As one of the most frequently diagnosed mental health disorders in the US, depression affects nearly 8 percent of people 12 and older, according to the National Health and Nutrition Examination Survey. Depression often co-occurs with substance abuse or addiction. Depression can even often predict the first incidence of alcohol use disorders, according to a study in the Journal of Clinical Psychiatry.
Because of this, people who have co-occurring substance use disorders and depression require specialized treatment to manage both disorders. The complex symptoms of both disorders and the ways in which they affect one another require integrated treatment to achieve and maintain recovery in the long run.
What Is Depression?
The National Institute of Mental Health (NIMH) describes depression as pervasive feelings of sadness, anxiety, and emptiness that do not improve over time. There are various types of depression, but they all encompass some basic general symptoms, including:
- Feelings of worthlessness, helplessness, or hopelessness
- Irritability or anxiety
- Fatigue and lack of interest in activities that used to be enjoyed
- Disruption of sleep patterns
- Disruption of eating patterns
- Inability to focus
- Unexplained body aches and pains that do not improve with direct treatment
- Suicidal thoughts
These symptoms of a depressive disorder can interfere with the person’s responsibilities, relationships, and health.
Defining Depression Disorders
Depression can be caused by a wide range of circumstances, resulting in various types of depressive disorders, according to NIMH. These include:
- Major depression: This is a severe sadness or emptiness that interferes with the ability to enjoy and participate in life. It may occur only once, or it may recur several times over a person’s lifetime.
- Persistent depressive disorder: This type of depression lasts at least two years. It may involve major depression symptoms periodically, but the feelings of sadness or emptiness last at least that amount of time.
- Postpartum depression: This is depression that begins specifically after the birth of a child, leading to feeling extremely overwhelmed by caring for the baby. This is not to be confused with the normal, hormonal fluctuations that lead to occasional sadness that dissipates over time.
- Seasonal affective disorder: This depression often occurs during the darker months of the year, from late fall through early spring. This type of depression is generally improved during the warm months from late spring through early autumn.
- Psychotic depression: This type of depression occurs in combination with hallucinations, delusions, or other psychosis.
- Manic-depressive disorder or bipolar disorder: This disorder involves continual cycling from extreme euphoria to extreme depression. This is not as common as major depression.
Depression is generally treated through a combination of therapy and medication. As described by the Anxiety and Depression Association of America, these two methods together can help a person control symptoms of depression by enabling the person to recognize and change depressive thoughts and behaviors and by adjusting the body’s hormonal and neurological pathways.
A number of other techniques can be used to help manage depression, such as:
- Meditation and relaxation techniques
- Self-help support groups
- Talking with family and/or connecting with a network of friends
We Treat Addiction & Depression Simultaneously
A challenge can arise with medication, however. Some medications used to treat depression can be addictive, and some people may try to self-medicate with other addictive substances. When this happens, depression and substance use disorders may co-occur, creating a challenge in treating both disorders effectively.
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The Challenge of Co-occurring Depression and Addiction
As with all co-occurring disorders, substance abuse and depression can complicate each other. If one only treats the addiction, it is likely that relapse to substance abuse will occur when depression rears its head. Likewise, if only the depression is treated, substance abuse will likely lead to a relapse in depressive symptoms.
To effectively recover, individuals need to seek treatment for both issues – addiction and depression. With an integrated treatment plan that addresses both issues, people can effectively achieve recovery on both fronts. It’s important for individuals to seek care at facilities that are equipped to treat both addiction and co-occurring mental health issues.
The Self-Medication Theory
One theory behind the common co-occurrence of depression and substance abuse involves something called self-medication, as described in a study from the journal Neuropsychopharmacology. The idea behind this theory is that when people feel extremely depressed, they may try to manage the symptoms themselves through alcohol or drug use.
This theory has been studied again and again over time. This study from the American Journal of Drug and Alcohol Abuse demonstrated that most people who were hospitalized for drug abuse stated that they started using drugs to deal with feelings of sadness, regardless of the drug type.
Addiction and Depression: Cause and Effect
The relationship between depression and substance abuse can be a confusing one, because it may be difficult to figure out which came first, and whether or not there’s a cause-and-effect connection between them. As mentioned above, sometimes self-medicating existing depression can trigger a substance abuse problem, leading to a spiraling condition where one issue cannot be treated without treating the other.
Conversely, sometimes drug use can cause symptoms that resemble depression, as described in an article from Psych Central. In fact, excessive use of some drugs can cause changes in the brain that create a depressed behavior response. In this case, sometimes when the substance abuse is treated, the depression symptoms may begin to diminish.
For this reason, the diagnosing professional and client should be prepared to be flexible with treatment. An expert will often be able to determine whether the depression is truly a co-occurring condition. However, during treatment, other symptoms may become apparent that alter the diagnosis and the plan for treatment slightly. Because it is important to adjust treatment to fit the specific individual’s situation, being flexible enough to manage changes in the treatment plan can help get the person closer to recovery with less difficulty.
Using an integrated model to treat co-occurring depression and substance abuse together is more likely to result in the person being able to manage both conditions in the long-term with a lower risk of relapse. The first step is for the treating professional to perform an assessment to determine the extent of both disorders and come up with a treatment plan for the specific individual. This plan will most likely emphasize therapy for treatment.
While there are medications that can treat both addiction and depression, they should be used cautiously, as some of the drugs used to help with depression and anxiety, known as benzodiazepines, also have addictive potential. Because of this, as described in a study in the American Journal of Psychiatry, many doctors hesitate to prescribe medications to manage these co-occurring disorders in order to avoid the potential of abuse and addiction.
Still, there are some medications with low addiction potential that can help manage both conditions during the course of treatment. As always, the use of medication should be determined on an individual basis and continually supervised by medical professionals. Therapy should be provided to help the person learn to manage symptoms and behaviors of both disorders.
Psychological Aspects of Treatment
A therapy type that tends to result in positive outcomes for both depression and substance abuse is Cognitive Behavioral Therapy (CBT), in which the person learns to recognize patterns of depression and manage them. According to a study in Addiction, this type of therapy has also improved treatment outcomes for co-occurring depression and substance abuse. With practice, a person in CBT can learn to recognize depressive feelings, manage them, and as a result, change the behavioral response to these symptoms without using drugs or alcohol.
Similarly, recent studies have shown that mindfulness therapy – creating a higher level of attention to and acceptance of the person’s current behaviors, conditions, and situation – can help reduce substance abuse behaviors in people who are struggling with co-occurring depression. Studies such as this one, also featured in Addiction, demonstrate that improving awareness can help a person recognize and manage both depressive and addictive behaviors.
Managing Depression and Addiction
After treatment, management of both depression and substance abuse must be continued in order to avoid relapse. Depression can be a strong trigger for addiction relapse, so it can be helpful for the person to remain involved in aftercare or alumni programs to stay motivated and connected with the lessons learned in treatment and to get feedback and support in case of struggles with relapse.
As an example, one post-treatment technique that helps people with depression avoid substance abuse relapse is Motivational Interviewing. One study from the Journal of Substance Abuse Treatment showed that this technique – which provided follow-up interviews about progress at three months and six months after treatment – helped participants maintain sobriety and co-occurring disorder management better than those who did not have this type of intervention.
Depression and substance use disorders cannot be cured, but recovery is possible. Integrated treatment that addresses both disorders can help individuals to lead healthy, balanced lives in recovery.