A groundbreaking study from the University of Chicago Medicine is challenging long-standing beliefs about the relationship between alcohol use disorder (AUD), depression, and the pleasure people experience when drinking. The research, published in the American Journal of Psychiatry, suggests that individuals with both AUD and depression experience heightened stimulation and pleasure when intoxicated, similar to those who drink without depression. This finding runs counter to the conventional wisdom that people drink excessively mainly to relieve negative emotions and to self-medicate for mental health conditions.
Rethinking Alcohol and Depression
The study’s lead author, Andrea King, Ph.D., a Professor of Psychiatry and Behavioral Neuroscience at the University of Chicago, has spent decades researching alcohol’s effects on the brain. According to King, the prevailing belief has been that individuals with depression drink heavily to alleviate negative emotions—a form of self-medication. However, this study, which examined drinking behavior in real-time using smartphone-based reports, paints a very different picture.
“We have this folklore that people drink excessively when they’re feeling depressed, and that it’s really about self-medicating,” King said. “But in this study, we found that participants with AUD and depression reported feeling acute, sustained positive and rewarding effects from alcohol—just like their non-depressed counterparts.”
This research adds a new layer to the understanding of alcohol consumption among individuals with AUD and depression. Rather than merely drinking to escape negative feelings, individuals with both conditions seem to experience the same pleasurable effects as those without depression, suggesting that alcohol’s pleasurable stimulation plays a significant role in their drinking habits.
The Study: How It Was Conducted
The study followed 232 participants from across the United States, aged between 21 and 35 years old, a demographic in which heavy drinking typically peaks. Half of the participants met the criteria for alcohol use disorder within the past year, while the other half did not. Participants were further divided based on whether they had experienced major depressive disorder in the past year.
To collect data, participants were asked to respond to questions every half hour during a typical alcohol-drinking episode and a non-alcohol episode. They used their smartphones to provide real-time reports on how they were feeling and how alcohol affected them. The results were telling:
- Alcohol consumption led to a reduction in negative feelings, but this reduction was small and not specific to either depression or AUD.
- The positive effects of alcohol were significantly higher in individuals with AUD compared to those without AUD. Surprisingly, the level of positive response was similar in those with AUD and depression as those without depression.
This discovery challenges the long-standing view that individuals with depression experience a diminished sense of pleasure when drinking, or that they drink primarily to manage negative emotions.
Implications for Treatment
The findings from this study have significant implications for the treatment of alcohol use disorder, especially in individuals who also have depression. Currently, treatments for AUD often focus on reducing stress and addressing symptoms of depression. While this approach is important, King argues that it only addresses one side of the problem.
“Currently, the focus of treatment is often on resolving stress and symptoms of depression,” King said. “But that is only addressing one side of the coin. If we don’t also address the heightened stimulation, liking, and wanting more alcohol that occur in both depressed and non-depressed people with AUD, we may be overlooking a critical factor.”
In other words, the enjoyment people experience from alcohol’s pleasurable effects may play a larger role in the development and maintenance of alcohol use disorder than previously thought. By focusing treatment on alcohol’s reward pathways, rather than solely on stress-responsive systems, mental health professionals could better target the underlying causes of AUD in people with depression.
Bridging the Gap Between Lab Studies and Real Life
Alcohol’s impact on the brain is complex, and understanding the factors that make some individuals more vulnerable to developing AUD and depression is essential for improving early intervention and treatment. Traditionally, studies on alcohol use have been confined to controlled lab settings, which often fail to capture the nuances of real-life drinking behavior. This study, however, used mobile technologies to track individuals’ drinking episodes in real-time, allowing the researchers to gather data that more accurately reflects actual drinking patterns in the natural environment.
Dr. Daniel Fridberg, an associate professor at UChicago and co-author of the study, emphasized how these new methodologies are providing valuable insights into the behavior of individuals with AUD and depression. “For nearly a decade, our group has been improving methods to use mobile technologies to measure real-time, clinically meaningful outcomes in people with AUD and those at risk for alcohol-related problems,” Fridberg said. “These approaches allow us to bridge the gap between the lab and real life and have led to new insights that could one day result in better treatments.”
Reexamining the Theory of Alcohol Addiction
The study’s findings also challenge the dominant theory of alcohol addiction, which posits that heavy drinking over time leads to brain changes that result in a diminished pleasure response to alcohol. This theory suggests that as addiction progresses, people drink not to experience pleasure, but to avoid the discomfort of withdrawal or stress. In contrast, King’s study shows that even people with AUD and depression report high levels of stimulation and enjoyment from alcohol consumption.
King’s findings point to the possibility that the brain’s reward system remains highly sensitive to alcohol’s effects even in individuals with long-term AUD. “As treatment providers, we’re taught people with AUD are drinking to self-medicate and feel better,” King said. “But what exactly are they feeling? From our study, it seems to be high levels of stimulation and pleasurable effects, with a modest decrease in negative states.”
What’s Next for Research?
King’s next study will look at whether older adults, aged 40 to 65, who have struggled with AUD for decades, still experience similar pleasurable responses to alcohol as younger adults. The conventional theory would suggest that these individuals should have developed a high level of tolerance to alcohol’s effects, leading to blunted pleasure responses. However, King will explore whether these older individuals, like the participants in the current study, continue to experience heightened enjoyment from alcohol.
If King’s next study confirms that individuals in the later stages of AUD still report strong pleasurable effects from drinking, it could further challenge existing treatment approaches and suggest that the drive to drink is not solely linked to escaping negative feelings but is also driven by alcohol’s stimulating effects.
Conclusion: A Shift in Understanding Alcohol Use Disorder
This study from the University of Chicago Medicine presents a radical shift in our understanding of alcohol use disorder, particularly in people with co-occurring depression. By emphasizing the role of alcohol’s pleasurable effects and its stimulation of reward pathways in the brain, the research suggests that treatment for AUD should not only address stress and depressive symptoms but also focus on the desire for alcohol’s positive effects.
As King and her team continue to explore these complex dynamics, the hope is that future treatments for alcohol use disorder will become more tailored to the individual’s experience of alcohol’s pleasurable effects, leading to more effective strategies for combating addiction.
Reference: Real-Time Assessment of Positive and Negative Alcohol Effects in Individuals With and Without Alcohol Use Disorder and Depressive Disorders, American Journal of Psychiatry (2025). DOI: 10.1176/appi.ajp.20240069