Alcohol Practical

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 56

1

Depression, anxiety and alcohol use: a correlational study.

Mata Sundri College for Women

Understanding And Dealing with Psychological Disorders

21044528059
2

Abstract

The present study aimed to evaluate the relationship between alcohol use and mental health

measures like depression, anxiety, and stress in individuals aged 25 to 35. Employing a cross-

sectional design, a sample of 49 participants, selected through purposive and snowball sampling,

provided insights into the prevalence and correlations between alcohol use and mental health

indicators. The Alcohol Use Disorders Identification Test (AUDIT) and the Depression, Anxiety,

and Stress Scales (DASS-21) were employed as assessment tools, allowing for a comprehensive

evaluation of participants' alcohol consumption patterns and mental health states. Correlation

analyses conducted using SPSS revealed significant associations between alcohol use and

depression (r = 0.504, p =.001), anxiety (r = 0.517, p =.001), stress (r = 0.424, p = 0.002), and the

overall DASS-21 scores (r = 0.552, p =.001). Using inferential statistics all four hypothesis were

rejected. The prevalence rates of depression, anxiety, and stress varied among participants, with

diverse levels of alcohol consumption, showcasing a notable relationship between higher alcohol

use and increased mental health issues.

Keywords: alcohol use, depression, anxiety, stress, DASS-21, AUDIT, correlational analysis.
3

Aim: To study the relationship between alcohol use/consumption and depression, anxiety and

stress.

Alcohol use disorder is a pattern of alcohol use that involves problems controlling your

drinking, being preoccupied with alcohol, or continuing to use alcohol even when it causes

problems. This disorder also involves having to drink more to get the same effect or having

withdrawal symptoms when you rapidly decrease or stop drinking. Alcohol use disorder includes

a level of drinking that's sometimes-called alcoholism. The words "alcoholic" and "alcoholism"

have been used in different ways by different groups in the past, which has caused some debate.

WHO no longer uses the word "alcoholism." Instead, they talk about "drinking that causes

detrimental health and social consequences for the drinker, the people around the drinker, and

society at large, as well as the patterns of drinking that are associated with increased risk of

adverse health outcomes" (2014a, p. 2). A person who drinks six or more alcoholic drinks at least

once a month is considered to be heavy episodic drinking by the WHO and experts in this field

(WHO, 2014a).

Prevalence

Alcohol abuse and alcohol dependence are major problems around the world and are

among the most destructive of psychiatric disorders because of the impact excessive alcohol use

can have on users’ lives and those of their families and friends. The prevalence of Alcohol Use

Disorder (AUD) in India has varied over time due to several factors like cultural attitudes,

socioeconomic changes, and government policies. As of the last update in 2022, the estimated

prevalence of alcohol use disorders in India ranged widely between different studies, but it was

generally reported to be around 4-6% of the adult population. However, these figures can

fluctuate and might not represent the current statistics. It's important to note that alcohol
4

consumption patterns and disorders can vary significantly across different regions and

demographics within India. Factors like urbanization, economic development, and cultural

practices can influence the prevalence rates. Alcohol abuse is found in priests, politicians,

surgeons, law enforcement officers, and teenagers; the image of the alcohol-abusing person as an

unkempt resident of skid row is clearly inaccurate. Recent research has shown that alcohol abuse

has a strong presence in the workplace, with 15 percent of employees showing problem

behaviors; many (1.7 percent, or 2.1 million people) actually drinking on the job; and 1.8

percent, or 2.3 million workers, drinking before they go to work (Frone, 2006).

Age of Onset

It appears that problem drinking may develop during any life period, from early

childhood through old age. About 10 percent of men over the age of 65 are found to be heavy

drinkers (Breslow et al., 2003). Surveys of alcoholism rates across different cultural groups

around the world have found varying rates of the disorder across diverse cultural samples

(Hibell et al., 2000). Although alcohol use is illegal for people under 21 years of age in the

United States, one-third of 8th graders and 70 percent of 12th graders have tried alcohol. Of

particular concern, 22 percent of 12th graders report having engaged in binge drinking in the

last year. Several studies suggest that the use of alcohol and the prevalence of alcohol-related

problems have been increasing among young people in recent decades and that the age at

which alcohol is first consumed is decreasing. In India, the mean age for initiation of drinking

ranged from 14.4 to 18.3 years.

Gender

Historically, most problem drinkers—people experiencing life problems as a result of

alcohol abuse—have been men; for example, men become problem drinkers at about five times
5

the frequency of women (Helzer et al., 1990). In most nations of the world, men are more likely

to drink alcohol than are women, and also are more likely to drink heavily or binge drink.

Similarly, across all age groups, males are much more likely to develop alcohol use disorders

than are females. The gender gap in alcohol use is much greater among men and women who

subscribe to traditional gender roles, which condone drinking for men but not for women.

Comorbidity

Alcohol significantly lowers performance on cognitive tasks such as problem solving and

the more complex the task, the more impairment (Pickworth et al., 1997). Organic impairment,

including brain shrinkage, occurs in a high proportion of people with alcohol dependence

(Gazdzinski et al., 2005), and alcohol abuse is associated with increased risk of a wide range of

other negative health outcomes such as diabetes, stroke, and cardiovascular disease (Molina et

al., 2014). Over 37 percent of people who abuse alcohol experience at least one coexisting

mental disorder (Lapham et al., 2001). Not surprisingly, given that alcohol is a depressant,

depression ranks high among the mental disorders often comorbid with alcoholism. There is a

high comorbidity of substance abuse disorders and eating disorders (Harrop & Marlatt, 2009). It

is also no surprise that many alcoholics die by suicide (McCloud et al., 2004). In addition to the

serious problems that excessive drinkers create for themselves, they also pose serious difficulties

for others. Alcohol abuse co-occurs with high frequency with personality disorder as well.

(Grant, Stinson, et al., 2004)

DSM 5 criteria for alcohol use disorder

A. A problematic pattern of alcohol use leading to clinically significant impairment or distress,

as manifested by at least two of the following, occurring within 12 months:


6

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 fulfill 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:


7

a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the

criteria set for alcohol withdrawal, pp. 499–500).

b. Alcohol (or a closely related substance, such as benzodiazepine) is taken to relieve or

avoid withdrawal symptoms.

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental

Disorders, Fifth Edition (Copyright © 2013). American Psychiatric Association

Clinical Picture of Alcohol use Disorder

Alcohol’s effects on the brain

Alcohol exerts complex effects on the brain. At lower levels, it triggers activation in the

brain's "pleasure areas," leading to the release of endogenous opioids stored in the body (Braun,

1996). However, at higher levels, alcohol depresses brain functioning by inhibiting one of the

brain's excitatory neurotransmitters, glutamate, subsequently slowing down activity in certain

brain regions (Koob et al., 2002). This inhibition of glutamate impairs learning ability and

influences higher brain centers, resulting in impaired judgement, diminished rational processes,

and reduced self-control. With declining behavioural restraints, a drinker may yield to normally

suppressed impulses. Observable effects include a lack of motor coordination, dulled

discrimination, and altered perceptions of cold, pain, and other discomforts. Typically, the

drinker experiences a sense of warmth, expansiveness, and well-being, screening out unpleasant

realities and elevating feelings of self-esteem and adequacy. In essence, intoxication is

determined by the amount of alcohol concentrated in bodily fluids, not the amount consumed.

The impact of alcohol varies among individuals based on their physical condition, the presence

of food in their stomach, and the duration of their drinking. Additionally, alcohol users may
8

develop tolerance over time, necessitating ever-increasing amounts to achieve the desired effects.

Women metabolize alcohol less effectively than men, making them susceptible to intoxication

with smaller amounts (Gordis et al., 1995). Beyond intoxication, excessive alcohol consumption

is associated with the phenomenon of an "alcohol hangover," characterized by symptoms such as

headache, nausea, fatigue, and cognitive impairment lasting for 8 to 24 hours after alcohol

consumption (Verster et al., 2010).

Development Of Alcohol Dependence

Excessive drinking can be viewed as progressing insidiously from early- to middle- to

late-stage alcohol-related disorder, although some abusers do not follow this pattern. Many

investigators have maintained that alcohol is a dangerous poison even in small amounts, but

others believe that in moderate amounts it is not harmful to most people. For pregnant women,

however, even moderate amounts are believed to be dangerous, and no safe level has been

established. Some are born with fetal alcohol syndrome (FAS), a condition that is caused by

excessive alcohol consumption during pregnancy and results in birth defects such as mental

retardation.

The Physical Effects of Chronic Alcohol Use

For individuals who engage in excessive drinking, the clinical outlook is notably

unfavorable (Turner et al., 2006). Alcohol, once consumed, must be assimilated by the body,

with only approximately 5 to 10 percent being eliminated through breath, urine, and perspiration.

The liver is responsible for the metabolism of alcohol; however, when large quantities are

ingested, the liver can be excessively strained, leading to irreversible damage (Lucey et al.,

2009). In fact, a significant percentage, ranging from 15 to 30 percent, of heavy drinkers develop
9

cirrhosis of the liver—a condition characterized by extensive stiffening of the blood vessels.

