Alcohol Use Disorder and Mental Health: Understanding The Interplay
In the intricate landscape of mental health care, the confluence of Alcohol Use Disorder (AUD) and mental health disorders represents a complicated challenge for professionals. AUD is not just a stand-alone health issue, rather, it’s often intertwined with various co-occurring mental health disorders, which create a complex web of symptoms and treatment considerations.
Understanding Alcohol Use Disorder (AUD)
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2025) defines alcohol as “a problematic pattern of alcohol use leading to clinically significant impairment or distress” and is based on the amount of symptoms a patient experiences in 12 months. Previously called alcohol abuse, AUD is now considered an alcohol use disorder, which reduces stigma for patients who suffer from this disease. AUD severity is determined by the number of symptoms the patient experiences placing them in Mild, Moderate, or Severe categories.
Mild AUD: Characterized by the presence of 2-3 symptoms from the diagnostic criteria. Individuals with mild AUD may start to experience negative effects on their health, social life, or work, but the symptoms are less severe compared to more advanced stages.
Moderate AUD: Defined by the presence of 4-5 symptoms. Here, the impact of alcohol use is more pronounced, and individuals are likely to face more significant health issues, interpersonal problems, and difficulties in managing day-to-day responsibilities.
Severe AUD: Indicated by the presence of 6 or more symptoms. This stage is marked by a high level of dependence on alcohol, significant health problems, and severe impairment in social and occupational functioning, often requires immediate and intensive treatment interventions in the hospital or intensive care unit.
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Deciphering the Stages of Severity in Alcohol Use Disorder
The severity of AUD is categorized into three stages and is based on the number of symptoms the patient experiences in a 12-month timeframe (NIAAA, 2025). There are eleven symptoms the study includes.
First Stage: The binge and intoxication stage where pleasure and rewards are associated with imbibing. This stage strengthens the habit and potentially lays the groundwork for compulsive use.
Second Stage: The negative affect and withdrawal stage manifests anxiety, irritability, dysphoria, and alcohol is necessary for pain and discomfort relief.
Third Stage: The preoccupation and anticipation stage is associated with deficits in the executive functions that help us to organize, regulate emotions, initiate tasks, and plan.
The spectrum of AUD severity is important for guiding treatment decisions and interventions. The more severe the AUD, the more intensive the treatment typically needs to be, often requires a combination of medication, therapy, and support services.
The Link Between AUD and Mental Health
Alcohol’s impact on brain chemistry and mental health is a multifaceted and complex issue, deeply intertwined with various mental health disorders. Research in this area requires a multidisciplinary approach, with physicians, mental health professionals, nurses, occupational therapists, pharmacists, and physical therapists who integrate rigorous examinations and cognitive testing with assessment tools for both youth and adults to recognize if an underlying psychiatric condition is present. A history of trauma and childhood trauma also increases the risk for the patient to have both AUD and a mental health diagnosis (Substance Use, 2024). Studies show that mental health disorders may contribute to increased substance use. Often, additional drugs are used as coping mechanisms that may help ease the temporary symptoms; however, over time, the brain changes in people who have mental health disorders, which may make symptoms worse over time. Screening early for mental health disorders and trauma will help protect the patients against AUD and other substance use disorders.
Impact on Mental Health Disorders
It is estimated approximately half of people who experience mental illness during their lifetime also experience substance abuse (Osborne & Pandalai, 2023) and alcohol is the most common substance used in the U.S. Clinicians are instructed to screen carefully for the following psychiatric conditions, which may manifest with alcohol use that is unhealthy (Nehring et al., 2024).
- Bipolar disorder
- Panic disorder
- Insomnia
- Posttraumatic stress disorder
- Dysthymic disorder
- Major depression
- Anxiety Disorder
Patients who are diagnosed with a mental health condition and trauma history have an increased risk of AUD (Understanding Alcohol Use, 2025), and clinicians must be diligent in their assessment, diagnosis, and evaluation of the patient. Careful active listening and assessment must occur by a primary physician and mental health practitioner to ensure the most accurate diagnosis and treatment plan.
Challenges in Diagnosis and Treatment
AUD is complex to diagnose and treat, fraught with various challenges that healthcare professionals must carefully navigate. One of the most significant barriers is the societal stigma and denial often associated with AUD. The stigma that surrounds alcohol dependence can lead individuals and families to deny the severity of the disease, which delays recognition and the pursuit of treatment.
Mental health conditions, such as depression, anxiety, or bipolar disorder, are often complicated further by alcohol use. These disorders can overlap or mask the symptoms of AUD, which creates a complex clinical picture that challenges even the most experienced practitioners. Additionally, the spectrum of AUD severity, ranging from mild to severe, means that symptoms can vary greatly among individuals, adding another layer of complexity to both diagnosis and treatment.
