Depression is one of the most common mental health issues in the United States. It seems to affect people from every age group and demographic, and it may have a particular impact on teens and young adults. Depression can lower your quality of life, but it can also get in the way of many aspects of your life, leading to significant impairment.
Substance use problems and addiction can further complicate depression. Together, the disorders feed off each other, and they can be challenging to deal with. Treating these problems separately can limit treatment success.
Unfortunately, depression and addiction frequently occur together. But why do depression and addiction occur in the same person so frequently? How can these complicated disorders be treated at the same time? Learn more about the relationship between depression and addiction and how they can be treated.
What Is Addiction?
Addiction is a disease that affects the reward center of the brain. Drug and alcohol addiction is officially diagnosed as a substance use disorder. Addiction causes changes in your brain that make you compulsively use a chemical substance in a way that gets out of control. A substance use disorder is often identified by compulsive use of a drug despite significant consequences.
For instance, alcohol addiction may cause you to continue drinking, even if alcohol is contributing to health complications. Even though no one tries to develop a substance use problem, the drug can encourage repeated use. Your reward center is designed to work with certain chemicals like dopamine, endorphins, serotonin, and norepinephrine, which are often called feel-good chemicals. Many substances can mimic or interact with those chemicals in the brain, causing your reward center to treat drug use as an important thing for you to repeat.
For many people, it’s difficult to deal with a substance use disorder without help. If it’s left untreated, addiction can start to take over many areas of your life, including your physical health, mental health, relationships, and finances.
Many people who seek help in treating a substance use disorder present to treatment with other needs as well. Mental health is a common problem among people with addiction issues, and the two problems often feed off each other. Treating one without addressing the other can lead to a relapse of both problems.
Why Do People Use Drugs?
There are many reasons why people use drugs and might fall into addiction. Drug and alcohol misuse is a common problem, and it can begin for various reasons. One of the most common reasons is to feel good. Recreational drug users seek a comfortable, euphoric, or exciting high. Sometimes people use drugs to feel better, especially when they have a mental health problem like depression.
Drugs and alcohol may offer temporary relief for certain mental health disorders, but they often make them worse in the long run. Some drugs are used to increase physical or mental performance. For instance, some ADHD medications are used as study drugs. Finally, some people misuse drugs or alcohol because of social pressure or curiosity.
How Is Addiction Diagnosed?
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are 11 signs of addiction. Substance use disorders are separated into three categories based on severity, including mild, moderate, and severe substance use disorders.
The severity of your substance use problem will depend on the number of these symptoms you experience. A mild substance use disorder involves two or three of the symptoms, four or five is a moderate disorder, and six or more is a severe substance use disorder. The signs and symptoms of addiction include:
- Dangerous drug use. You may use the drug in a way that’s risky or has led to dangerous situations like overdose, drunk driving, or passing out.
- Social issues caused by drug use. If your substance use is causing interpersonal conflicts or strained relationships, it may be a sign of addiction.
- Neglect of responsibilities. Addiction can cause you to prioritize finding and using drugs in a way that causes you to neglect your responsibilities at home, work, or school.
- Withdrawal symptoms. If you experience uncomfortable symptoms or cravings when you try to quit or cut back, you may be chemically dependent, which is a sign of addiction.
- Tolerance. As you become chemically dependent, you will need higher or more frequent doses to achieve the same effects.
- Increased use. If you respond to tolerance by increasing your dose, using for longer periods, or using more often, you may be addicted.
- Repeated attempts to gain control or quit. Addiction can get out of control and resist attempts to quit. If you try to cut back or quit many times without success, it could point to an addiction.
- More time is spent using substances. Active addiction can take over more and more of your day. You may spend more and more time seeking, using, and recovering from drugs or alcohol.
- Physical or mental health problems. Addiction can have a serious impact on your biological and psychological health, and it may get worse over time without treatment.
- Giving up activities to use. Substance use problems often cause you to give up some of the things you used to enjoy. You may lose interest in them or give them up to have more time to manage your addiction.
- Cravings. Drug and alcohol use can cause powerful cravings or compulsions to use.
What Is Dual Diagnosis?
Dual diagnosis refers to the co-occurrence of a substance use disorder and a mental health problem. Depression is a common mental health disorder to accompany an addiction, but dual diagnosis can also involve anxiety, post-traumatic stress, schizophrenia, and other mental health problems. Dual diagnosis can be more difficult to treat than substance use problems or mental health issues on their own.
In the past, these issues may have been addressed separately or even at different times. However, one problem may thwart efforts to treat the other problem. For instance, depression gets in the way of treatment progress and contributes to powerful cravings to use the drug. On the other hand, active addiction can make it very difficult to address a mental health disorder. Instead, effective treatment will involve therapeutic approaches for both of the problems at the same time.