Notably, many of the 36,000 annual cirrhosis-related deaths are attributed to alcohol (Centers for

Disease Control and Prevention [CDC], 2015b). Alcohol consumption also diminishes a drinker's

appetite for other food. As alcohol lacks nutritional value, individuals who engage in excessive

drinking are prone to malnutrition (Derr & Gutmann, 1994). Moreover, heavy drinking hampers

the body's ability to effectively utilize nutrients, making it challenging to compensate for

nutritional deficiencies through vitamin supplementation. Additionally, many individuals who

abuse alcohol may experience heightened gastrointestinal symptoms such as stomach pains

(Fields et al., 1994).

Psychosocial Effects of Alcohol Abuse and Dependence

In addition to physical and medical issues, individuals who engage in heavy drinking

often experience chronic fatigue, heightened sensitivity, and depression. Initially, alcohol may

appear as a useful crutch for coping with life's stresses, especially during acute stress periods, by

temporarily shielding the individual from intolerable realities and boosting feelings of adequacy

and worth. However, the excessive use of alcohol eventually becomes counterproductive, leading

to impaired reasoning, compromised judgment, and gradual personality deterioration. Behavioral

changes become apparent, characterized by coarseness and inappropriateness. The individual

often assumes decreasing responsibility, loses pride in personal appearance, neglects spouse and

family, and becomes irritable and unwilling to address the problem. As judgment becomes

increasingly impaired, the heavy drinker may find it challenging to maintain employment and

becomes ill-equipped to handle new challenges (Frone, 2003). General personality

disorganization and deterioration may manifest in job loss and marital breakdown. The

individual's overall health eventually declines, accompanied by damage to the brain and liver.
10

For instance, there is evidence suggesting that an alcoholic's brain accumulates diffuse organic

damage even in the absence of extreme organic symptoms (Sullivan, Deshmukh, et al., 2000).

Mild to moderate drinking can adversely affect memory and problem-solving abilities (Gordis,

2001). Other researchers have associated extensive alcohol consumption with increased organic

damage in later life (Lyvers, 2000). However, recent research utilizing functional magnetic

resonance imaging (fMRI) indicates that some of this damage is partially reversible if the

individual abstains from alcohol use (Wobrock et al., 2009).

Psychoses associated with severe alcohol abuse.

Acute psychotic reactions that align with the diagnostic classification of substance-

induced disorders can manifest due to the excessive use of alcohol. These reactions often occur

in individuals who have engaged in prolonged and heavy drinking. Termed alcohol-induced

psychotic disorders, these acute reactions are characterized by a temporary loss of contact with

reality (Jordaan & Emsley, 2014). The episodes typically last for a short duration and commonly

involve symptoms such as confusion, excitement, and delirium. Among individuals who engage

in prolonged and excessive alcohol consumption, a specific reaction known as alcohol

withdrawal delirium (formerly referred to as delirium tremens) may emerge. This reaction

typically occurs during a prolonged drinking spree when the individual enters a state of

withdrawal. Minor stimuli like slight noises or sudden movements can trigger significant

excitement and agitation. The full-blown symptoms include.

(1) disorientation for time and place, in which, for example, a person may mistake the hospital

for a church or jail, no longer recognize friends, or identify hospital attendants as old

acquaintances.

(2) vivid hallucinations, particularly of small, fast-moving animals like snakes, rats, and roaches.
11

(3) acute fear, in which these animals may change in form, size, or color in terrifying ways.

(4) extreme suggestibility, in which a person can be made to see almost any animal if its

presence is merely suggested.

(5) marked tremors of the hands, tongue, and lips; and

(6) other symptoms including perspiration, fever, a rapid and weak heartbeat, a coated tongue,

and foul breath.

The delirium associated with alcohol withdrawal typically endures for a period ranging

from 3 to 6 days, followed by a profound sleep. Upon awakening, few symptoms persist, but

individuals are often left feeling frightened and may abstain from drinking for several weeks or

months. It is estimated that 5 to 25 percent of individuals experiencing alcohol withdrawal

delirium may succumb to complications such as convulsions, heart failure, and other severe

issues (Trevisan et al., 1998). Medications like chlordiazepoxide (Librium) have demonstrated

efficacy in reducing withdrawal symptoms and, consequently, the risk of death due to

withdrawal (Kumar et al., 2015).

Another alcohol-related psychosis is alcohol amnestic disorder, formerly known as

Korsakoff's syndrome. First described by the Russian psychiatrist Korsakoff in 1887, it stands as

one of the most severe alcohol-related disorders (d’Ydewalle & Van Damme, 2007). The

primary symptom is a memory defect, particularly concerning recent events, often accompanied

by the falsification of events known as confabulation. Individuals with this disorder may fail to

recognize pictures, faces, rooms, and other objects they have just seen, although they may sense

familiarity. These individuals increasingly fill memory gaps with confabulations, leading to

disjointed and distorted associations. Although they may appear delirious, delusional, and
12

disoriented, their confusion and disordered actions are often linked to attempts to compensate for

memory gaps. Memory disturbance is associated with an inability to form new associations,

typically observed in long-time alcohol abusers after years of excessive drinking. These

individuals may also exhibit cognitive impairments such as planning deficits, intellectual decline,

emotional deficits, judgment deficits, and cortical lesions. Symptoms of alcohol amnestic

disorder stem from malnutrition, specifically the deficiency of vitamin B (thiamine). If diagnosed

correctly within the first 48 to 72 hours, treatment with thiamine can reverse the condition, and

memory functioning may be restored with prolonged abstinence. However, if left undiagnosed

and the disease progresses beyond several days, the brain damage causing this condition

becomes irreversible (Latt & Dore, 2014).

Causal Factors of Alcohol Dependence

Some researchers have stressed the role of genetic and biochemical factors (Hartz &

Bierut, 2010); others have pointed to psychosocial factors, viewing problem drinking as a

maladaptive pattern of adjustment to the stress of life; and still others have emphasized

sociocultural factors such as the availability of alcohol and social approval of excessive drinking.

some combination of all of these factors seems to influence the risk for developing alcohol abuse

or alcohol dependency.

Biological Causal Factors in Alcohol Abuse and Dependence

Substances such as alcohol, cocaine, and opium have powerful effects—an overpowering

hold that occurs in some people after only a few uses of the drug is due to the ability of most,

addictive substances to activate areas of the brain that produce intrinsic pleasure and sometimes

immediate, powerful reward. The second factor involves the person’s biological makeup, or
13

constitution, including his or her genetic inheritance and the environmental influences that enter

into the need to seek mind-altering substances to an increasing degree as use continues. The

development of an alcohol addiction is a complex process involving many elements:

constitutional vulnerability and environmental encouragement, as well as the unique biochemical

properties of certain psychoactive substances.

The neurobiology of addiction. Psychoactive drugs differ in their biochemical

properties as well as in how rapidly they enter the brain. There are several routes of

administration, including oral, nasal, and intravenous. Alcohol is usually drunk, the slowest

route, whereas cocaine is often self-administered nasally or by injection. Central to the

neurochemical process underlying addiction is the role the drug plays in activating the “pleasure

pathway.” The mesocorticolimbic dopamine pathway (MCLP) is the center of psychoactive drug

activation in the brain. The MCLP is made up of neuronal cells in the middle portion of the brain

known as the ventral tegmental area and connects to other brain centers such as the nucleus

accumbens and then to the prefrontal cortex. This neuronal system is involved in such functions

as control of emotions, memory, and gratification. Alcohol produces euphoria by stimulating this

area in the brain. Research has shown that direct electrical stimulation of the MCLP produces

great pleasure and has strong reinforcing properties (Littrell, 2001).

Genetic vulnerability. Many experts agree that heredity plays an important role in a

person’s developing sensitivity to the addictive power of drugs like alcohol (Plomin & DeFries,

2003; Volk et al., 2007). Several lines of research point to the importance of genetic factors in

substance related disorders. A review of 39 studies of the families of 6,251 alcoholics and of

4,083 nonalcoholics who had been followed over 40 years reported that almost one-third of

alcoholics had at least one parent with an alcohol problem (Cotton, 1979). Likewise, a study of
14

children of alcoholics found that for males, having one alcoholic parent increased the rate of

alcoholism from 12.4 percent to 29.5 percent and having two alcoholic parents increased the rate

to 41.2 percent. For females with no alcoholic parents, the rate was 5.0 percent; for those with

one alcoholic parent, the rate was 9.5 percent; and for those with two alcoholic parents, it was

25.0 percent (Cloninger et al., 1986). Adoption studies also provide evidence for a genetic

vulnerability for alcohol problems. In these studies, researchers followed up with children of

alcoholics and children of nonalcoholics who all were adopted by nonalcoholic families. Such

studies have shown that the children of alcoholic parents who had been adopted by nonalcoholic

foster parents were nearly twice as likely to have alcohol problems by their late 20s as the

control group of adopted children whose biological parents were not alcoholics (Goodwin et

al.,1973). Another approach to understanding the precursors to alcohol-related disorders is to

study pre alcoholic personalities—individuals who are at high risk for substance abuse but who

are not yet affected by alcohol. An alcohol-risk personality has been described as an individual

who has an inherited predisposition toward alcohol abuse and who is impulsive, prefers taking

high risks, and is emotionally unstable.

Genetics. Some experts are not convinced of the primary role of genetics in substance

abuse disorders. Genetic transmission in the case of alcohol related disorders does not follow the

hereditary pattern found in strictly genetic disorders. Importantly, the majority of children who

have parents with alcohol-related problems do not themselves develop substance abuse disorders

—whether or not they are raised by their biological parents. Overall, although much evidence

implicates genetic factors in the etiology of alcoholism, we do not know what precise role they

play. At present, it appears that the genetic interpretation of alcoholism remains an attractive

hypothesis; however, additional research is needed for us to hold this view with confidence. It is
15

not likely that genetics alone will account for the full range of alcohol and drug problems. Social

circumstances are still considered powerful forces in providing both the availability and the

motivation to use alcohol and other drugs.

