Using Alcohol to Cope with Burnout: Where Stress Relief Turns into Dependency

The first step toward developing healthier ways to cope with burnout, understanding how stress and drinking can develop a vicious cycle, recognizing the warning signs of increasing dependency on drinking, and learning about free alternatives without the fear of being judged is critical.

Drinking affects the central nervous system (CNS), which temporarily boosts levels of GABA in the brain to produce relaxation by reducing stress signals. However, the temporary effects of drinking disappear once the body has processed and eliminated the alcohol, resulting in increased "rebound" anxiety, poor sleep quality, and greater stress the following day. Additionally, drinking significantly impairs deep and rapid eye movement (REM) sleep, making an individual less refreshed and more susceptible to future stresses.

Over time, the body adapts to these changes through a process known as tolerance. Therefore, individuals require larger amounts of alcohol to achieve the same relaxing effect. Moreover, the underlying source(s) of stress remain unaddressed, potentially escalating. What began as a healthy coping mechanism now has become necessary for daily life.

Research indicates that when individuals have chronic stress they tend to drink to regulate their negative emotions. Furthermore, research has shown that those who drink to manage their emotions will tend to drink more heavily and experience more problems with their drinking behaviors. Consequently, when an individual experiences burnout they experience depletion of their emotional resources. Drinking then further depletes these resources through impaired regulation of moods, decision-making processes and recovery. These factors create a vicious cycle where stress drives drinking, drinking exacerbates stress and functioning issues, and ultimately creates a sense of entrapment.

Mental health issues related to substance abuse continue to hold strong social stigmas. In some communities, there exists a perception that seeking assistance for burnout or substance use issues represents a sign of weakness or a personal failure. Due to this stigma, many individuals experiencing symptoms remain silent regarding their needs. Stigma contributes to the estimated 86% treatment gap for alcohol use disorders within India, and lack of awareness and availability of specialized service delivery also contribute to this high treatment gap. The Mental Health Care Act 2017 asserts the right to mental care and recognizes substance use disorders as health issues. However, cultural attitudes toward these health issues currently do not align with the legal standards established in the act. When open dialogue occurs surrounding mental health and addiction issues it eliminates shame associated with seeking help and improves opportunities for recovery.

Practical indicators of an unhealthy dependence on stress-relieving drinks include:

• Drinking beyond intended amounts and/or at greater frequencies — especially by yourself and/or using your job as a reason to drink.

• Using alcoholic beverages to sleep or reduce stress.

• Giving up all other methods you've used previously to cope with stress or enjoy life.

• Feeling irritable, anxious, and/or unable to concentrate while sober.

• Despite being aware of the damage to your health, your relationships, and your ability to perform at work — continuing to engage in this behavior.

All of these are not personal flaws. They're warning signs that your nervous system and habits need help.

There are healthier alternative ways to recover and these are better for the long-term. A couple of simple and evidence-based strategies include:

• Taking breaks throughout the day to do things like take short walks, stretch, etc., which will also be calming to your stress response but won't result in a "chemical rebound".

• Prioritizing sleep: going to bed at the same time every night, reducing/eliminating screen time before bedtime, limiting alcohol consumption before bedtime.

• Creating healthy boundaries between your work-life and rest-time to allow your body to get out of "fight or flight" mode.

• Staying connected with trusted individuals; Isolation creates both burnout and problematic drinking behaviors.

• Keeping track of how you consume your drinks: amount, timing, reasons for consumption — in an honest manner, free from judgment. There are tools available (e.g. the AUDIT Questionnaire - Alcoholic Use Disorder Identification Test) that can alert you to potential risk early.

Professional Help and Treatment

If you find that you cannot stop consuming drinks even though you want to, there is professional help available and it is helpful. In fact, the American Psychiatric Association's 2018 practice guideline for treating alcohol use disorders states that many patients will benefit from combining medications (like Naltrexone or Acamprosate) along with psychosocial treatments for most cases. Following a thorough evaluation. Even if a person has developed a full blown dependence on their drinking, they can still receive successful treatment through the proper combination of both. Brief Interventions — a structured conversation with the individual identifying areas of concern (risks), setting goals for reduction — are helpful when an individual consumes alcohol at levels considered hazardous or harmful prior to developing full dependence. The ICMR Standard Treatment Workflows for Alcohol Use Disorders, along with guidelines provided by NIMHANS clearly outline pathways for evaluating individuals who may be struggling with problems related to alcohol. This includes obtaining an accurate history regarding the quantity, frequency, withdrawal symptoms and consequences associated with each persons drinking behaviors; conducting screenings for co-existing mental or physical health issues; Providing brief interventions for those identified as hazardous or harmful drinkers; Offering detoxification services, psychosocial support and/or medication when necessary; and referring them to specialists if dependence exists. The Indian Psychiatric Society Clinical Practice Guidelines emphasize the importance of maintaining patient dignity and involving families wherever possible in the process and ensuring that the care is integrated. Screening for alcohol-related problems in community settings and primary care settings can greatly aid in closing the large treatment gap currently existing in India. Recovery is NOT dependent upon achieving absolute abstinence immediately. Nor is it simply based upon will-power alone. For some individuals, this means drinking less frequently with ongoing support; for others this may mean ceasing all drinking altogether. Regardless of whether one chooses to continue drinking at lower levels or abstain from drinking altogether, both paths require professional assistance; social support from peers (recovery groups); and addressing the underlying burn-out — either through making changes in one’s workplace environment; seeking therapy for managing chronic stress/anxiety; or implementing lifestyle modifications. Seeking assistance is an indication of respect for oneself; it is not indicative of failure. Burn-out is a common condition and is becoming increasingly widespread. It is not unreasonable that someone would turn to alcohol as a means of coping with it since our society places great value on productivity while devaluing rest. However, what may seem reasonable initially can quickly lead to creating another problem as the same substance that provides temporary escape also increases feelings of exhaustion and further exacerbates the original problem.

Breaking the Vicious Cycle

Recognize the behavior pattern as soon as possible, implement positive replacement habits (as outlined above), talk openly about mental illness with friends and loved ones; and seek evidence-based treatment when needed, an individual can begin breaking the vicious cycle. One doesn’t necessarily have to obtain stress relief through a glass.