Alcohol Practical
Alcohol Practical
Alcohol Practical
21044528059
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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
Keywords: alcohol use, depression, anxiety, stress, DASS-21, AUDIT, correlational analysis.
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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
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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
Gender
alcohol abuse—have been men; for example, men become problem drinkers at about five times
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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.
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
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
alcohol use.
10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts
a. The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental
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 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
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
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
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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
headache, nausea, fatigue, and cognitive impairment lasting for 8 to 24 hours after alcohol
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.
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
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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
abuse alcohol may experience heightened gastrointestinal symptoms such as stomach pains
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
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
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.
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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
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
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
(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.
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(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
(6) other symptoms including perspiration, fever, a rapid and weak heartbeat, a coated tongue,
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
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
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
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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
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.
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
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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
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
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
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
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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
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
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
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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
Genetic influences and learning. Learning factors appear to play an important part in
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.
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
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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
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,
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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
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
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
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expectancy over time. That is, older students showed less expectation of the benefits of alcohol
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
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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.
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,
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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
experiencing solely depressive episodes. For at least two weeks, this disorder causes
along with other symptoms like changes in sleep patterns, appetite, or feelings of
worthlessness.
disorder.
Another primary kind of mood episode is a manic episode, in which a person shows a
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,
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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
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
Alcohol can even worsen depression and depressive symptoms. Alcohol dependence can
also interfere with recovery from depression. Depressed study participants who were heavy
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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
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.
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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
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
If a person suffers from anxiety, it’s important not to be tricked by the temporary feeling
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.
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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
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
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
Stress
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
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
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
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
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
(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
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
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
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
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.
5. To assess the relationship of alcohol use and Dass (Depression, Anxiety and Stress)
Hypothesis:
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
related to alcohol consumption. The study featured alcohol use as the independent variable and
Independent Variable
Dependent Variable
The level of depression, anxiety, and stress (mental health of the person) experienced by
the participants.
Inclusive criteria
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
Exclusive criteria
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
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
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
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
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-
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
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,
Results
Table 1
The prevalence rates of depression, anxiety, stress and DASS in the participants.
f % f % f % f %
Severe
Figure 1.1
Figure 1.2
Figure 1.3
Table 2
Total 49 100
Figure 2
Table 3
Figure 3
Table 4
Figure 4
Table 5
Figure 5
Table 6
Figure 6
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
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
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
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
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
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
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.
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
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
alcohol use.
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
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
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,
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
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
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