Genetic influences and learning. Learning factors appear to play an important part in

the development of predetermined tendencies to behave in particular ways. Having a genetic

predisposition or biological vulnerability to substance abuse, of course, is not a sufficient cause

of the disorder. The person must be exposed to the substance to a sufficient degree for the

addictive behavior to appear. In the case of alcohol, almost everyone in America is exposed to

the drug to some extent—in most cases through peer pressure, parental example, and advertising

(Andrews & Hops, 2010). The development of alcohol-related problems involves living in an

environment that promotes initial as well as continuing use of the substance. People become

conditioned to stimuli and tend to respond in particular ways as a result of learning. Learning

appears to play an important part in the development of substance abuse and antisocial

personality disorders. There clearly are numerous reinforcements for using alcohol in our

everyday lives.

Psychosocial Causal Factors in Alcohol Abuse and Dependence

Failures in parental guidance. Stable family relationships and parental guidance are

extremely important molding influences for children (Hasin & Katz, 2010), and this stability is

often lacking in families of substance abusers. Children who have parents who are extensive

alcohol or drug abusers are vulnerable to developing substance abuse and related problems

(Erblich et al., 2001). The experiences and lessons we learn from important figures in our early

years have a significant impact on us as adults. Children who are exposed to negative role
16

models and family dysfunction early in their lives or experience other negative circumstances

because the adults around them provide limited guidance often falter on the difficult steps they

must take in life (Fischer et al., 2005). These formative experiences can have a direct influence

on whether a young person becomes involved in maladaptive behavior such as alcohol or drug

abuse.

Psychological vulnerability. In recent years, substantial research has focused on the link

between alcohol related disorders and such other disorders as antisocial personality, depression,

and schizophrenia to determine whether some individuals are more vulnerable to substance abuse

disorders. About half of those with schizophrenia have either alcohol or drug abuse or

dependence as well (Kosten, 1997). In addition, antisocial personality disorder, alcohol, and

aggression are strongly associated (Moeller & Dougherty, 2001), and in a survey of eight alcohol

treatment programs, Morganstern and colleagues (1997) found that 57.9 percent of those in

treatment had a personality disorder, with 22.7 percent meeting the criteria for antisocial

personality disorder. Considerable research also has suggested that there is a relationship

between depressive disorders and alcohol abuse, and there may be gender differences in the

association between these disorders (Kranzler et al., 1997). For whatever reason they co-occur,

the presence of other mental disorders in patients who abuse alcohol or drugs is a very important

consideration when it comes to treatment.

Stress, tension reduction, and reinforcement. Studies on patients undergoing substance

abuse treatment have shown high levels of trauma in their prior histories— about 25 to 50

percent of PTSD patients also have substance abuse disorders (Schafer & Najavits, 2007). In one

study, Deters and colleagues (2006) found that 98 percent of the American Indian adolescents in

their substance abuse study reported having a history of trauma such as threat of personal injury,
17

witnessing of injury, or sexual abuse. One recent controlled-treatment study of disaster workers

who experienced PTSD following the September 11, 2001, terrorist attacks found that excessive

alcohol use was associated with dropout from treatment (Difede et al., 2007). In addition, high

exposure to threatening situations and atrocities among Iraq War veterans has been associated

with a positive screen for alcohol abuse (Wilk et al., 2010). A number of investigators have

pointed out that the typical individual who abuses alcohol is discontented with his or her life and

is unable or unwilling to tolerate tension and stress (Rutledge & Sher, 2001). Hussong and

colleagues (2001) reported a high degree of association between alcohol consumption and

negative affectivity such as anxiety and somatic complaints.

Expectations of social success. Some research has explored the idea that cognitive

expectation may play an important role both in the initiation of drinking and in the maintenance

of drinking behaviour once the person has begun to use alcohol (Marlatt et al., 1998). According

to the reciprocal-influence model, adolescents begin drinking as a result of expectations that

using alcohol will increase their popularity and acceptance by their peers. From this perspective,

alcohol use in teenagers can be countered by providing young people with more effective social

tools and with ways of altering these expectancies before drinking begins. Some researchers have

suggested that prevention efforts should be targeted at children before they begin to drink so that

the positive feedback cycle of reciprocal reinforcement between expectancy and drinking will

never be established (Smith et al., 1995). Time and experience do have moderating influences

on these alcohol expectancies, although heavy drinking in early college years can result in risky

behavior and low academic motivation (Hoeppner et al., 2012). In a longitudinal study of college

drinking, Sher and colleagues (1996) found that there was a significant decrease in outcome
18

expectancy over time. That is, older students showed less expectation of the benefits of alcohol

than beginning students.

Marital and other intimate relationships. Adults with less supportive relationships tend

to show greater drinking following sadness or hostility than those with close peers and with more

positive relationships (Hussong et al., 2001). Excessive drinking often begins during crisis

periods in marital or other intimate personal relationships, particularly crises that lead to hurt and

self-devaluation. Marital relationships may actually serve to maintain the pattern of excessive

drinking. Marital partners may behave toward each other in ways that promote or enable a

spouse’s excessive drinking. For example, a husband who lives with a wife who abuses alcohol

is often unaware of the fact that, gradually and inevitably, many of the decisions he makes every

day are based on the expectation that his wife will be drinking. These expectations, in turn, may

make the drinking behavior more likely. Eventually an entire marriage may center on the

drinking of a substance-abusing spouse. Excessive use of alcohol is one of the most frequent

causes of divorce in the United States (Perreira & Sloan, 2001) and is often a hidden factor in the

two most common causes—financial and sexual problems. The deterioration in interpersonal

relationships of the alcohol abuser or dependent, of course, further augments the stress and

disorganization in her or his life. Family relationship problems have also been found to be central

to the development of alcoholism (Dooley & Prause, 2007). In a classic longitudinal study of

possible etiologic factors in alcohol abuse, Vaillant and colleagues (1982) described six family

relationship factors that were significantly associated with the development of alcoholism in the

individuals they studied. The most important family variables that were considered to predispose

an individual to substance use problems were the presence of an alcoholic father, acute marital
19

conflict, lax maternal supervision and inconsistent discipline, many moves during the family’s

early years, lack of “attachment” to the father, and lack of family cohesiveness.

Sociocultural Causal Factors

Social events often revolve around alcohol use, and alcohol use before and during meals

is commonplace. Alcohol is often seen as a “social lubricant” or tension reducer that enhances

social events. The effect of cultural attitudes toward drinking is well illustrated by Muslims and

Mormons, whose religious values prohibit the use of alcohol, and by orthodox Jews, who have

traditionally limited its use largely to religious rituals. The incidence of alcoholism among these

groups is minimal. In comparison, the incidence of alcoholism is high among Europeans. For

example, one survey showed the highest alcohol-use rates among young people to be in

Denmark and Malta, where one in five students reported having drunk alcohol 10 times within

the past 30 days (ESPAD, 2000). Interestingly, Europe and six countries that have been

influenced by European culture—Argentina, Canada, Chile, Japan, New Zealand, and the United

States—make up less than 20 percent of the world’s population and yet consume 80 percent of

the alcohol (Barry, 1982). The behavior that is manifested under the influence of alcohol also

seems to be influenced by cultural factors. Lindman and Lang (1994), in a study of alcohol-

related behavior in eight countries, found that most people expressed the view that aggressive

behavior frequently follows their drinking “many” drinks. However, the expectation that alcohol

leads to aggression is related to cultural traditions and early exposure to violent or aggressive

behavior.

Depression

Depression is a mood disorder that causes a persistent feeling of sadness and a loss of

interest in things and activities you once enjoyed. It can also cause difficulty with thinking,
20

memory, eating, and sleeping. Depression, also called major depressive disorder or clinical

depression, affects how an individual thinks, feels, and behaves and can also lead to a variety of

emotional and physical problems. It is also a common yet serious medical disorder that is related

to the person’s mood, can affect anyone every day, and lasts for a longer time. This disorder is

more likely to affect women than men.

There are two types of depressive disorders:

1. Unipolar Depressive Disorder, also known as Major Depressive Disorder, involves

experiencing solely depressive episodes. For at least two weeks, this disorder causes

pronounced feelings of depression or a loss of interest in previously enjoyed activities,

along with other symptoms like changes in sleep patterns, appetite, or feelings of

worthlessness.

2. Bipolar-depressive disorder encompasses both depressive and manic episodes. The

presence of mania or hypomanic episodes distinguishes bipolar disorder from unipolar

disorder.

Another primary kind of mood episode is a manic episode, in which a person shows a

markedly elevated, euphoric, or expansive mood, often interrupted by occasional outbursts of

intense irritability or even violence, particularly when others refuse to go along with the manic

person's wishes and schemes. These moods must persist for at least two weeks. However, in the

case of hypomania, the symptoms last for four days in a row and are not severe enough to require

hospitalization.

