Addressing Alcohol-Related Paranoia

Paranoia describes an unfounded suspicion or belief that others are out to cause you harm. While it’s not unusual to have a paranoid thought from time to time, persistent paranoia is often a sign of an underlying challenge. Among others, alcohol misuse is one possible cause of paranoia. Here, we’ll explore the relationship between alcohol, paranoia, and mental health overall.

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Alcohol and paranoia

As a clinical symptom, paranoia can have many different causes. Mental health disorders like schizophrenia and paranoid personality disorder are some of the most commonly associated. However, they’re not the only ones. Medical conditions like Parkinson’s disease and dementia can trigger paranoia, as can extended sleep deprivation. In addition, certain substances have the potential to cause this symptom, including cocaine, amphetamines, certain prescription medications, and alcohol.

While many people are aware that long-term alcohol use can cause liver disease and other physical health problems, fewer know that drinking alcohol may also prompt mental health symptoms like paranoia. When alcohol triggers paranoia, it may be colloquially referred to as "alcohol paranoia." Alcohol paranoia isn't an official, clinical disorder or diagnosable condition. However, there is a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) called alcohol-related psychosis that can include paranoia as a key symptom.

Alcohol-related psychosis

The article cited above indicates that there’s a lifetime prevalence of alcohol-related psychosis of 0.4% in the general population, and this number increases to 4% for those with alcohol dependence. Related disorders include alcohol-induced psychotic syndrome (AIPS) and alcohol-induced psychotic disorder (AIPD). Outdated terms for these phenomena include alcohol psychosis and alcohol hallucinosis. 

Signs of alcohol-related psychosis

Signs of a primary psychotic disorder like alcohol-induced psychosis can include the following:

• Hallucinations, such as seeing things or hearing sounds that aren't actually there
• Feelings of paranoia
• Delusions, or beliefs that aren't rooted in reality, often of a paranoid nature
• Suicidal thoughts or behaviors
• Unpredictable or violent behavior
• A lack of awareness that alcohol prompted the symptoms

Sometimes, psychotic symptoms of this condition subside once a person stops drinking alcohol. In fact, discontinuing alcohol use is generally viewed as the top treatment option, whether on one’s own or under the supervision of a healthcare provider (as is recommended for those with coexisting mental or physical health conditions or severe alcohol dependency). In some cases, though, symptoms may continue and require ongoing treatment, even if a person quits drinking. Early diagnosis and treatment may improve outcomes for a person with alcohol-related psychosis.

The relationship between unhealthy alcohol use and mental health

Alcohol misuse and mental health appear to be connected in multiple ways. For one, people who have alcohol use disorder often also have other coexisting mental illnesses, such as anxiety, depression, trauma-related disorders, and/or psychotic disorders like schizophrenia. 

Whether alcohol use causes mental illness or mental illness causes alcohol use isn't straightforward. Most likely, each factor increases the risk of the other. In other words, a pre-existing mental illness may make a person more likely to drink alcohol in unhealthy ways, and drinking alcohol in unhealthy ways may raise the risk of developing a mental illness as a result. Also, research suggests that alcohol use disorder and mental illnesses often share the same risk factors, such as genetics and traumatic childhood experiences, which could make both more likely to occur.

What are the signs of an alcohol use disorder?

Alcohol use disorder refers to an unhealthy use of alcohol or excessive alcohol consumption. In the past, alcohol use disorder was often referred to as “alcoholism,” “alcohol abuse,” or “alcohol addiction.” These terms are outdated; currently, “alcohol use disorder” is the preferred term. 

Symptoms of alcohol use disorder can include:

• Times when you drank more or for longer than intended
• Wanting to cut back on alcohol or stop drinking more than once, but being unable to
• Spending a lot of time drinking, being sick from drinking, or recovering from drinking
• Wanting a drink so badly that you can't think of anything else
• Having drinking or being sick from drinking interfere with home life, family, work, or school
• Continuing to drink despite it causing trouble with family or friends
• Giving up or cutting back on other important or interesting activities in order to drink
• Getting into risky or dangerous situations while drinking, like driving, swimming, operating machinery, or having unsafe sex
• Continuing to drink despite it causing depression or anxiety, worsening a health problem, or leading to a memory blackout
• Needing to drink more than you used to in order to get the same effect, or noticing the same number of drinks having less of an effect than before
• Having withdrawal symptoms when alcohol wears off, like shakiness, trouble sleeping, restlessness, nausea, sweating, a rapid heartbeat, seizures, or sensing objects or sounds that aren't there

When a person has two or three symptoms from this list, they are typically thought to have mild alcohol use disorder. Moderate alcohol use disorder usually involves four or five of the listed symptoms, and severe alcohol use disorder involves the presence of six or more symptoms on the list

Treatment for alcohol use disorder

Before treating alcohol use disorder, healthcare professionals are usually advised to first identify whether or not a person is likely to go through withdrawal. If a person might go through withdrawal when quitting drinking alcohol, they may undergo a slightly different treatment process, as described below. If they are not likely to experience withdrawal, the treatment depends on whether the alcohol use disorder is mild, moderate, or severe and the goals of treatment.