Today, many treatment centers and addiction treatment professionals are prepared to address issues like addiction alongside substance use disorders. The ASAM Criteria is one of the premier methods of assessing a person’s need in addiction treatment. One of the six points of this criteria is psychological conditions or complications. The presence of mental health issues can be an important factor in determining your level of care and forming your treatment plan.
How Common Is Dual Diagnosis with Depression and Addiction?
Addiction and mental health disorders co-occur at the same time in many people, and depression is one of the most common mental health issues in the United States. In 2019, 14.5 million people met the criteria for an alcohol use disorder, and 8.3 million people had substance use disorders related to illicit drugs.
Major depression is commonly seen alongside substance use disorder, and it’s a big problem in the United States. More than 15% of teens aged 12 to 17 experienced a major depressive episode in 2019. Around the same amount of young adults between 18 and 25 experienced a major depressive episode in the same year. Nearly 9% of adults aged 26 to 49 also experienced a major depressive episode.
But how much do depression and substance use problems overlap?
In 2019, adolescents that experience major depressive episodes were more likely to use illicit drugs than their peers that did not experience depression. More than 31% of teens that experienced depression also used illicit drugs. Of these, 4.1% of depressed teens used opioids in 2019, and 8.9% binged alcohol. Around 49.4% of adults with a serious mental illness also used illicit drugs, and 32.7% binged alcohol.
According to the National Institute on Drug Abuse (NIDA), research shows that around half of people who experience substance use disorders in their lifetime also experience a mental health problem.
Why Are Depression and Addiction Connected?
Depression and substance use disorders are both complicated problems that can be caused by various factors. They may also come with several consequences to your physical and mental health that can further complicate treatment. Both disorders are generally caused by a host of factors that work together, and it’s rare to identify a single cause for addiction or depression.
It’s often debated whether mental health problems can cause addiction or vice versa. They may both be caused by other factors. The connection between depression and addiction can be explained by several potential factors, including the mind-altering nature of some drugs, common risk factors between the two disorders, and the practice of self-medication.
Some Drugs Can Trigger or Worsen Mental Illness
Drugs and alcohol can cause significant changes in the brain that can be dangerous to people who are vulnerable to mental illness. For instance, it is thought that people who are predisposed to issues like schizophrenia may experience psychotic symptoms when they’re exposed to marijuana or psychedelics.
While it’s unclear whether or not these drugs can cause serious mental health problems in otherwise healthy people, it’s clear that they can trigger them in people who are vulnerable to them. Drugs may also worsen common mental health issues like depression and anxiety.
If you have a mild mood disorder, you could experience more severe major depressive episodes after developing a substance use problem. In many cases, feelings of shame and the loss of control that often come with substance use problems can cause you to fall deeper into depression.
Addiction and Mental Health Problem Causes May Overlap
It’s difficult to pinpoint a single cause for either addiction or depression. In most cases, they’re caused by a combination of factors, including genetic, developmental, and environmental causes. Many of the problems that cause a substance use disorder may also cause depression. For instance, neglectful parents can lead to children developing depression later in life, but it’s also a risk factor for substance misuse and addiction.
Addiction and mental health problems are also thought to be significantly influenced by genetics. If you have a parent or grandparent that struggled with both disorders, your chances of experiencing them are higher. Socioeconomic factors can also create an environment that leads to both disorders.
Mental Illness Can Lead to Self-Medication
Depression and other mental health disorders can cause you to seek relief from your uncomfortable symptoms. Many people use alcohol or drugs to treat mood disorders like depression because they can offer some temporary relief. Alcohol is commonly used as a form of self-medication, which is the use of a chemical substance to treat mental issues without consulting a doctor.
Alcohol can lift your mood while your blood-alcohol concentration (BAC) level is rising, and then it can relax you, dulling your worries and anxieties as your BAC begins to drop. However, relying on alcohol or other drugs to mask uncomfortable emotions or mental health issues increases your chance of developing an addiction.
How Is Dual Diagnosis Treated?
Dual diagnosis is a complicated problem to address, but if you have a substance use problem and depression, there are several approaches to treatment you can take to achieve sobriety and better mental health. The first step is to reach out for help. You can talk to your family doctor or reach out to an addiction treatment center.
Either way, getting help starts with assessing your needs and finding a treatment approach that works for you. There is no one-size-fits-all treatment plan, especially when you consider co-occurring problems like depression that also need to be addressed. But if you enter a treatment program with a dual diagnosis, you may go through some of the following treatment options.