The presence of mania distinguishes bipolar disorder (I) from major depressive disorder. A

mixed episode is characterized by symptoms of both full-blown maniac and major depressive

episodes for at least 1 week, either intermixed or alternating rapidly every few days. Moreover,
21

many patients in a manic episode have some symptoms of a depressed mood, anxiety, guilt, and

suicidal thoughts. However, even if a person shows only manic symptoms, it is nevertheless

assumed that a bipolar disorder exists and that a depressive episode will eventually occur.

Bipolar disorder (II) is a distinct form of bipolar disorder in which a person does not

experience full-blown manic or mixed episodes but experiences clear-cut hypomanic episodes

and major depressive episodes. This type is equally or somewhat more common than bipolar (I)

disorder.

Cyclothymic disorder is the repeated experience of hypomanic symptoms for at least 2 years.

It is a milder but more chronic version of bipolar disorder because it lacks mood and behavioral

changes, psychotic features, and marked impairment as seen in bipolar. It is a chronic alteration

of mood, elevation, and depression that does not reach the severity of manic or major depressive

episodes. Individuals with Cyclothymic Disorder tend to be in one mood state or another for

years, with relatively few periods of neutral mood. This pattern must last for at least 2 years and

1 year for children and adolescents.

Relationship between alcohol abuse and depression

A study in JAMA Psychiatry points out that there may be a direct cause-and-effect

association between alcohol misuse, dependence, and major depressive disorder in certain

instances. Alcohol can not only lead to depressive symptoms but also worsen depressive

symptoms in people who already experience them or in those who may be genetically vulnerable

to depressive disorders. If drinking alcohol is the cause of depressive symptoms, they might go

away after significantly cutting back or stopping.

Alcohol can even worsen depression and depressive symptoms. Alcohol dependence can

also interfere with recovery from depression. Depressed study participants who were heavy
22

drinkers displayed worse outcomes from depression treatment; furthermore, even mild to

moderate amounts of alcohol appeared to worsen depression, with depressed patients who drank

low levels of alcohol (less than 1 oz per day) experiencing worse outcomes from

pharmacological treatments. Alcohol use disorders may be more prevalent in people who also

have depression than they are in the general population. The occurrence of alcohol use disorder

and a depressive disorder is associated with greater severity and a worse prognosis for both

disorders.

Anxiety

Anxiety is a feeling of worry or fear about what’s going to happen. It can be mild or

severe and affect your thoughts and the way you feel. It often has physical symptoms like

increasing your heart rate and making you sweat or tremble. Anxiety can become a health

problem if it affects a person's ability to live life as fully as they want to.

Generalised anxiety disorder (GAD), social anxiety, panic attacks, and phobias are just a

few of the medical categories that doctors use to describe anxiety. One thing they have in

common is that they cause the body to go into ‘fight or flight’ mode, releasing hormones into the

bloodstream to prepare a person to react or run away.

Several types of anxiety disorders may manifest in different ways, depending on the

individual, but all of them share symptoms of excessive worry and fear. Common types of

anxiety disorders that co-occur with substance use disorders, including alcohol use disorders,

include:

Generalised anxiety disorder (GAD) - The main symptoms are chronic, excessive worry

and fear about general, everyday things that interfere with your ability to function. The feelings

must occur most days and last at least 6 months to qualify for this diagnosis.
23

Recurrent, unexpected panic attacks, which are sudden, intense episodes of fear and

dread that are frequently incapacitating and can feel life-threatening, are the root cause of panic

disorder. Some people feel like they are having a heart attack. Symptoms can include chest pain,

difficulty breathing, feelings of impending doom, heart palpitations, and feeling like you’re out

of control.

Social anxiety disorder (SAD): It was previously referred to as social phobia and involves

intense fear of social or performance situations such as public speaking. You might experience

intense fear or worry that other people will judge your feelings and behaviour negatively. And

because alcohol interferes with the ‘fight or flight’ response, drinking can make the person more

vulnerable to these anxiety disorders and make symptoms worse.

Relationship between alcohol use and anxiety

Alcohol is a depressant. It slows down processes in your brain and central nervous

system and can initially make you feel less inhibited. In the short term, you might feel more

relaxed, but these effects wear off quickly. If you’re experiencing anxiety, drinking alcohol could

make things worse. Over time, if one regularly drinks heavily, the central nervous system gets

used to the suppressing effect of the alcohol, which means your brain is affected if the alcohol

level suddenly drops. They can go straight into ’fight or flight’ mode as the alcohol leaves the

system with the same reaction as an anxiety disorder.

If a person suffers from anxiety, it’s important not to be tricked by the temporary feeling

of relaxation from drinking alcohol to avoid being trapped in a vicious circle.

You drink alcohol. You initially feel calm as the alcohol affects the brain You feel anxious as a

symptom of alcohol withdrawal You may want to drink again to try Tcircle. ve your anxiety.
24

But the last step only starts the process again from the beginning. As the initial calm feeling

fades, you can feel anxiety as the effects of the alcohol wear off. The more one drinks, the

greater their tolerance for alcohol, meaning they need to drink more alcohol to get the same

feeling. If a person relies on alcohol to mask anxiety, they may find out that they become reliant

on it to relax, putting them at risk of alcohol dependence.

Drink long enough, and the person is probably familiar with the dreadful feeling that

comes the morning after a night of over-imbibing. Maybe you try to replay the evening’s

conversations in your mind or scroll through text messages to make sure you didn’t send

something you regret. Or maybe you immediately start issuing mass apologies to friends and

family.

While this can be a normal reaction to binge drinking, it can also be a sign of a deeper

issue, something called “hangxiety.” Hangxiety has become a buzzword that describes the

uneasy feeling that often accompanies heavy alcohol use Alcohol may be a temporary, unhealthy

way to relieve anxiety and forget about your underlying stressors; however, using alcohol does

not erase these underlying triggers. Whether your anxiety is related to past trauma, financial

stress, or untreated depression, alcohol is merely a temporary Band-Aid, and the longer one

depends on alcohol to help treat their anxiety, the more at risk they are of developing an alcohol

use disorder.

Chronic alcohol use affects your ability to respond to stress in healthy and effective ways,

which can lead to anxiety. This may be due to alcohol’s effect on the amygdala, the area of your

brain that regulates negative emotions. Brain imaging studies have found abnormalities in

amygdala functioning in individuals with alcohol use disorders.


25

Alcohol and panic attacks. Alcohol has an effect on many chemicals in the brain,

including GABA, serotonin, and dopamine, and when these brain chemicals are altered, it can

throw off how the body reacts in everyday situations. Alcohol can induce panic because of its

effects on GABA, a chemical that normally has a relaxing effect. Mild amounts of alcohol can

stimulate GABA and cause feelings of relaxation, but heavy drinking can deplete GABA,

causing increased tension and feelings of panic. Individuals with panic disorder and many other

types of anxiety disorders may try to self-medicate with alcohol in hopes of reducing their

anxiety levels. However, heavy alcohol use over time can potentially make them dependent on

alcohol, and as a result, when they stop drinking, they are at risk of alcohol withdrawal, which

can result in severe anxiety.

Stress

Stress is a dynamic and intricate response to environmental pressures or challenges that

individuals perceive as exceeding their ability to cope effectively. It involves a complex interplay

of psychological, physiological, and behavioural components. When faced with stressors, which

can range from everyday hassles to major life events, the body initiates the stress response. The

release of hormones like adrenaline and cortisol causes this response, also referred to as the

"flight or fight mechanism." The way we respond to stress makes a big difference in our overall

well-being. Physiologically, this leads to an increased heart rate, heightened alertness, and a

redirection of resources to prepare the body to confront the threat.

Hans Selye (1956) also noted that stress could occur not only in negative situations (for

example, taking an examination) but also in positive situations (like attending a wedding). Both

kinds of stress can tax a person’s resources and coping skills. Individual differences play a

crucial role in the stressful experience. Factors such as personality traits, coping mechanisms,
26

and past experiences shape how individuals perceive and respond to stressors. What one person

may find challenging, another may perceive as overwhelming, influencing the intensity of the

response. Coping strategies vary widely and can be adaptive or maladaptive. Healthy coping may

include problem-solving, practising relaxation techniques, etc. Maladaptive coping may involve

substance abuse, alcohol consumption, avoidance, etc.

Relationship between stress and alcohol

While some individuals may turn to alcohol as a way to cope with stress temporarily, the

consumption of alcohol can worsen a person’s stress in the long run. Stress can contribute to

alcohol use, as some individuals may turn to alcohol to cope with or escape stressful situations.

It's a way some people self-medicate to temporarily alleviate emotional distress. Stress triggers a

physiological response, releasing hormones like cortisol. In an attempt to alleviate this stress,

some individuals turn to alcohol. Alcohol can have a sedative effect, temporarily reducing

feelings of tension and anxiety. The immediate relief experienced creates a positive

reinforcement loop, as individuals associate alcohol consumption with stress relief. Moreover,

people may use alcohol as a form of self-medication to cope with emotional pain or trauma. The

numbing effect of alcohol provides a temporary escape from overwhelming emotions. This

coping strategy may become habitual, especially if individuals lack alternative, healthier ways to

manage stress. Additionally, societal and cultural factors can influence the relationship between

stress and alcohol use. For instance, social environments that normalise or glamorise drinking as

a way to unwind may contribute to the association between stress and alcohol consumption. The

social context and environment play a crucial role. Suppose someone is in a social setting where

alcohol use is normalised as a way to cope with stress or is seen as a common stress-relief

strategy. In that case, the likelihood of turning to alcohol in stressful situations increases.
27

Cultural influences and societal norms regarding alcohol can also contribute to this behaviour.

