When depression drives you to drink

When you drink, do you get depressed? Or is it the reverse: when you’re depressed, do you drink?

An eight-year study of close to 1,300 teenagers by Canadian, American and German researchers appears to indicate the latter, and points to a solution: self-awareness.

If people learn to recognize when they’re in a funk and deal with it, they’re less likely to self-medicate through alcohol, the authors of the study believe.

Co-authored by Jennifer O’Loughlin of Université de Montréal’s School of Public Health, the study was published Nov. 11 in the Journal of Adolescent Health.

“We found that adolescents increased their drinking in response to short-term elevations that exceeded their ‘normal’ level of depressive symptoms,” said O’Loughlin.

“But that they did not have more symptoms after short-term elevations in the frequency of their drinking,” she continued.

“This is important because, if we can teach adolescents to recognize and cope with these short-term fluctuations in negative emotions, we can possibly prevent escalations in drinking.”

Interviewed 20 times

The new study looked at 1,293 Montreal high-school students who were followed between 1999 and 2006 by O’Loughlin in her Nicotine Dependence in Teens (NDIT) study, funded by the Canadian Cancer Society. The students were interviewed 20 times, every three months from Grades 7 through 11, about their consumption habits, including drinking.

With O’Loughlin and colleagues in Toronto and Kiel, Germany, addiction expert Robert Wellman of the University of Massachusetts Medical School used the data from those 20 sets of interviews to look at the timing of drinking and depressive symptoms.

“One of the challenges was to tease out the influence of ‘interindividual’ and ‘intraindividual’ factors affecting this relationship,” said Wellman, the study’s lead author. “Interindividual factors are differences between people, such as their sex, age, genetic makeup and psychological characteristics, while intraindividual factors are fluctuations that occur within a person, such as sleepiness or level of energy at a particular time of day.”

Just like blood pressure

He gave the example of blood pressure, which in most people follows a course over time that can be predicted by genetic makeup (did your parents have high blood pressure), sex (men tend to have higher blood pressure than women), age (blood pressure tends to rise as one gets older), and similar interindividual influences.

“But on any given day, when you go to the doctor, your blood pressure is also affected by intraindividual influences, such as whether you just had a cup of coffee or slept poorly last night. In our study with the Canadian teenagers, we had to find a way to account for the interindividual influences on drinking and depressive symptoms to allow the intraindividual differences to emerge.

“Ours is the first study to demonstrate a relationship between depressive symptoms and drinking frequency after accounting for associations with the interindividual factors of sex, age, mother’s education, sensation-seeking, and impulsivity.”

Almost half of teens drink

Many adolescents drink alcohol. In surveys, 45 percent of students in Grades 7 to 12 in Canada have reported using alcohol in the preceding year. At the same time, it is common for adolescents to experience symptoms of depression, such as feeling sad or losing interest in activities they previously found engaging. Between 10 and 25 percent of 8th to 10th graders in the U.S. have reported such symptoms.

Many research studies have found an association between alcohol consumption and depression. Teens who drink have more depressive symptoms than their non-drinking peers, and teens who experience more depressive symptoms begin drinking earlier, and drink and become intoxicated more frequently than their peers with fewer symptoms.

Moreover, drinking combined with depressive symptoms carries a greater risk of negative outcomes such as alcohol-use disorder, severe depression and suicide than does either drinking or depressive symptoms by themselves.

In order to better design prevention and intervention programs, public-health experts have long been asking the “chicken and egg” question of whether adolescents who drink alcohol are at risk of future depression and, conversely, whether adolescents who experience depressive symptoms are at risk of greater alcohol consumption in the future.

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