Alcohol use disorder treatment often involves a combination of medication and behavioral treatment through an addiction recovery program. There are three medications currently approved by the US Food and Drug Administration (FDA) for alcohol use disorder, which are typically prescribed in conjunction with behavioral treatments as they’re not intended to be standalone treatments. Behavioral treatments may involve skills training, one-on-one therapy, and group therapy.

Goals of mental health treatment for alcohol use disorder

Traditionally, the goal of alcohol use disorder treatment was for a person to completely quit consuming alcohol. Now, experts recognize that this outcome isn't realistic for all people. In some cases, harm reduction that involves lessening alcohol use and its associated risks may be a more feasible goal. When harm reduction is the goal, treatment focuses on reducing risky behaviors like drinking and driving as well as improving quality of life and related factors, like finding stable employment and housing, if applicable.

Symptoms of alcohol withdrawal

Although paranoia often occurs during or after acute intoxication, the symptom may also develop during alcohol withdrawal. What people generally call "alcohol withdrawal" refers to alcohol withdrawal syndrome. Alcohol withdrawal syndrome can happen when a person who has been drinking alcohol regularly stops drinking. When a person is going through alcohol withdrawal, they may experience these symptoms:

• Anxiety
• Digestive upset, ranging from mild stomach aches to severe nausea and vomiting
• Headaches
• Rapid heartbeat
• Aggressive behavior
• Shaking
• Confusion
• Hallucinations
• Changes in sensation
• Sweating
• High body temperatures

Alcohol withdrawal can range from mild to severe. Delirium tremens (DT) describes the most severe type of alcohol withdrawal. When a person has delirium tremens, they should seek immediate medical care, as it can be potentially life-threatening. The most prominent symptom of delirium tremens is shaking or tremors, especially of the hands. Another prominent symptom is extreme confusion, or delirium. 

Alcohol withdrawal treatment

There are treatments available to make alcohol withdrawal easier to tolerate. There are medications and prescription drugs as well as dietary supplements that can help ease withdrawal symptoms. People going through severe alcohol withdrawal syndrome should seek professional help and not try to treat it themselves. Withdrawal can come with serious risks, like seizures or death, but proper treatment may help prevent these.

Alcohol and misuse of other substances (formerly “substance abuse”)

Use of alcohol and use of other substances by the same individual is not uncommon. (Note that, like the term “alcohol use disorder,” there are outdated versions of the terms “substance use” and “substance use disorder.” Phrases like “substance misuse” are now preferred over “substance abuse.”)

Substance use disorder can describe the unhealthy use of substances like prescription medications and/or illegal drugs. Statistics suggest that over 47% of women and 40% of men who have alcohol use disorder will also have a substance use disorder at some point.

Substance use disorder can also prompt paranoia. If a person has both alcohol use disorder and substance use disorder at once, they may not be able to easily discern which type of substance led to paranoia. In most cases, healthcare providers recommend quitting both alcohol and any other substances, if possible, and engaging in harm reduction if quitting isn't possible.

Substance misuse treatment per the Substance Abuse and Mental Health Services Administration (SAMHSA)

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), treatments for alcohol use disorder and substance use disorder are often similar: a combination of medication and behavioral treatments like therapy. The medications available for substance use disorder depend on what types of substance or substances a person is using. If a person is using a substance that can cause withdrawal when stopping use, medications may also be used to make the withdrawal process safe and easier to move through.

Treatment options for paranoia

Paranoia is generally a symptom rather than a disorder. As such, healthcare providers generally treat the underlying cause of paranoia rather than the symptom itself. If a person has paranoia due to a mental illness, they will typically pursue the treatment recommended for that illness. When a person's paranoia appears to have been prompted by alcohol use, discontinuing the use of alcohol if possible is usually the first suggested treatment. If paranoia continues after alcohol use has ceased, other causes and treatment methods may be explored.

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Therapy for alcohol misuse and related challenges

Many people struggle with difficult emotions while trying to quit consuming alcohol. Therapy is a resource that can provide a supportive and encouraging environment as a person copes with the feelings and mental health challenges that may come up along the way. 

Not everyone is able to or comfortable with attending in-person therapy appointments, however. In cases like these, remote therapy allows people to discuss their mental health challenges and receive support virtually from a safe, comfortable space of their choosing. BetterHelp is an online therapy platform that can connect you with a licensed therapist in as little as 48 hours.

A growing body of research suggests that online therapy can be as effective as in-person therapy in many cases. There’s research on virtual therapy for substance use disorders in particular as well, which suggests that this treatment method is a promising potential solution for those living with substance use challenges. There’s also a large body of research indicating that online therapy can be effective for treating symptoms of mental illnesses like anxiety and depression, which can often co-occur with alcohol use disorder.