Stress can trigger a desire for relief, and some individuals turn to alcohol as a coping mechanism.

When stressed, the body releases cortisol and alcohol may temporarily alleviate these feelings by

affecting neurotransmitters like GABA, inducing a calming effect. However, this coping strategy

is often temporary and can lead to a cycle of reliance on alcohol to manage stress, risking the

development of alcohol use as a maladaptive coping mechanism. Over time, this pattern can

develop into a problematic cycle, with alcohol use escalating as a maladaptive coping

mechanism. This behavior, if left unaddressed, can lead to alcohol dependence or other substance

use disorders.

Darshan et al. (2013) conducted a study on professional stress, depression, and alcohol

use among Indian IT professionals. Stress has touched almost all professions, posing a threat to

mental and physical health. This cross-sectional online study was conducted using screening

questionnaires like the Professional Life Stress Scale, the Centre for Epidemiological Studies

depression scale, and the alcohol use disorder identification test. This study was conducted

specifically on professionals working in an IT firm with the designation of a software engineer.

Subjects who were at risk for developing depression had a 4.1 times higher prevalence of

harmful alcohol use compared with those who were not at risk for developing depression. They

concluded that high rates of professional stress, the risk for developing depression, and harmful

alcohol use among software engineers could hinder the progress of IT development and also

significantly increase the incidence of psychiatric disorders.

Ramanan and Singh (2016) studied the harmful use of alcohol as the cause of a lot of

deaths and the global burden of disease and injury. The objective of this study was to determine

the prevalence of alcohol consumption, the pattern of drinking, and its effect on people’s health
28

and social consequences. Their cross-sectional study was conducted in 850 households selected

from 19 villages in two primary health centers. A total of 30 clusters were selected, and from

each cluster, 28 houses were surveyed by the random walk method. Information was collected on

predesigned and pretested questionnaire forms. The prevalence of alcohol use in Puducherry was

low and restricted to males only. The prevalence was high among uneducated farmers and

laborers. About one-third of users had alcohol dependence problems, and one-fifth had chronic

health problems.

Nagendrappa et al. (2018) wanted to study the gender differences in demographic and

clinical profile and psychiatric comorbidity among patients with alcohol dependence syndrome

(ADS),. They conducted a cross-sectional study at Shridevi Institute of Medical Sciences and

Research Hospital, a tertiary care center located in Tumkur, India, from 2015 to 2016. Seventy

male and 50 female subjects (aged 18 to 50 years) meeting the criteria for ADS, were assessed

using socio-demographic and clinical proforma, severity of alcohol dependence questionnaire

(SADQ), and mini-international neuropsychiatric interview (MINI). It was seen that stress was

the foremost reason cited for initiation of drinking and physical sickness to seek medical

treatment by both. Females have more comorbid psychiatric problems compared to males.

Das et al. (2020) studied that stress is known to affect the prognosis of alcohol

dependence disorder. Using Perceived Stress Scale, levels of stress among 60 alcohol-dependent

in-patients selected through convenience sampling techniques were measured after the period of

detoxification. Analysis was done to examine association of stress and alcohol as well as

relationships of stress with other socio-demographic and alcohol-related variables. They noted a

significant association between the level of stress and severity of alcohol dependence.

Individuals with higher PSS scores were more severely dependent. Stress and alcohol
29

dependence was found to be highly correlated. The Pearson Correlation Half Matrix revealed

that PSS was significantly positively correlated with SADQ. The findings of the study point

towards a strong association between stress and severity of alcohol dependence in individuals

with alcohol dependence. All the factors namely level of stress and severity of alcohol

dependence are correlated.

Sharma et al. (2020) assessed The Depression, Anxiety, and Stress Scale (DASS), which

is a widely used measure of negative emotional states on an Indian sample. A large community

sample of English-speaking Indian adults completed the DASS 21-item version, and

confirmatory factor analyses were conducted. The results indicated a good fit for a three factor

(depression, anxiety, and stress) and a one-factor model (general psychological distress). There

was no substantial difference between the fit of the models, and the DASS subscales were very

strongly correlated with one another (r ≥ .80). The findings from this sample suggest that the

DASS-21 items appear to assess general psychological distress, with little evidence that the items

assess three distinct subscales.

Ray et al. (2023) conducted a study at a rural tertiary care hospital in Wardha,

Maharashtra, Central India. This study was conducted to assess the behavioral and personality

changes in alcohol dependence syndrome. The participants were assessed using a self-report

questionnaire. The parameters of assessment were aggressive behavior, domestic violence,

workplace violence, verbal abuse, and variables including the forensic aspects of alcohol

consumption, such as road traffic accidents, etc. The results indicated that participants reported

to have decreased psychomotor function upon alcohol consumption compared to the time they

were not under the influence of alcohol. Aggressive behavior associated with irritability and

agitation was observed. There were also instances of verbal abuse and memory loss.
30

The study delves into the correlation between alcohol use, stress, anxiety, and depression

which holds paramount significance in the realm of psychology and public health. As a prevalent

societal issue, alcohol consumption affects a substantial portion of the global population. The

economic burden, healthcare costs, and social consequences associated with alcohol use make it

a significant public health concern. Therefore, studying the prevalence of alcohol use provides a

foundation for addressing its broader implications and developing targeted interventions. The

study acknowledges the profound impact of alcohol on brain chemistry. Chronic alcohol use

alters neurotransmitter function, affecting mood regulation and cognitive processes. This insight

is crucial for unraveling the complex interplay between alcohol and mental health disorders. The

link between alcohol use and mental health disorders is well-established through extensive

research. Individuals who engage in heavy or problematic drinking are at an increased risk of

developing mental health conditions such as stress, anxiety, and depression. The relationship is

complex, involving both biological and psychosocial factors. Identifying the specific

mechanisms by which alcohol contributes to mental health disorders is crucial for developing

preventive strategies and evidence-based interventions. This knowledge informs the design of

targeted treatment approaches that address both the substance use and underlying mental health

issues, promoting more effective and comprehensive care. Policy makers can use this

information to design regulations and initiatives aimed at curbing excessive alcohol

consumption, promoting responsible drinking, and supporting individuals at risk of mental health

disorders related to alcohol use. Informed policies can contribute to a healthier and more resilient

society. Scientifically, this study adds to the growing body of literature on the complex

relationship between alcohol use and mental health. As our understanding deepens, it opens
31

avenues for further research and exploration, fostering a continuous cycle of knowledge

development that can lead to more nuanced and effective interventions in the future.

Objectives

1. To assess the prevalence of alcohol use, depression, anxiety, stress in 25-35 years of

participants.

2. To assess the relationship between alcohol and depression.

3. To assess the relationship of alcohol use and anxiety

4. To assess the relationship of alcohol use and stress.

5. To assess the relationship of alcohol use and Dass (Depression, Anxiety and Stress)

Hypothesis:

H01: There is no significant relationship between Alcohol Use and Depression.

H02: There is no significant relationship between Alcohol Use and Anxiety.

H03: There is no significant relationship between Alcohol Use and Stress.

H04: There is no significant relationship between Alcohol Use and DASS

Method

Design

A single cross-sectional and correlational study design was used, as the aim was to

investigate the outcome and the exposures in the study participants at the same time. A cross-

sectional study looks at data at a single point in time. The participants in this type of study are

selected based on variables of interest. Researchers record the information that is present in a

population, but they do not manipulate variables. Correlational studies aim to find out if there are

differences in the characteristics of a population depending on whether or not its subjects have

been exposed to an event of interest in the naturalistic setting. This method is often used to make
32

inferences about possible relationships. The participants in a cross-sectional study are selected

based on the inclusion and exclusion criteria set for the study. Once the participants have been

selected for the study, the investigator follows the study to assess the exposure and the outcomes.

Cross-sectional designs are used for population-based surveys and to assess the prevalence of the

variable of interest. A purposive and snowball sampling approach was utilized, with the initial

sample of 49 participants aged 25 to 35 years deliberately chosen on unique characteristics

related to alcohol consumption. The study featured alcohol use as the independent variable and

mental health as the dependent variable.

Independent Variable

The amount and frequency of alcohol consumption reported by the participants.

Dependent Variable

The level of depression, anxiety, and stress (mental health of the person) experienced by

the participants.

Inclusive criteria

We deliberately selected participants aged 25 to 35 who met an inclusive category -

specifically, those who engaged in drinking three times a week. individuals who conducted the

study were granted informed consent, ensuring their voluntary agreement to participate based on

comprehensive understanding of the study’s objective and procedure.

Exclusive criteria

In our study, we centered our investigation on patterns of alcohol consumption, as part of

exclusive criteria, we didn’t incorporate individuals who abstained from alcohol consumption.
33

Sample

A sample of 49 participants, aged 25 to 35, was selected using purposive and snowball

sampling. Purposive sampling involved deliberately choosing individuals based on unique

characteristics or relevance to the research; in our case, those who consumed alcohol three times

a week. This approach facilitated gathering valuable insights related to our study's objectives.

For snowball sampling, a non-probability technique, participants from the initial sample

recruited others from their network of friends. This method was particularly useful when the

population we aimed to study—individuals with a specific drinking pattern—was challenging to

reach or lacked a comprehensive list. Snowball sampling leveraged existing connections to

expand our sample, providing a practical solution for studying a specific and potentially hard-to-

reach population.