Cultural and social factors also play a significant role in the diagnosis and treatment of AUD. In some cultures and social settings, heavy drinking might be normalized, which can delay the recognition of AUD as a serious health issue. This normalization can also influence an individual’s willingness to acknowledge their disorder and seek help.
Access to treatment presents another hurdle. Issues like limited availability of specialized addiction services, coupled with the cost of treatment and lack of insurance coverage, may prevent an individual from exploring or continuing care. Additionally, AUD is characterized by a high relapse rates, which poses a significant challenge in the management and prevention of the disorder. Ongoing support and potentially long-term management strategies are needed to ensure sustained recovery.
Pharmacotherapy, counseling, behavioral therapies, and support groups are essential for successful outcomes (Nehring et al., 2024), but can be a challenge to implement. Additionally, the lack of standardized screening for AUD in many healthcare settings can cause missed opportunities for early detection and intervention, which is crucial for long-term outcomes.
Finally, the unique nature of each individual’s experience with AUD underscores the need for personalized treatment plans. Plans should be tailored specifically for the patient’s holistic circumstances, including co-occurring mental health disorders, social and family support systems, and personal motivation for change.
The journey to effectively diagnose and treat AUD is laden with various obstacles. These range from societal attitudes and personal denial to the intricacies of co-occurring disorders and the need for personalized treatment strategies. Challenges must be addressed, and they require a comprehensive, empathetic, and multidisciplinary approach to ensure that individuals suffering from AUD receive the holistic necessary to succeed.
Navigating Strategies in Treating Alcohol Use Disorder
The treatment of AUD is a comprehensive and integrative process that combines both psychological and pharmacological strategies. Nonpharmacological interventions are the core psychological treatments,such as Motivational Interviewing (MI), Motivational Enhancement Therapy (MET), and Cognitive Behavioral Therapy (CBT) (NIAAA, 2025).
MI is a counseling approach designed to help individuals recognize and confront their alcohol-related challenges and is effective for those uncertain about changing their behavior. It aims to enhance intrinsic motivation for change by working through ambivalence, a method supported by research indicating its effectiveness over no treatment.
MET, building on the principles of MI, focuses on strengthening an individual’s motivation and commitment to change their alcohol behaviors and utilizes personal assessments to explore their patterns of alcohol consumption.
Cognitive Behavioral Therapy (CBT) is another critical psychological approach that emphasizes the interplay between thoughts, behaviors, and emotions. CBT equips patients with the skills to identify triggers and unrecognized factors that influence the desire to drink and aids in coping strategies (Substance Use, 2024).
Pharmacological treatments complement psychological methods; non-addictive medications like:
- Naltrexone: can be taken daily PO or monthly IM administered in the clinical setting. This medication decreases drinking days or amounts by inhibiting the pleasure found in drinking, which decreases the craving. This is a first line medication for AUD.
- Acamprosate: taken in tablet form, this medication may be difficult to take regularly because of the frequency of dosing, and can not be used for patients in renal failure. This is another first-line medication
- Disulfiram: Causes an undesirable reaction when combined with alcohol. This medication can cause numerous side effects when introduced to alcohol in the body. Liver enzymes must be checked while on this medication.
Pharmacology plays a unique role to manage, stop, or reduce drinking and aims to prevent the recurrence of drinking.
Given the chronic nature of AUD, recovery is often a long-term process, with the possibility of lapses or setbacks. Support, continuous monitoring, and flexibility in adapting the treatment plan are crucial for sustained recovery and effective long-term management. This integrated treatment approach encompasses psychological therapies, pharmacological interventions, personalized care plans, and robust support systems that form the bedrock of effective AUD treatment strategies.
In-Depth Case Studies on Alcohol Use Disorder
To relate to treatment options for Alcohol Use Disorder (AUD), consider the findings from a post hoc analysis of a clinical trial, which provide insights into treatments for severe AUD cases (Pettinati et al., 2011). The analysis, derived from a multicenter, placebo-controlled, 24-week randomized trial of XR-NTX for alcohol dependence involving 624 participants, focused on patients with higher baseline severity. Severity was measured using the Alcohol Dependence Scale (ADS) and whether the patient had undergone detoxification before randomization.
The study’s findings are particularly relevant in understanding treatment efficacy for severe alcohol dependence. It also examines the role of pretreatment severity in predicting outcomes, specifically the relationship between these indices and achieving at least 4 days of lead-in abstinence before treatment. This factor was a major predictor of positive outcomes in the original study. Such research underscores the importance of tailored treatment approaches and highlights the potential of pharmacological interventions like XR-NTX in improving treatment outcomes.
