Heavy drinking among people with depression dropped dramatically when improved antidepressants hit the market, according to a new study.
The findings suggest those who use drugs or alcohol to relieve mental and physical pain will switch when better, safer treatment options are available.
“We know depression and heavy drinking go hand in hand, but no one has tested the notion that, if good medicine comes along, many people will drink less or abstain altogether,” says Nicholas Papageorge, an economist at Johns Hopkins University.
“People look at heavy drinking as a problem or a mistake. But what we’re saying is people rationally self-medicate. If there are no good options, people will use what’s available.”
To test the hypothesis, Papageorge and Michael Darden, an economist at Johns Hopkins’ Carey Business School, used 40 years of longitudinal data from the Framingham Heart Study, in which 5,000 people reported alcohol, tobacco, and antidepressant consumption as well as diagnoses of depression.
Between 1971 and the late 1980s, fewer than 2 percent of those surveyed were on antidepressants. But in 1988, with the introduction of selective serotonin reuptake inhibitors, a class of antidepressants widely considered to be a vast improvement over what had been on the market, antidepressant use jumped.
Simultaneously, heavy drinking among those with moderate depression dropped 22 percent. There was also a 12 percent increase in the number of people who reported entirely abstaining from alcohol, the researchers say.
Men, who made up more of the heavy drinkers, primarily drove the result.
The results might have been even stronger, if not for heavy drinkers who had been doing so for a long time, became addicted, and were unable to try another option, even a better one, the researchers say.
They created a model that shows as many as 30 percent of the heavy drinkers would have switched to antidepressants if they factored out this long-term drinking effect.
“When SSRIs come along, the options for managing depressive symptoms improves,” Darden says. “But if you’ve been self-medicating for a long time, even with the introduction of SSRIs, it may be difficult for you to switch because of dependence.”
Don’t criminalize self-medication
Policymakers should take the self-medication theory into account when considering how to combat addiction, the researchers say. Instead of criminalizing self-medication, they suggest, policymakers should promote medical innovation to come up with better treatments.
One concern in making self-medication harder—for example, by limiting supply, raising prices, or criminalizing use of the drugs—is that people could respond by turning to even more dangerous substances.
“We hear about all of these people in downward addiction spirals, but what we hear tends to ignore the point that many, many of these people started using drugs or alcohol to mitigate their symptoms,” Papageorge says.
“I’m not saying that’s OK, but if we want to understand addiction, it’s important to look at the whole history and I don’t think that’s been discussed enough.”
The National Bureau of Economic Research circulated the working paper.
Source: Johns Hopkins University