Tools

The tools used in the study were the Depression, Anxiety, and Stress Scales (DASS-21)

and the Alcohol Use Disorders Identification Test: Self-report version (AUDIT). The DASS-21

is a widely used screening tool, which can separately measure depression, anxiety, and stress

symptoms. The DASS-21 has been derived from the original 42-item DASS-21 developed by

Lovibond and Lovibond (1995), which has three sub-scales, namely the depression subscale

(DASS-D), Anxiety subscale (DASS-A) and stress subscale (DASS-S). The DASS assesses

negative emotional symptoms by using a 4-point Likert scale, ranging from 0 to 3 where (0

means did not apply to me at all, 1 means applied to me to some degree, or some of the time, 2

means applied to me to a considerable degree, or a good part of me, 3 means applied to me very

much, or most of the time). The DASS-21 had good internal reliability (Cronbach’s alpha), and

its ordinal alpha demonstrated good internal reliability for all its sub-scales. The overall
34

Cronbach’s alpha for the DASS-21 scale was 0.74. Regarding the criterion validation, only the

DASS-D demonstrated a satisfactory ability to discriminate cases from non-cases.

The WHO established AUDIT as a straightforward means of screening for AUDs in the

previous 12 months. It has 10 questions about recent alcohol usage (Items 1–3), alcohol-

dependent syndromes (Items 4–6), and alcohol-related disorders (Items 7–10). Eight of ten items

are rated on a 5-point scale 0–4; Item numbers 9 and 10 are rated on a 3-point scale. The overall

score is a number between 0 and 40. A total score of 8 or more is considered a strong predictor

of alcoholism. Several studies have indicated high internal consistency of the Audit. A test-retest

reliability study indicated high reliability (r=.86) in a sample consisting of non-hazardous

drinkers, cocaine abusers, and alcoholics. The AUDIT was validated on Kenyan samples from

around the world which has been validated in Zambia and South Africa.

Procedure

The present research aims to explore the relationship between alcohol consumption and

depression, anxiety and stress for which AUDIT (Alcohol Use Disorders Identification Test)

and DASS (Depression, Anxiety, and Stress Scale) were employed. The AUDIT, a well-

established tool, provides a systematic means of assessing alcohol consumption patterns,

meanwhile, DASS, with its components measuring depression, anxiety, and stress, offers a

nuanced understanding of participants' mental health states. Cross-sectional design was used as

it made data collection feasible from numerous participants at a single point of time. A

convenience sample of male participants aged 25-35 were selected. The convenience sampling

method, though recognizing its inherent limitations, provides a pragmatic approach for

participant recruitment, offering feasibility in data collection. Following ethical approval,

participants were recruited, and informed consent was obtained. The participants were made
35

comfortable and relaxed by rapport formation and only then the instructions were given, the

following instructions were read out, while the participant read them along “Please read each

statement and circle a number 0,1,2 or 3 which indicates how much the statement applied to

you over the past week. There are no right or wrong answers. Do not spend too much time on

any statement” for DASS and then for AUDIT- self report version the following instructions

were given “Because alcohol use can affect your health and can interfere with certain

medications and treatments, it is important that we ask some questions about your use of

alcohol. Your answers will remain confidential so please be honest. Place an X in one box that

best describes your answer to each question.” Various precautions were observed while

administering such as participants were given sufficient time to fill the questionnaire; the

administrators refrained from probing responses. No instructions other than those printed on the

sheet were given. After the two tools were administered, the respondents were thanked for their

participation. Following which the collected data was then scored based on established

guidelines for both the instruments. Subsequently, the scored data were pooled into a dataset,

ensuring confidentiality and anonymity. Utilizing SPSS software, a correlation analysis was

conducted to examine the relationship between AUDIT and DASS scores. The results were

interpreted in terms of the strength and direction of the correlation. The findings, limitations,

and potential areas for future research were further discussed. The study contributes to the

understanding of the interplay between alcohol use and mental health in a specific age group,

offering insights for both academic discourse and practical applications.


36

Results

Table 1

The prevalence rates of depression, anxiety, stress and DASS in the participants.

Depression Anxiety Stress DASS

f % f % f % f %

Normal 7 14.2857143 7 14.2857143 14 28.5714286 28 19.047619

Mild 3 6.12244898 3 6.12244898 4 8.16326531 10 6.80272109

Moderate 15 30.6122449 10 20.4081633 11 22.4489796 36 24.4897959

Severe 15 30.6122449 9 18.3673469 16 32.6530612 40 27.2108844

Extremely 9 18.3673469 20 40.8163265 4 8.16326531 33 22.4489796

Severe

49 100 49 100 49 100 147 100

Figure 1.1

Prevalence of depression in the participants


37

Figure 1.2

Prevalence rates of anxiety of participants

Figure 1.3

Prevalence rates of stress of participants


38

Table 2

The prevalence rates of alcohol of participants

Alcohol score Score Percentage

Low Risk 2 4.08163265

Medium Risk 7 14.2857143

High Risk 18 36.7346939

Addiction Likely 22 44.8979592

Total 49 100

Figure 2

prevalence rates of alcohol of participants


39

Table 3

Correlation between depression and alcohol

Measures Depression Alcohol p-value

Depression ------ .504 -----

Alcohol .504 ------ .001

Note. *p<.05, **p<.01, ***p<.001

Figure 3

Scatterplot showing the correlation between depression and alcohol.


40

Table 4

Correlation between anxiety and alcohol

Measures Anxiety Alcohol p-value

Anxiety ------ .517 -----

Alcohol .517 ------ .001

Note. *p<.05, **p<.01, ***p<.001

Figure 4

Scatterplot showing the correlation between anxiety and alcohol.


41

Table 5

Correlation between stress and alcohol

Measures Stress Alcohol p-value

Stress ------ .424 -----

Alcohol .424 ------ 0.002

Note. *p<.05, **p<.01, ***p<.001

Figure 5

Scatterplot showing correlation between stress and alcohol


42

Table 6

Correlation between DASS-21 and alcohol

Measures DASS-21 Alcohol p-value

DASS-21 ------ .552 -----

Alcohol .552 ------ .001

Note. *p<.05, **p<.01, ***p<.001

Figure 6

Scatterplot showing correlation between alcohol and DASS consolidated score

Discussion
43

This study aims to ascertain the potential correlation between increased alcohol

consumption and heightened levels of depression, anxiety, and stress within this specific

demographic, shedding light on the interplay between these two variables. The scores of

DASS-21 for this study were split into 3 subscales: depression subscale, anxiety subscale and

stress subscale. The objectives of the study were set out as five main aspects, which were firstly

to assess the prevalence of alcohol use, depression, anxiety, and stress in 25- 35-year-old

participants. Then to assess the relationship between alcohol and depression, and third to assess

the relationship between alcohol use and anxiety. Then, to assess the relationship between

alcohol use and stress, and lastly, to assess the relationship between alcohol use and DASS

(depression, anxiety, and stress).

The results in Table I showed the prevalence rate distribution of depression, anxiety,

stress and DASS which are divided into five aspects: Normal, Mild, Moderate, Severe and

Extremely Severe. The table shows the prevalence in the form of frequencies and percentages

under each aspect. It is clear that most of the target population falls under moderate to severe

categories in all the 4 domains. Depression showed a prevalence of 14% in the normal category

and 6% in the mild, 30% in severe and moderate and 18% in the extremely severe category as

depicted in figure 1., which shows that a high percentage of people of the age 25-25 years who

consume alcohol suffer from depression according to DASS 21. Luitel, Baron, Kohrt et al

conducted a study on prevalence and correlates of depression and alcohol use disorder among

adults attending primary health care services in Nepal: a cross sectional study. The results

showed that of the total, 39.9% reported that they consumed alcohol sometimes in their life

whereas this percentage was 29.6% for the past 12 months. Of the total, 16.8% met the

threshold for depression and 7.3% for AUD. Anxiety showed a prevalence of 14% in the
44

normal category and 6% in the mild category like depression. 20% of people were in the

moderate range and 18% in the severe range of anxiety. The prevalence of anxiety is 40.81

percent under the domain of extremely severe according to figure 2, which shows that a high

percentage of people of 25-35 years who consume alcohol report having anxiety. Alcohol

Rehab Guide has stated in its anxiety and alcohol statistics that 1- in 5 individuals with anxiety

report using alcohol to cope with stress and almost 20% of people diagnosed with an alcohol or

substance use disorder also suffer from anxiety or mood disorder. The prevalence of stress was

recorded and 28% of participants exist in the normal range of stress and 8% in the mild range

22% in moderate and is 32.65 percent under severe category, which shows that stress is also

highly present in people of 25 -35 years who consume alcohol regularly. A recent research

study by YouGov has revealed that almost 60% of adults in the UK drink alcohol in order to

cope with the stress of everyday life. This means that people drink more when they are under

stress, stress plays an important role in the increased consumption of alcohol as it is also a

causing agent in people who drink regularly and often more than 3 drinks at a time.

As seen in table 2, prevalence rates of alcohol use are highest in the category of

addiction likely with 44% of participants lying in the category. Figure 2 shows that the

prevalence of using alcohol is 4% at low risk and 14% at medium risk 36% of people are at

high risk of alcohol use disorder as recorded on AUDIT scale. Which shows that a majority

of the participants in the study are heavy drinkers.

