People with unhealthy patterns of alcohol intake often have concomitant mental health problems. Whether one factor is the more dominant influence in this dialectic is a subject of ongoing debate. Is it the heavy drinking which leads to mental health problems? Or is it the other way around—are mental health problems leading to unhealthy drinking patterns?

An interesting cohort study reported in the April 2015 issue of Alcoholism: Clinical & Experimental Research suggests an answer. The researchers followed 500 heavy drinkers in the Birmingham, England, area for a 10 year period. The participants were three-fourths men, 90% white, from diverse socio-economic backgrounds, and 60% were smokers. The age at study entry ranged from 25 to 55 years old. Every two years, participants were interviewed about their alcohol use and various mental health issues. The study found that mental health problems tended to lead to heavy drinking, much more so than the other way around.

This is one of those studies which needs to be viewed with caution. Clearly, for any given individual, the cause-and-effect relationship may vary. But this study does focus attention on the reality that it is hard to separate problem drinking behavior from mental health problems. When addressing heavy alcohol intake with a patient, including referring him or her for treatment, we need to be mindful of the likelihood of a strong mental health driver for the drinking. Without addressing the individual’s mental health issues, the problem drinking may be not be as amenable to treatment. If the treatment focuses exclusively on the alcohol, the outcome may be less favorable.

Or, to put it in different terms, neither the chicken nor the egg can exist independently.

Richard Fleming, MD