According to NIDA, addiction treatment needs to be personalized for it to be effective. People may come to addiction treatment with a variety of underlying issues or complications that require a unique treatment plan. Co-occurring problems like depression further illustrate the need for a complex treatment approach to address a complicated problem.
When you enter an addiction treatment program, you’ll go through an assessment process that’s designed to pinpoint your needs and start you on a personalized treatment plan. This may involve a biopsychosocial assessment, which involves examining biological, psychological, and social issues that you may have. You’ll also go through both medical and psychological assessments to make sure your mental and physical health is considered.
Your treatment may also be personalized based on the level of care you’re in. There are four major levels of care in addiction treatment, including medically managed intensive inpatient treatment (detox), inpatient/residential treatment, partial hospitalization and intensive outpatient treatment, and outpatient treatment.
Each level of care is separated by the type of care you receive and the hours you spend in treatment services, with the most being 24-hours each day and the least involving fewer than nine hours each week. Addiction treatment professionals will likely use the ASAM Criteria to help determine the level of care you need. The criteria involve six factors that are important in addiction treatment, including:
- Withdrawal potential
- Medical conditions and complications
- Psychological conditions and complications
- Your readiness to change
- Relapse potential
- Your living environment
If you have high-level needs in any of these categories, you may need a higher level of care in addiction treatment. As you progress in treatment, your needs may decrease, allowing you to succeed in a lower level of care.
The U.S. Food and Drug Administration (FDA) has approved various medications to treat depression and a few that treat specific substance use disorders. Depression can be treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).
These medications work with chemicals in your brain that are tied to mood, reward, and motivation. Low levels of serotonin can cause you to experience more periods of low mood and fatigue. SNRIs and SSRIs both work to block the process of reuptake, which removes certain chemicals from your system and recycles them. Reuptake inhibitors can increase the levels of serotonin in your brain to correct chemical imbalances that can cause depression.
There are many medications that can be used to address symptoms in addiction treatment, but there are only a few that are approved to treat addiction directly. For instance, buprenorphine is used to treat opioid use disorders. Buprenorphine is a partial opioid agonist, which means it can bind to opioid receptors to have a limited effect on them. It’s used to replace more harmful or difficult to manage opioids in people who have become addicted.
Buprenorphine is also less likely to cause an intoxicating high. Ideally, you can take it to avoid withdrawal and cravings while avoiding intoxication. Suboxone is a common medication that contains buprenorphine, and methadone is another medication that’s used for similar purposes.
Individual therapy is an important part of addiction treatment. You’ll meet with a therapist one-on-one on a regular basis through the course of your treatment plan. In fact, you’ll likely meet with a therapist at the beginning of treatment to form your treatment plan. You’ll meet with them again at least once a week to assess and process your treatment progress.
Depending on your needs and your level of care, you may meet with them multiple times per week. Your therapist will walk through different therapies according to your needs in recovery. If you have specific issues like PTSD or an eating disorder, you may be referred to another therapist that specializes in those issues. Your therapist will be able to help you address your substance use problems, depression, and how they may relate to each other.
Of course, meetings with a therapist on an individual basis are important, but group therapy has also shown to be effective in addiction treatment. Group therapy sessions can provide peer support and accountability. You may begin to feel like you’re part of a community with similar goals and like you’re not alone in what you’re going through. Every person is unique in what they have to overcome to achieve sobriety and mental health, but hearing the stories of people who have gone through similar challenges can make yours seem more manageable. Group therapy also dispels the feeling of isolation that can come with both substance use problems and depression. Group therapy also helps you to develop social skills that will be helpful in dealing with problems and people in your life in the future.
Behavioral therapies are a form of psychotherapy that examines the way your thoughts and coping strategies can influence your behavior. There are several types of behavioral therapy that are used to treat both depression and addiction. Some of the most common behavioral therapies include:
- Contingency management. This is a form of therapy that uses tangible rewards like vouchers, prizes, or monetary rewards to encourage and motivate treatment progress. The chip systems of Alcoholics Anonymous and similar 12-step programs also use principles of contingency management.
- Motivational enhancement. Motivational enhancement is an approach to therapy that’s specifically intended to help people address hesitation or ambivalence to engage in treatment. This form of therapy focuses on helping people advance on the Stages of Change Model. It’s ideal for people who enter treatment reluctantly or due to a court order.
- Cognitive behavioral therapy (CBT). Cognitive behavioral therapy is an important form of behavioral therapy that’s used to treat substance use problems and a variety of other behavioral and mental health issues. CBT involves examining the coping responses you have to high-risk situations and triggers. Poor coping skills can contribute to substance misuse and negative emotions that are associated with depression. In CBT, you can learn to identify triggers and develop coping mechanisms to deal with them.