Mental Health & Comorbidity

What is the relationship between alcohol consumption and mental health?

The relationship between alcohol and mental health is complex. Alcohol consumption can cause alcohol-related mental health conditions such as an alcohol use disorder. It is also associated with a higher likelihood of having other mental health disorders such as anxiety or depression.

Excessive alcohol use can also make it difficult for health professionals to assess and treat existing mental health conditions. Many of the symptoms of alcohol-related mental health disorders are similar to those of general mental health disorders.

In addition, heavy alcohol use can lead to poorer outcomes for people who have existing mental health conditions. For example, people who are depressed and also drink heavily are at greater risk of self-harm and suicide.

What are the diagnostic criteria for alcohol-related mental health disorders?

The reference guide used by clinicians to diagnose mental health disorders is known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The most recent version of the manual, the DSM-5, was released in May 2013. Prior to this, the DSM-IV-TR was used by clinicians and researchers from 2000 to 2013.

The diagnostic criteria for alcohol-related mental health disorders differ significantly between the DSM-IV-TR and the new DSM-5. These differences are explained in more detail below. For the purposes of the NADK, all reported data on alcohol-related mental health disorders utilise the DSM-IV-TR diagnostic criteria. This is because at the time of data collection, the newer version of the DSM had not been released.

DSM - IV Diagnostic Criteria

According to the Diagnostic and Statistical Manual of Mental Disorders – 4th Edition, Text Revision (DSM-IV-TR), there are two main alcohol-related mental health disorders: alcohol dependence and alcohol abuse. The diagnostic criteria for each are presented below.

Alcohol Dependence

Alcohol dependence is defined by the DSM-IV-TR as:

A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occurring at any time in the same 12-month period:

1.  Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

b. Markedly diminished effect with continued use of the same amount of alcohol.

2.  Withdrawal, as defined by either of the following:

a. The characteristic withdrawal syndrome for alcohol (refer to DSM-IV-TR for further details).

b. Alcohol is taken to relieve or avoid withdrawal symptoms.

3.  Alcohol is often taken in larger amounts or over a longer period than was intended.
4. There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.
5.  A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.
6.  Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
7.  The individual continues to use alcohol despite knowing that they suffer from a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by drinking alcohol.

Alcohol Abuse

Alcohol abuse is defined by the DSM-IV-TR as:

A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:

  1. Recurrent alcohol use resulting in failure to fulfil major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).
  2. Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).
  3. Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
  4. Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights).

DSM-5 Diagnostic Criteria

According to the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5), there is one main alcohol-related mental health disorder: an alcohol use disorder.

Alcohol Use Disorder

Alcohol use disorder is defined by the DSM-5 as:  

A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1.  Alcohol is often taken in larger amounts or over a longer period than was intended.
2.  There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3.  A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4.  Craving, or a strong desire or urge to use alcohol.
5.  Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home.
6.  Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7.  Important social, occupational, or recreational activities are given up or reduced because of alcohol use
8.  Recurrent alcohol use in situations in which it is physically hazardous
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol
10. Tolerance, as defined by either of the following:

a.  A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b.  A markedly diminished effect with continued use of the same amount of alcohol.

11. Withdrawal, as manifested by either of the following:

a.  The characteristic withdrawal syndrome for alcohol (refer to DSM-5 for further details).
b.  Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

A mild alcohol use disorder is defined as the presence of 2-3 of the above symptoms.

A moderate alcohol use disorder is defined as the presence of 4-5 of the above symptoms.

A severe alcohol use disorder is defined as the presence of 6 or more of the above symptoms.

Sources: American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.); American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders: fourth edition, text revision. In use from 2000-2013.

DSM-5: Diagnostic and Statistical Manual of Mental Disorders: fifth edition. Released May 2013.

What proportion of Australians has met the diagnostic criteria for an alcohol disorder at some time in their life?

Approximately 19% of the Australian population has met the diagnostic criteria for harmful alcohol use and approximately 4% have met the diagnostic criteria for alcohol dependence at some time in their life.

Source: Australian Bureau of Statistics (2008). 2007 National Survey of Mental Health and Wellbeing: Summary of results.

Dependence: A maladaptive pattern of use in which the use of drugs or alcohol takes on a much higher priority for a person than other behaviours that once had greater value. The central characteristic is the strong, sometimes overpowering, desire to take the substance despite significant substance-related problems.

Harmful Use: A pattern of use of alcohol or drugs that is responsible for (or substantially contributes to) physical or psychological harm, including impaired judgement or dysfunctional behaviour.

Does the proportion of Australians that has met the diagnostic criteria for an alcohol disorder at some time in their life differ by gender?

Australian men are more likely than women to have met the diagnostic criteria for an alcohol disorder at some time in their life.

Source: Australian Bureau of Statistics (2008). 2007 National Survey of Mental Health and Wellbeing: Summary of results.

Dependence: A maladaptive pattern of use in which the use of drugs or alcohol takes on a much higher priority for a person than other behaviours that once had greater value. The central characteristic is the strong, sometimes overpowering, desire to take the substance despite significant substance-related problems.

Harmful Use: A pattern of use of alcohol or drugs that is responsible for (or substantially contributes to) physical or psychological harm, including impaired judgement or dysfunctional behaviour.

What proportion of Australians has met the diagnostic criteria for an alcohol disorder in the past 12 months?

Approximately 3% of the Australian population has met the diagnostic criteria for harmful alcohol use and 1% has met the diagnostic criteria for alcohol dependence during the past 12 months.

Source: Australian Bureau of Statistics (2008). 2007 National Survey of Mental Health and Wellbeing: Summary of results.

