.
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Analyzes limitations of the currently dominant, or mainstream, approaches to understanding and explaining "depression" in women. The often-cited finding that "depression" is a problem particularly afflicting women is one that mainstream theoretical approaches have been unable to explain satisfactorily. Such theories have been critiqued as inherently dualist and reductionist and as employing concepts that are implicitly androcentric. Mainstream theories promote a view of depression as a form of individual disorder or psychopathology, capable of being understood without regard to the broader sociocultural context. Neglected within mainstream theory and research on depression are social-structural and discursive conditions that regulate women's lives and shape their experiences. Research informed by feminist standpoint and social constructionist epistemological perspectives provides one avenue for offsetting the limitations of mainstream approaches. At this juncture, forms of inquiry drawing on qualitative methodologies offer more useful, and potentially more emancipatory, strategies for understanding depression in women than mainstream approaches, because they can more fully acknowledge the lived experiences of women. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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