Depression and Substance Abuse

The relationship between depression and substance abuse is a two-way street. Often times mental health conditions such as depression can lead to drug and alcohol abuse as a means of coping. On the other hand, substance abuse can put individuals at a higher risk of developing clinical depression. These co-occurring conditions create a dangerous cycle that can make everyday life difficult, but with the right approach to this dual diagnosis, individuals can address their health from every aspect and achieve long term recovery. 

How Does Drug Abuse Affect Depression, and Vice Versa?

Depression is a mood disorder characterized by a persistent feeling of sadness, lethargy, hopelessness, and a lack of interest in everyday life. Depression can be situational and triggered by a specific life event, or it can be clinical, meaning it occurs for long periods of time with no identifiable source. 

Many people perceive depression as a “bad mood” or “feeling down”, but depression is much more serious than that. Depression occurs when the chemicals and hormones in the brain and body aren’t able to function or regulate properly, ultimately altering the body’s natural chemistry. For this reason, depression should be addressed under the supervision of a medical professional. Some symptoms of depression include:

  • Severe sadness, lethargy, irritability, and frustration 
  • Lack of interest in normal activities and hobbies 
  • Difficulty thinking, making decisions, and feeling present
  • Extreme fatigue
  • Insomnia
  • Weight fluctuations
  • Unexplained body aches and pains
  • Reoccuring thoughts of death or suicide 

Approximately one-third of adults with major depressive disorder also have a drug or alcohol addiction. For those in the midst of a depressive episode, which can last from weeks to months, or even years, the numbing effects of drugs and alcohol seem like an easy solution. Although the substances may temporarily relieve some of the negative feelings that come with depression, your body will eventually become dependent on them and experience a full-blown addiction with exacerbated depression. 

Our bodies are very smart and very adaptable. If we constantly send the message that substances are what will make it feel better, it will adapt to believe that to be true. Where the body once knew how to organically produce “happy” hormones and brain chemicals, it will lose this ability and result in the co-occurrence of depression and substance abuse. The effects of drugs and alcohol will cause further regulation of the body’s chemicals making it much more difficult to control the depression. 

Not only does drug abuse intensify the symptoms of depression, but it can lead individuals to refuse treatment, thinking that substances are the only solution. The longer the body functions at this level, the more difficult it will be to treat. Often times these co-occurring conditions last for long periods of time, which is why a licensed medical professional who understands the complexity of this dual diagnosis should be utilized to create an individualized treatment program. 

Diagnosing Depression and Substance Abuse Disorder

It’s important to see an experienced physician to conduct a full evaluation of your symptoms to properly identify the conditions and come to the conclusion of a dual diagnosis. When both of these conditions co-occur, treating only one will not make for successful rehabilitation. 

There are several ways doctors and therapists can identify these coexisting conditions and create a treatment plan from the perspective of not one condition, but both simultaneously. 

The processes of diagnosing will likely include the following:

  • Physical Examination
  • Lab Tests
  • Psychological Examination

During these evaluations, the patient will work one on one with experienced professionals to understand the severity and specific characteristics of his or her substance addiction and co-occurring depression. 

There are different types of depression and different types of substance addiction that can all fall under the category of this dual diagnosis, so it’s important, to be honest with your treatment team about your drug use, thoughts, and experiences that led you to seek help. 

Why is a Dual Diagnosis Hard to Diagnose? 

Comorbidities tend to contribute to one another, making the symptoms more difficult to distinguish. For example, someone with depression may experience more intense substance abuse a result. At the same time, someone with an intense addiction may develop extreme depression. 

What can make the dual diagnosis easier to understand and treat is to determine which illness came first and led to the evolution of the other. By determining this, doctors are better able to understand the patient’s brain and how it responds to these conditions. Once the detoxification process is complete, medical staff will determine which symptoms remain in order to identify the characteristics of the addiction vs. depression. 

To meet the criteria for dual diagnosis, patients must have a mental health disorder as defined by The American Psychiatric Association, as well as an active or history of substance abuse. 

 From there, a recovery plan designed to specifically address the individuals experience with the co-occurring conditions will be put in place to simultaneously treat both. 

Treatment for Substance Abuse and Depression 

Treatment for a dual diagnosis of depression and substance abuse disorder will include a blend of treatments that address both the mental and physical effects of these co-occurring conditions. Many factors come into play, and options for treatment typically include a combination of the following:

  • Detox
  • Depression medications
  • Talk Therapy
  • Nutritional Therapy
  • Meditation & Yoga
  • Behavioral Modification Therapy
  • Relapse Prevention 

Antidepressants are not always used, especially if there is a concern for addiction after substance abuse, however, they have proven successful in a large percentage of patients. Antidepressants including SSRIs and Tricyclics are designed to help the brain’s chemistry function at its normal levels. Often times they will be prescribed only for a short period of time while the patient has time to readjust.

Individual counseling sessions with a psychiatrist or counselor will be able to address both your mental illness and substance addiction, and help find the root causes of their co-occurrence. Trauma from past experiences is often a major factor in the development of both conditions and talking with a professional will enable you to learn how to accept and let go of whatever experiences are triggering your depression and addiction.  

Holistic approaches should also be integrated into the treatment program for dual diagnosis to teach individuals how to cope with everyday stressors and triggers. Yoga and meditation offer tools of relaxation and mindfulness, and acupuncture or massage therapy can lessen the tension that has manifested as a result of chronic stress. 

Typically, residential treatment is preferred for patients receiving treatment for a dual diagnosis of depression and substance abuse. Outpatient care is suitable for less severe conditions, but the comorbidity of these conditions calls for a more highly supervised treatment program. 

How Long is Treatment?

Treatment length varies from patient to patient but should extend long enough for the individual to fully recover from the substance addiction and stabilize their mental health condition. The Center for Disease Control and Prevention suggests that the ideal length of time for treatment should include a 30-day inpatient program with an extended program lasting 3-12 months. This is not always an option, whether due to financial reasons or other external circumstances, so patients should stay as long as possible to ensure skills and strategies for coping and staying sober are achieved. 

There are many options for extended programs, including Sober Living Homes, Intensive Outpatient Programs, and outpatient treatment services. Once your initial treatment is complete, your team of doctors and clinical professionals will be able to advise what the next steps are to successfully address your co-occuring conditions and maintain recovery

Get Help for Depression and Substance Abuse

Without proper treatment for a dual diagnosis of depression and addiction, the conditions will impact your life negatively and increase in severity. Sobriety and health are achievable, and at the Discovery Institute, we have the experience and knowledge to get you there. If you or a loved one needs help recovering from addiction and substance abuse, contact us today to discuss how we can give you the help you deserve. 

Reviewed for Medical & Clinical Accuracy by Dr. Joseph N. Ranieris D.O.

Dr. Joseph Ranieri D.O. earned his BS in Pharmacy at Temple University School of Pharmacy in 1981 and His Doctorate Degree in Osteopathic Medicine at the Philadelphia College of Osteopathic Medicine in 1991. He is Board Certified by the American Board of Family Medicine and a Diplomate of the American Board of Preventive Medicine Addiction Certification.