Dependence: A maladaptive pattern of use in which the use of drugs or alcohol takes on a much higher priority for a person than other behaviours that once had greater value. The central characteristic is the strong, sometimes overpowering, desire to take the substance despite significant substance-related problems.

Harmful Use: A pattern of use of alcohol or drugs that is responsible for (or substantially contributes to) physical or psychological harm, including impaired judgement or dysfunctional behaviour.

Does the proportion of Australians that has met the diagnostic criteria for an alcohol disorder in the past 12 months differ by gender?

Australian men are more likely than women to have met the diagnostic criteria for an alcohol disorder during the past 12 months.

Source: Australian Bureau of Statistics (2008). 2007 National Survey of Mental Health and Wellbeing: Summary of results.

Dependence: A maladaptive pattern of use in which the use of drugs or alcohol takes on a much higher priority for a person than other behaviours that once had greater value. The central characteristic is the strong, sometimes overpowering, desire to take the substance despite significant substance-related problems.

Harmful Use: A pattern of use of alcohol or drugs that is responsible for (or substantially contributes to) physical or psychological harm, including impaired judgement or dysfunctional behaviour.

Are Australians with an alcohol disorder, compared to those without an alcohol disorder, more likely to have other mental health or physical disorders?

Of Australians who have an alcohol disorder, the majority (72%) are also likely to have at least one additional mental health disorder or physical condition (i.e., alcohol comorbidity). Among Australians without an alcohol disorder, only 16% suffer from comorbid health problems (i.e., have two or more mental health disorders and/or physical health conditions).

Source: Australian Bureau of Statistics (ABS).  2007 National Survey of Mental Health and Wellbeing (NCETA secondary analysis, 2013).

Comorbidity: Having more than one disorder at the same time is known as comorbidity. Alcohol comorbidity is defined as being diagnosed with an alcohol-related mental health disorder in addition to another mental health disorder or physical condition.

What types of other physical and mental health disorders do Australians with an alcohol disorder have?

Of all Australians with an alcohol disorder, 23% have at least one other mental health disorder, 16% have at least one physical condition, and 33% have at least one additional mental health disorder and at least one physical condition.

Source: Australian Bureau of Statistics (ABS). 2007 National Survey of Mental Health and Wellbeing (NCETA secondary analysis, 2013).

Comorbidity: Having more than one disorder at the same time is known as comorbidity. Alcohol comorbidity is defined as being diagnosed with an alcohol-related mental health disorder in addition to another mental health disorder or physical condition.

Are Australian men or women with an alcohol disorder more likely to have other physical or mental health disorders?

Among those with an alcohol disorder, men are more likely than women to have a comorbidity involving a mental health disorder or a physical condition. Men are also more likely than women to have an alcohol disorder alone. By contrast, women are more likely than men to have a comorbidity involving an additional mental health disorder and a physical condition. 

Source: Australian Bureau of Statistics (ABS).  2007 National Survey of Mental Health and Wellbeing (NCETA secondary analysis, 2013).

Please note: Percentages may not tally to 100% due to rounding.

Comorbidity: Having more than one disorder at the same time is known as comorbidity. Alcohol comorbidity is defined as being diagnosed with an alcohol-related mental health disorder in addition to another mental health disorder or physical condition.

What additional mental health disorders do Australians with an alcohol disorder have?

Among Australians with an alcohol disorder, more than half also have at least one additional mental health disorder. The most common additional mental health disorder is an anxiety disorder (23%), followed by an anxiety disorder that is experienced in conjunction with an affective mood disorder (15%).

Source: Australian Bureau of Statistics (ABS). 2007 National Survey of Mental Health and Wellbeing (NCETA secondary analysis, 2013).

Please note: Percentages may not tally to 100% due to rounding.

Affective Mood Disorders: Disorders that involve mood disturbance. Examples include bipolar affective disorder, depressive episode, and dysthymia.

Anxiety Disorders: Disorders that involve feelings of tension, distress, or nervousness. In the National Survey of Mental Health and Wellbeing (NSMHW) (2007) the following anxiety disorders were collected: Panic Disorder, Social Phobia, Agoraphobia, Generalised Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), and Obsessive-Compulsive Disorder (OCD).

Comorbidity: Having more than one disorder at the same time is known as comorbidity. Alcohol comorbidity is defined as being diagnosed with an alcohol-related mental health disorder in addition to another mental health disorder or physical condition.

Do the types of additional mental health disorders experienced by Australians with an alcohol disorder differ by gender?

Alcohol comorbidities involving at least one additional mental health disorder are typically more prevalent among Australian women than men. 

Source: Australian Bureau of Statistics (ABS). 2007 National Survey of Mental Health and Wellbeing (NCETA secondary analysis, 2013).

* Estimate has a relative standard error of 25% to 50% and should be used with caution.

** Estimate has a relative standard error greater than 50% and is considered too unreliable for general use.

Please note: Percentages may not tally to 100% due to rounding.

Affective Mood Disorders: Disorders that involve mood disturbance. Examples include bipolar affective disorder, depressive episode, and dysthymia.

Anxiety Disorders: Disorders that involve feelings of tension, distress, or nervousness. In the National Survey of Mental Health and Wellbeing (NSMHW) (2007) the following anxiety disorders were collected: Panic Disorder, Social Phobia, Agoraphobia, Generalised Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), and Obsessive-Compulsive Disorder (OCD).

Comorbidity: Having more than one disorder at the same time is known as comorbidity. Alcohol comorbidity is defined as being diagnosed with an alcohol-related mental health disorder in addition to another mental health disorder or physical condition.