Concerning effective AUD treatments, extended-release naltrexone (XR-NTX), a once-a-month injectable formulation approved by the FDA, has shown efficacy. An analysis of patients who achieved 4 or more days of voluntary abstinence revealed that XR-NTX (380 mg) with counseling led to significantly higher abstinence rates than placebo. Key findings include a longer median time to first drink (41 vs. 12 days), a higher rate of continuous abstinence (32% vs. 11%), and a delayed time to first heavy drinking event (over 180 vs. 20 days). XR-NTX also reduced drinking days by 90% and heavy drinking days by 93%. The higher dosage group showed more than double the number of responders, highlighting XR-NTX 380 mg’s potential in prolonging abstinence and reducing heavy drinking days.
Essential Resources and Support for Mental Health Professionals in AUD Treatment
Mental health professionals treating patients with Alcohol Use Disorder (AUD) have access to a variety of resources and support mechanisms to enhance their practice and provide effective care. These resources not only offer information and tools for treatment but also support the well-being of the professionals themselves, who often face challenges in their work. Some key resources and support options include:
Professional Organizations and Associations: Organizations such as the American Psychological Association (APA), the American Psychiatric Association (APA), and the Association for Addiction Professionals (NAADAC) offer resources, training, and networking opportunities for professionals dealing with AUD. These organizations often provide access to the latest research, treatment guidelines, and continuing education opportunities.
Specialized Training and Certification Programs: There are numerous training programs and certifications available for mental health professionals focusing on addiction and substance abuse treatment, such as the Certified Alcohol and Drug Counselor (CADC) certification. These programs enhance knowledge and skills specific to AUD treatment.
Online Resources and Databases: Websites like the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and Substance Abuse and Mental Health Services Administration (SAMHSA) offer extensive online resources that include treatment guidelines, research updates, and toolkits for managing AUD.
Peer Support and Supervision: Engage in peer support groups or seek supervision from experienced professionals may provide mental health practitioners with valuable insights and strategies to cope while dealing with the challenges of treating AUD.
Conferences and Workshops: Conferences and workshops are a great optionfor professionals to stay updated on the latest developments in AUD treatment and network with peers and experts in the field.
Online Forums and Professional Networks: Professionals who deal with AUD can utilize online forums and professional social media networks to discuss cases, share experiences, and seek advice from other professionals.
Self-Care Resources: Mental health professionals must take care of their mental health. Resources that focus on self-care, stress management, and burnout prevention are important to maintain personal well-being and professional effectiveness.
Patient Education Materials: Access to a variety of patient education materials, such as brochures, websites, and videos, can provide professionals information to educate their patients and families.
Referral Networks: Detox centers, inpatient and outpatient treatment programs, and support groups like Alcoholics Anonymous (AA), are crucial to provide comprehensive care to patients with AUD.
Research Journals and Publications: Subscriptions to journals and publications that focus on addiction and mental health keep professionals informed about the latest research and evidence-based practices in the field.
These resources and support systems significantly enhance the ability of mental health professionals to provide effective, evidence-based treatments for patients with AUD while their professional growth and personal well-being grow.
AUD is multifaceted, and treatment programs are individualized, created by interdisciplinary professionals which combine care for co-occuring mental health disorders and other addictions. A detailed and non-bias patient history, background, clinical, and physical assessment must be completed by healthcare providers to ensure proper diagnoses and treatment plan is created, that intertwines the patient’s holistic self and family that will participate in the road to recovery. Recovery is a process, but with step by step goals, recovery from AUD is possible.
Christine Hockemier, MSN, RN, CMSRN, CNEcl, is a freelance nurse writer and a certified clinical nurse educator. With 14 years of nursing experience, she has worked in many specialties, including Intensive Care Units and travel nursing, and currently teaches nursing school at a local college. In her free time, she enjoys being outdoors, dancing, and spending time with friends and family.
References
Nehring, S. M., Chen, R. J., & Freeman, A. M. (2024, March 16). Alcohol use disorder. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK436003/#article-17343.s9
Osborne, J. C., & Pandalai, S. P. (2023, October 10). Mental health, alcohol use, and substance use resources for workers and employers. Centers for Disease Control and Prevention. https://blogs.cdc.gov/niosh-science-blog/2023/10/10/mental-health-substance-use/
Pettinati, H. M., Silverman, B. L., Battisti, J. J., Forman, R., Schweizer, E., & Gastfriend, D. R. (2011). Efficacy of extended-release naltrexone in patients with relatively higher severity of alcohol dependence. Addiction Biology, 16(4), 552–561. https://doi.org/10.1111/j.1530-0277.2011.01524.x
U.S. Department of Health and Human Services. (2025, January). Understanding alcohol use disorder. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
U.S. Department of Health and Human Services. (2024, March). Substance use and co-occurring mental disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
U.S. Department of Health and Human Services. (2025, January). National Institute on Alcohol Abuse and Alcoholism (NIAAA). National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/
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