Hypotheses 1 of the current study is that there is no significant relationship between

alcohol consumption and depression in participants. Table 3 shows that the correlation

between depression and alcohol is 0.504 (p<0.001). The p value is less than the significance

level (p< 0.05 and *p< 0.01 or **p< 0.001) which means that the null hypothesis is rejected,
45

and the correlation is significant. The scatter plot in Figure 3 also displays a positive, linear

and moderate and statistically significant correlation between alcohol consumption and

depression scores. This indicates that as depression level increases, use of alcohol is

heightened and vice versa. This indicates that individuals with higher levels of alcohol

consumption tend to exhibit elevated depression scores. The positive direction of the

correlation implies that as alcohol consumption increases, there is a corresponding increase in

the severity of depressive symptoms among participants and vice versa. Observational studies

by Visontay, Sunderland, Slade, et al, (2022) applying traditional regression methods have

detected J- or U-shaped relationships between levels of drinking and risk of depression, with

the lowest risk among light or moderate drinkers and higher risk among abstainers as well as

above-guideline or risky drinkers. As many as 80 percent of alcoholics report periods of

sadness in their medical histories, with approximately one out of three alcohol-dependent

men and women having experienced a severe depression that lasted for at least several weeks

and interfered with his or her functioning. The relationship between alcohol consumption and

depression in India is complex and influenced by various factors.

Hypotheses 2 of the current study is that there is no significant relationship between

alcohol consumption and anxiety in the participants. Table 4 shows the correlation between

alcohol and anxiety is 0.517 (p<0.001). The p value is less than the significance level (taken to

be *p5.05, **p<.01, ***p<.001). which means that the null hypothesis 2 is rejected and the

correlation is significant. The scatter plot in Figure 4 also displays a positive, linear and

moderate statistically significant correlation between alcohol consumption and anxiety scores.

This indicates that as anxiety increases, use of alcohol is heightened and vice versa. This

suggests that participants with higher levels of alcohol consumption tend to exhibit elevated
46

anxiety scores. The positive direction of the correlation implies that an increase in alcohol

consumption is associated with a corresponding increase in the severity of anxiety symptoms

among the participants. These findings are further supported by existing studies, a study by

Dheeraj et al. (2015) conducted in an Indian population found consistent results, revealing a

positive association between alcohol consumption and anxiety levels. The convergence of

findings across different cultural contexts strengthens the external validity of the present study's

results and underscores the universality of the relationship between alcohol use and anxiety.

Individuals with anxiety drink to alleviate their anxiety when inebriated; however, this is just a

temporary fix, and after the alcohol wears off, the individuals return to their anxious condition.

Hypothesis 3 of the current study is that there is no significant relationship between

alcohol consumption and stress in participants. Table 5 shows the correlation between alcohol

and stress as 0.424. The p value is less than the significance level (taken to be *p<.05.**p<.01,

***p<.001). which means that the null hypothesis 3 is rejected. This depicts that there is a

significant correlation between stress and intake of alcohol. The analysis of stress scores (Figure

7) and the correlation analysis revealed a positive and weak relationship between alcohol

consumption and stress scores. This indicates that participants with higher levels of alcohol

consumption tend to exhibit slightly elevated stress scores. The moderate positive and weak

relationship suggests that while there is a discernible association, it may not be of substantial

magnitude. A recent epidemiological study based on almost 30,000 past-year drinkers

established a consistent positive relationship between the number of past-year stressors

experienced and heavy drinking. It was also found that stress did not result in a higher frequency

of drinking, but in greater quantities when alcohol was consumed (Dawson et al., 2005d). This

may be the reason as to why stress was reported less severely than depression and anxiety.
47

Another probable reason can be societal expectations and traditional gender roles may influence

the expression of stress. Men may be conditioned to prioritize stoicism and emotional restraint.

potentially downplaying their stress levels in self-reports. This socialization may contribute to an

underestimation of stress compared to more overtly observable indicators like depression or

alcohol use.

Hypothesis 4 of the current study Is that there is no significant relationship between

alcohol consumption and DASS scores of the participants. Table 6 represents the correlation

between DASS-21 and alcohol as 0.5 (p<0.01). P value is less than alpha value (p<0.05 and

**p<0.01 or **p<0.001) which means that the null hypothesis 4 is rejected and the relationship is

significant. Figure 6 depicts that the correlation is positive, linear and moderate. This shows that

as the score of DASS increases, intake of alcohol is heightened and vice versa. The substantive

high positive correlation of .552 (Table 6) between DASS-21 scores and alcohol consumption

offers significant insights into the complex relationship between mental health and substance

use. This finding aligns with existing literature that suggests individuals may engage in alcohol

consumption as a coping mechanism for managing stress. In the Indian context, where cultural

nuances play a pivotal role, this correlation emphasizes the universality of stress-related alcohol

use patterns. The Depression, Anxiety, and Stress Scale (DASS-21), validated by Lovibond and

Lovibond (1995), emerges as a crucial instrument in capturing these multifaceted experiences.

Cultural dimensions, as elucidated by studies in India like that by Benegal et al. (2005),

contribute additional layers, shaping how mental health symptoms are expressed and influencing

alcohol consumption patterns.

Conclusion

From the results, it can be concluded that there is a significant relationship between
48

AUD and depression, anxiety, and stress. On further exploration, it was found that there exists a

moderate positive correlation between alcohol use and depression, alcohol use and anxiety and

between AUDIT and DASS-21 scores. However, between alcohol use and stress, a weak yet

positive correlation exists, which signifies that as alcohol use increases, depression, anxiety,

and stress also increase and vice versa.

Limitations

The focus on the age bracket of 25–35 who drink alcohol at least three times a week

raises the possibility of sample bias and might limit the generalizability of the findings to a larger

population. Furthermore, there is a gender imbalance in the study as the majority of participants

were male which may have led to distortion of the results and limit the applicability of findings

to both genders. In addition, the use of self-reported data might lead to having socially desirable

responses from the participants, which could affect the veracity of the information. Moreover,

placing too much emphasis on a single assessment tool for assessing levels of depression,

anxiety and stress might overlook nuances captured by a more diverse set of measures. These

limitations underscore the need for consideration of contextual factors for further research.

Suggestions

In order to strengthen the study, expanding the sample through the incorporation of a

more heterogeneous age range and guaranteeing an equitable representation of genders should be

taken into consideration. Additionally, instead of just relying on what people report about their

habits, use of a mix of methods will provide a fuller picture of how alcohol affects mental health.

Furthermore, Incorporation of socioeconomic variables and rural and urban dynamics can help to

gain a deeper comprehension of their influence on results. Finally, engaging interdisciplinary


49

experts to enrich the study’s perspectives and insights. Finally, establishing stringent protocols to

safeguard participant’s confidentiality will help in minimizing the risk of introducing biases

References
50

Alcohol Use Disorders Identification Test (AUDIT). (n.d.-a).

https://nida.nih.gov/sites/default/files/files/AUDIT.pdf

Andrews, J., & Hops, H. (2010). The influence of peers on substance use. In L. Scheier (Ed.),

Handbook of drug use etiology: Theory, methods, and empirical findings (pp. 403–20).

Washington, DC: American Psychological Association.

Barry, H., III. (1982). Cultural variations in alcohol abuse. In I. Al-Issa (Ed.), Culture and

psychopathology. Baltimore: University Park Press.

Braun, S. (1996). Buzz (Vol. 1). New York: Oxford University Press.

Breslow, R. A., Faden, V. B., & Smothers, B. (2003). Alcohol consumption by elderly Americans. J.

Stud. Alcoh., 64, 884–92.

Cloninger, C. R., Reich, T., Sigvardsson, S., von Knorring, A. L., & Bohman, M. (1986). The effects

of changes in alcohol use between generations on the inheritance of alcohol abuse. In

Alcoholism: A medical disorder: Proceedings of the 76th Annual Meeting of the American

Psychopathological Association.

Cotton, N. S. (1979). The familial incidence of alcoholism. J. Stud. Alcoh., 40, 89–116.

Das21 - Maic. (n.d.-a). https://maic.qld.gov.au/wp-content/uploads/2016/07/DASS-21.pdf

Derr, R. F., & Gutmann, H. R. (1994). Alcoholic liver disease may be prevented with adequate

nutrients. Medical Hypotheses, 42, 1–4.

Dawson, D. A., Grant, B. F., Stinson, F. S., Chou, P. S., Huang, B., & Ruan, W. J. (2005). Recovery

from DSM-IV alcohol dependence: United States, 2001-2002. Addiction (Abingdon,

England), 100(3), 281–292. https://doi.org/10.1111/j.1360-0443.2004.00964.x

d’Ydewalle, G., & Van Damme, I. (2007). Memory and the Korsakoff syndrome: Not remembering

what is remembered. Neuropsychologia, 45(5), 905–20.


51

Difede, J., Malta, L. S., Best, S., Henn-Haase, C., Metzler, T., Bryant, R., et al. (2007). A

randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in

disaster workers. J. Nerv. Ment. Dis., 195, 861–65.

Erblich, J., Earleywine, M., & Erblich, B. (2001). Positive and negative associations with alcohol

and familial risk for alcoholism. Psych. Addict. Behav., 15(3), 204–09.

Fields, J. Z., Turk, A., Durkin, M., Ravi, N. V., & Keshavarzian, A. (1994). Increased

gastrointestinal symptoms in chronic alcoholics. Am. J. Gastroenterology, 89, 382–86.

