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Low Self-Esteem, Depression and Alcohol Misuse

For anyone aiming to change their pattern of alcohol consumption, it can be helpful to think about some of the emotional and psychological factors involved.  In this article, we are going to look at depression and self-esteem; consider how they are involved in habitual, and dependent, alcohol consumption and think about how we can use this knowledge to make changing behaviour more successful and enduring.


What do we mean by depression?

‘Depression’ is a widely used word that has quite precise definitions in some mental health classifications.  Regardless of the formal diagnostic term, most of us would generally recognise depression as an experience of feeling low in mood, sad or tearful; lacking interest in activities that we would have previously enjoyed; being fatigued and finding it hard to sleep – or over sleeping; feeling hopeless; having difficulty concentrating; feeling like there is something missing and generally seeing the world through a ‘negative lens’. 


What is the link with drinking alcohol?

When someone is feeling depressed, turning to alcohol is really understandable.  In the short term, while they are drinking, alcohol can help them to feel brighter, more relaxed and less concerned about life’s worries.  It can also help them to fall asleep, although the sleep is generally not good quality or restorative.


The problems arise later.  Often after drinking, or even the morning after, we notice feeling low or anxious.  One reason for this is that alcohol changes our brain chemistry, reducing the amount of available serotonin, one of the ‘feel good’ neurochemicals.  People are obviously at risk of drinking again to relieve those unpleasant feelings and so depression and alcohol use can quite easily become mutually reinforcing. 



Depression and alcohol use can be mutually reinforcing
Depression and alcohol use can be mutually reinforcing


Of course, this is very over-simplified but it does give us a sense of just how strong, and biologically natural, the relationship is between alcohol and depression.

It is generally understood through research that the more we drink, the worse the symptoms of depression.  So, conversely, even cutting down slightly could be helpful and could give someone a little extra capacity to look at other things contributing to their depression.


How to understand Self-Esteem

There are many definitions of self-esteem and it has been a theory that psychologists have debated over for decades.  It can certainly be confused with other terms  such as self-confidence but, even if we can’t quite pin down the words to explain it, in general we tend to know when our self-esteem is low.  One definition that I think reflects many people’s experience is that self-esteem relates to how we perceive our own value. It is connected to whether we feel that we are entitled to take our place in the world.  It is related to our view of the degree to which we are permitted to ask for what we want and need, and to say ‘no’ to what is not good for us.  Self-esteem is reflected in the degree to which we consider our own needs as being as important as anyone else’s.  Perhaps most importantly, high self-esteem is demonstrated by a person’s ability to retain a sense of self-worth even in the face of criticism by others.  If a person’s self-esteem is low, it is likely that they will judge themselves based on how they imagine that others will judge them.  It is likely that they will also choose their actions based on how they anticipate others will judge them.  So self-esteem is about our sense of our own value that comes from within and doesn’t rely on others to approve of us.


Relationship between Self-Esteem and Alcohol consumption

Intuitively, one might imagine that low self-esteem would go ‘hand in hand’ with excessive alcohol consumption – we drink to feel better about ourselves, right?   But the research results really aren’t that straightforward.  In fact the results are very unclear with both high and low self-esteem being related to excessive drinking.  So why might high self esteem have this effect?  One suggestion is that overly high self esteem gives us an unrealistic view of ourselves and prevents us from recognizing the negative consequences of our drinking behaviour.  Maybe we feel somewhat immune from those consequences – for example, if we do something embarrassing or insult someone while drunk, we might refuse to reflect on the harm we are doing.



Some research has found that, over time, heavy drinkers with higher self-esteem, actually drank more on a weekly basis and had fewer days of abstinence from drinking.  However, heavy drinkers with low self-esteem reported more disadvantages to drinking alcohol and also reported the development of greater dependency.  So this could suggest that there is something protective about having high self-esteem when it comes to becoming dependent on alcohol.  It could seem reasonable to deduct that heavydrinkers with high self-esteem still maintain their sense of self-worth following a drinking session when they might have behaved in embarrassing ways.  Therefore, they do not need to drink again to distract from their feelings.  However, those drinkers with low self-esteem, may feel highly ashamed of how they embarrassed themselves, or abandoned responsibilities, and therefore seek an escape from those very painful feelings through drinking again.  The long established link between shame and low self-esteem explains the need to repeat drinking behaviour to manage painful emotions.  So while high self-esteem does not necessarily protect against becoming a heavy drinker, it could protect against becoming dependent on drinking alcohol. 


Of course any research is inevitably selective in the elements it studies and therefore this is only one way of understanding self-esteem and alcohol dependence and the picture is likely to be much more complex than this.


Self-Esteem, Depression and Alcohol Dependence

Another paper concludes that low self-esteem contributes to depression rather than depression eroding self-esteem.  We can speculate about what the mechanisms for this would be:  The tendency to ruminate about difficult life experiences might be one pathway; low self-esteem is likely to lead to social withdrawal – a known contributor and maintainer of depression; people with low self-esteem may also tend to dampen positive feelings and feel undeserving of positive outcomes so not benefit from the enjoyable aspects their lives.

It is easy to see how low self esteem can be a strongly reinforcing factor in the maintenance of of dependent alcohol drinking.



How low self-esteem effects alcohol dependency
Low self-esteem could be a key factor in alcohol dependence



What helps with reducing drinking?

When we realise that we are drinking more than we intend, we will probably try to stop for a while or at least cut down.  There is a good chance that we will be successful for a while …….. but as the weeks pass, we can find it increasingly difficult to stick to our commitment.  So, although alcohol in its own right can be an addictive substance, if our need to drink is being driven by underlying psychological processes, we will need an approach that is more than commitment and willpower.  Our emotional life is going to need some attention. 


For many people depression can be a long term condition but for others it is often a reaction to specific circumstances in their lives.  In this case, as our situation improves, so our depression can lift.  For many people, starting to increase their activity levels; establishing good daily routines; taking part in activities they enjoy and that give them a sense of mastery and increasing their socialising might be all that is needed to start to restore their sense of wellbeing. 

There are also things we can do to increase our self-esteem.  Practice accepting compliments; Keep a daily journal to record one thing a day that you appreciate about yourself (however small); Spend time with people who tend to make you feel good about yourself; Be your own best friend – talk to yourself as you would speak to someone you cared about; Practice being assertive – respecting yourself, as well as the other person, when you are in communication. However, even when things are going well in our lives, our lack of a sense of self-worth means that, in different ways, we often don’t allow ourselves to enjoy it. 


If you are finding it difficult to improve your emotional wellbeing or reduce your alcohol consumption with self-help strategies such as those above, do talk to someone such as your GP who can help or can direct you to a suitable professional.  You will also find further information on this site under Other Resources.

 

Reading

Alcohol and self-esteem. Praveen L Subravgoudar and Dr. J Rukumani. International Journal of Advanced Psychiatric Nursing 2021; 3(2): 15-19

 

The Long-term Effects of Self-Esteem on Depression: The Roles of Alcohol and Substance Uses during Young Adulthood.  Kiwoong Park, Doctoral Student and Tse-Chuan Yang, Ph.D

 

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