SAD & the Holidays: A Perfect Storm for Excessive Drinking?

Maybe it's not so good & cheery, that fluid sedative.

Posted Dec 04, 2018

Holiday cheer may refer to the ho ho hos of a Santa, a stack of presents, a beautifully decorated tree and/or a tumbler full of holiday cheer. Indeed, alcohol may bring good mood, warmth, and delight as the annual holiday spirit is shared with family and friends. But for some, drinking alcoholic beverages is not a means of participating in the joy and cheer of the holidays. Rather, it's a form of self-medication to dull the pain of depression.

The holiday season coincides with the darkest days of the year, a time when many are vulnerable to the mood, sleep, and appetite symptoms of  Seasonal Affective Disorder (SAD). This seasonal depression, often referred to as the winter blues, not only causes increased sleep, fatigue, weight gain, and decreased interest in work and social activities. It may also cause excessive alcohol intake. Indeed, seasonal alcoholism may be a symptom of SAD.

However, implicating winter depression as the trigger for excessive drinking in the late fall and early winter is complicated by the depression and increased alcohol intake associated with the holidays. Beginning around Thanksgiving, articles warn that the holiday season may sharpen the emotional distance between those surrounded by loving family and friends and those who are alone by choice or circumstance. Not everyone will go to a  Norman Rockwell Thanksgiving dinner, or appear rosy-cheeked and laden with presents at the door of beaming grandparents on Christmas Eve.

Many dread the annual outing to family gatherings and hope that they will leave still talking to the other guests at the dinner table or party.  Others will, by choice or circumstance, be eating dinner alone on Thanksgiving or Christmas Day and watch the first seconds of the New Year on a television screen by themselves.  The seemingly endless depictions of communal gatherings filled with delight and good cheer fail to acknowledge that for many the holidays are something simply to be endured. Is it any wonder then that some choose to obtain their cheer from a glass rather than a greeting card?

Of course, the health effects of the excessive drinking, whether due to depression caused by darkness, the holidays, or both, will last beyond the first day of the coming year, and the toll on health may be permanent.  But before implementing strategies to control, decrease, or avoid alcohol intake, it is essential to know whether the drinking is associated with seasonal depression or is situational, that is, brought on by the holidays.

If it is the latter, preventing excessive drinking and/or helping someone return to abstinence might benefit from psychotherapy, alcohol abstinence support groups, and lifestyle coaching. Those at risk should avoid situations such as parties with open bars or hosts overly generous with the cocktail shaker. Emotionally fraught social encounters with family or friends that provoke drinking in order to be endured should be limited or avoided altogether. Lack of sleep, combined with the stress of meeting work obligations and also the demands of the holidays, may increase the need to drink or imbibe. Even something as simple as not having time to exercise may lead to drinking for someone who relies on regular physical activity to decrease stress.

Loneliness contributes to excessive alcohol intake, and it is a difficult problem to solve. Eating Thanksgiving or Christmas dinner alone may seem intolerably sad, especially when the aloneness is due to a death or divorce or the necessity of living far from family and friends. In many places, few establishments are open on those days, thereby limiting the opportunity simply to see another person. Reaching out to others in similar circumstances to share a meal, a movie, or a walk, weather permitting, makes these days pass a little more easily. Hospitals, animal shelters, and organizations that deliver meals to shut-ins usually welcome volunteers, but one cannot just show up. Training and going through security checks several weeks beforehand is usually necessary.

Conversely, if depression and the drinking that it triggers is associated with the diminished hours of light from late November through February, situational solutions will not be effective.  It is important for someone who is struggling with abstinence from alcohol to recognize his or her vulnerability to seasonal depression and the drinking that follows. Seeking help from support groups and self-discipline may not be sufficient, as the depression must be treated along with the alcohol intake.   

Light therapy and/or the use of antidepressants has been used to treat SAD. And if the alcoholism is a response to the depression, treating the latter may be effective in bringing about abstinence. Moreover, there is no reason to wait to initiate treatment for SAD and increased alcohol intake until the newspapers ads for Christmas turkeys and cranberry sauce appear. The symptoms of SAD and alcoholism may increase noticeably around the move to standard time at the beginning of November.  If treatment options such as light therapy or antidepressants are successful in decreasing both depressive symptoms and drinking, then an improvement in well-being should bring its own holiday cheer.

References

“Alcohol use, seasonal depression, and suicidal behavior,” Sher L,  British Medical Journal 2001; 323 : 817 editorial. 

 “Relationships between seasonality and alcohol use: a genetic hypothesis,” Sher L, Med Hypotheses 2002 ;59: 85-88.