Fischer, J. L., Pidcock, B. W., Munsch, J., & Forthun, L. (2005). Parental abusive drinking and

sibling role differences. Al. Treat. Quart., 23(1), 79–97.

Frone, M. R. (2003). Predictors of overall and on-the-job substance use among young workers. J.

Occup. Health Psych., 8, 39–54.

Frone, M. R. (2006). Prevalence and distribution of illicit drug use in the workforce and in the

workplace: Findings and implications from a U.S. national survey. J. Appl. Psych., 91(4),

856–69.

Gazdzinski, S., Durazzo, T., & Meyerhoff, D. J. (2005). Temporal dynamics and determinants of

whole brain tissue volume changes during recovery from alcohol dependence. Drug Al. Dep.,

78(3), 263–73.

Gordis, E. (2001). Cognitive impairment and recovery from alcoholism. Alcohol Alert (National

Institute on Alcohol Abuse and Alcoholism, No. 53). Washington, DC: U.S. Department of

Health and Human Services.

Gordis, E., Dufour, M. C., Warren, K. R., Jackson, R. J., Floyd, R. L., & Hungerford, D. W. (1995).

Should physicians counsel patients to drink alcohol? JAMA, 273, 1–12.


52

Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, P., Dufour, M., Compton, W., et al. (2004).

Prevalence and co-occurrence of substance use disorders and independent mood and anxiety

disorders: Results from the national epidemiologic survey on alcohol and related conditions.

Arch. Gen. Psychiatry, 61(8), 807–16.

Hartz, S. M., & Bierut, L. J. (2010). Genetics of addictions. Psychiatr. Clin. North Am., 33(1), 107–

24.

Harrop, E. N., & Marlatt, G. A. (2010). The comorbidity of substance use disorders and eating

disorders in women: Prevalence, etiology, and treatment. Addictive Behaviors, 35, 392–98.

Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of major

depressive disorder: Results from the national epidemiologic survey on alcoholism and

related conditions. Arch. Gen. Psychiatry, 62(10), 1097–106.

Helzer, J. E., Canino, G. J., Yeh, E. K., Bland, R., et al. (1990). Alcoholism—North America and

Asia: A comparison of population surveys with the Diagnostic Interview Schedule. Arch.

Gen. Psychiatry, 47(4), 313–19.

Henry, J. D., & Crawford, J. R. (2005). The short‐form version of the Depression Anxiety Stress

Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample.

British Journal of Clinical Psychology, 44(2), 227-239.

Hibell, B., Anderson, B., Ahlstrom, S., Balakireva, O., Bjaranson, T., Kokkevi, A., et al. (2000). The

1999 ESPAD Report: Alcohol and other drugs among students in 30 European countries.

Stockholm: Swedish Council for Information on Alcohol and Drug Abuse.

Hoeppner, B. B., Barnett, N. P., Jackson, K. M., Colby, S. M., Kahler, C. W., Monti, P. M, et al.

(2012). Daily college student drinking patterns across the first year of college. J. Stud.

Alcohol Drugs, 73
53

Hussong, A. M., Hicks, R. E., Levy, S. A., & Curran, P. J. (2001). Specifying the relations between

affect and heavy alcohol use among young adults. J. Abn. Psychol., 110(3), 449–61.

Jordaan, G. P., & Emsley, R. (2014). Alcohol-induced psychotic disorder: A review. Metabolic

Brain Disease, 29, 231–43.

Kumar, C. N., Andrade, C., & Murthy, P. (2015). A randomized, double-blind comparison of

lorazepam and chlordiazepoxide in patients with uncomplicated alcohol withdrawal. J.

Studies on Alcohol and Drugs, 70, 467–74.

Koob, G. F., Mason, B. J., De Witte, P., Littleton, J., & Siggins, G. R. (2002). Potential

neuroprotective effects of acamprosate. Alcoholism: Clinical & Experimental Research,

26(4), 586–92.

Kranzler, H. R., Del Boca, F. K., & Rounsaville, B. (1997). Comorbid psychiatric diagnosis predicts

three-year outcomes in alcoholics: A posttreatment natural history study. J. Stud. Alcoh.,

57(6), 619–26.

Lapham, S. C., Smith, E., Baca, J. C., Chang, L., Skipper, B. J., Baum, G., et al. (2001). Prevalence

of psychiatric disorders among persons convicted of driving while impaired. Arch. Gen.

Psychiatry, 58, 943–49.

Latt, N., & Dore, G. (2014). Thiamine in the treatment of Wernicke encephalopathy in patients with

alcohol use disorders. Internal Medicine J., 44, 911–15.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison

of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety

Inventories. Behaviour research and therapy, 33(3), 335–343. https://doi.org/10.1016/0005-

7967(94)00075-u
54

Lucey, M. R., Mathurin, P., & Morgan, T. R. (2009). Alcoholic hepatitis. N. Engl. J. Med., 360(26),

2758–69.

Lyvers, M. (2000). “Loss of control” in alcoholism and drug addiction: A neuroscientific

interpretation. Exp. Clin. Psychopharm., 8(2), 225–4.

Marlatt, G. A., Baer, J. S., Kivahan, D. R., Dimeoff, L. A., Larimer, M. E., Quigley, L. A., et al.

(1998). Screening and brief intervention for high-risk college student drinkers: Results from

a 2-year follow up assessment. J. Cons. Clin. Psychol., 66(4), 604–15.

McCloud, A., Barnaby, B., Omu, N., Drummond, C., & Aboud, A. (2004). Relationship between

alcohol use disorders and suicidality in a psychiatric population: In-patient prevalence study.

Brit. J. Psychiatry, 184, 439–45.

Moeller, F. G., & Dougherty, D. M. (2001). Antisocial personality disorder, alcohol and aggression.

Alc. Res. Health, 25(1), 5–11.

Pickworth, W. B., Rohrer, M. S., & Fant, R. V. (1997). Effects of abused drugs on psychomotor

performance. Exp. Clin. Psychopharm., 5(3), 235–41.

Plomin, R., & DeFries, J. C. (Eds.). (2003). Behavioral genetics in the postgenomic era. Washington,

DC: American Psychological Association.

Ray, A. Ninave, S., Patil, P., Ninave, S., & Khan, T. J. (2023). Assessing the behavioral and

personality changes in alcohol dependence syndrome in Wardha, central India. Cureus.

https://doi.org/10.7759/cureus.48419

Ramanan, V. V., & Singh, S. K. (2016). A study on alcohol use and its related health and social

problems in rural Puducherry, India. Journal of family medicine and primary care, 5(4), 804-

808. https://doi.org/10.4103/2249-4863.201175
55

Sharma, M. K., Hallford, D. J., & Anand, N. (2020). Confirmatory factor analysis of the Depression,

Anxiety, and Stress Scale among Indian adults. Indian journal of psychiatry, 62(4), 379-383.

https://doi.org/10.4103/psychiatry.IndianJPsychiatry_313_19

Smith, G. T., Goldman, M. S., Greenbaum, P. E., & Christiansen, B. A. (1995). Expectancy for

social facilitation from drinking: The divergent paths of high-expectancy and low-expectancy

adolescents. J. Abn. Psychol., 104, 32–40.

Sullivan, E. V., Deshmukh, A., Desmond, J. E., Lim, K. O., & Pfefferbaum, A. (2000). Cerebellar

volume decline in normal aging, alcoholism, and Korsakoff’s syndrome relation to ataxia.

Neuropsych., 14(3), 341–52.

Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. (1998). Complications of alcohol

withdrawal: Pathophysiological insights. Alcohol Health and Research World, 22, 61–66.

Turner, R. J., Lloyd, D. A., & Taylor, J. (2006). Physical disability and mental health: An

epidemiology of psychiatric and substance disorders. Rehabilitation Psychology, 51(3), 214–

23.

Turner, R. J., Lloyd, D. A., & Taylor, J. (2006). Physical disability and mental health: An

epidemiology of psychiatric and substance disorders. Rehabilitation Psychology, 51(3), 214–

23.

Verster, J. C., Stephens, R., Penning, R., Rohsenow, D., McGeary, J., Levy, D., et al. (2010). The

Alcohol Hangover Research Group consensus statement on best practises in alcohol

hangover research. Current Drug Abuse Reviews, 3, 116–126.

Visontay, R., Mewton, L., Sunderland, M., PaiJ.K., PatelC.J., AnsarW., AvanA., BellS.,

BrienS.E., BryazkaD., CalderP.C., ChuL., CoventryB.J., ElliottJ., FurmanD.,

GiollabhuiN.M., González-ReimersE., & HamerM. (2023, April 20). A comprehensive


56

evaluation of the longitudinal association between alcohol consumption and a measure of

inflammation: Multiverse and vibration of effects analyses. Drug and Alcohol Dependence.

https://www.sciencedirect.com/science/article/abs/pii/S0376871623001242?dgcid=author

WHO World Mental Health Survey Consortium. (2004). Prevalence, severity, and unmet need for

treatment of mental disorders in the World Health Organization World Mental Health

Surveys. JAMA, 291, 2581–90.

Wobrock, T., Falkai, P., Schneider-Axmann, T., Frommann, N., Wölwer, W., & Gaebel, W. (2009).

Effects of abstinence on brain morphology in alcoholism: A MRI study. Eur. Arch. Psychiatr.

Clin. Neurosci., 259(3), 143–50.

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy