Research has established that substance use disorder (SUD) and mental health disorders often co-occur. That means a person suffering from substance abuse is more likely to have a mental health disorder and vice versa. According to the National Institute on Drug Abuse, about half the people with mental illnesses have a substance use disorder.
The relationship between depression and substance abuse is complex and can significantly affect a person’s mental and physical health. We’ll help you understand the connection between addiction and depression as well as the potential causes of this relationship. But first, let’s look at depression and its symptoms.
What is Depression
Depression is not simply feeling sad or down; it’s a pervasive and persistent feeling of hopelessness, worthlessness, and despair. Individuals with depression find it difficult to function in their daily lives. The condition influences their ability to work, socialize, and care for themselves.
Depression affects millions of people globally. According to NIMH (National Institute of Mental Health), about 21 million adults in the U.S., representing 8.4% of the adult population, had one or more major depressive episodes in 2020.
Common symptoms of depression include:
- Feeling sad, hopeless, or empty for extended periods.
- Losing interest in activities the person once enjoyed, such as hobbies, socializing with friends or family, or work-related activities.
- Changes in appetite, leading to overeating and gaining weight or failure to eat and losing weight.
- Changes in sleeping patterns, such as insomnia, oversleeping, or waking up earlier than normal.
- Feeling tired or without energy, even after sleeping or getting enough rest.
- Agitated or restlessness that is observable to others.
- Inability to concentrate on tasks or make decisions, leading to low productivity.
- Feelings of excessive worthlessness or guilt every day whose nature is primarily delusional.
- Experiencing headaches, stomachaches, or other bodily pain unrelated to medical conditions.
- Having suicidal thoughts.
How Does Depression Cause Substance Use Disorder
To overcome the symptoms of depression, such as feeling hopeless, some people start taking alcohol and drugs. It’s a form of self-medication that is extremely dangerous. Depressed people do it because they feel it helps suppress negative emotions, uplift their mood, overcome insomnia, and boost their energy. But while it might seem effective in the short term, self-medication often leads to more problems.
Keep in mind that drugs and alcohol don’t treat depression. They only provide temporary relief, so people find it necessary to keep taking them regularly to extend the effect. Eventually, they become addicted. The body starts craving drugs, leading to substance use disorder.
Depression can also lead to self-isolation, which makes patients feel lonely. Spending a lot of time alone also increases the likelihood of drug abuse. Drugs seem to provide some comfort that compensates for lost connection and love from people.
Young adults are more vulnerable to depression and addiction. The problem can start in adolescence and become worse in adulthood. Part of the reason is that most youths may have no access to treatment. So they end up seeking self-medication.
How Does Substance Use Disorder Cause Depression
Addiction to drugs and alcohol can alter brain chemistry, increasing the risk of depression. Even though drugs and alcohol can increase dopamine and serotonin levels, they can also deplete their reserves. Without these two mood-boosting chemicals, people can feel depressed and tired.
Additionally, chronic use of alcohol and drugs is associated with increased cortisol levels, which leads to increased stress and depression.
There’s also a close relationship between depression and addiction recovery. Once a person’s body becomes dependent on drugs, withdrawing becomes a challenge. Typically, they become depressed if they stop using them immediately. That’s because their brain used to rely on drugs to produce mood-boosting chemicals and now can’t do it on its own.
Can Depression and Addiction Co-Occur Independently
According to the National Survey on Drug Use and Health, in 2019, 9.5 million adults in the U.S. with SUD had a co-occurring mental illness. But in some cases, the co-occurrence happened independently of each other. The causes of independent comorbidity include:
- Genetic vulnerabilities. Some types of genes can lead to both SUD and mental illness. The National Institute of Drug Abuse shows that specific types of genes increase the likelihood of developing addictions to marijuana, alcohol, and cigarettes. The same genes also increase the possibility of having a mental illness.
- Environmental factors. Exposure to environmental stressors can lead to drug abuse and depression. These include factors like chronic stress, trauma, and adverse childhood experiences.
Diagnosis for Depression and Substance Abuse
Diagnosis for co-occurring addiction and depression can be complicated. It might not be easy to know which came first or whether the disorders happened independently. But it’s possible to know how each disorder affects the person.
For instance, a healthcare provider can help a patient withdraw from the drug and observe the effect of long-term abstinence. Doing so can help differentiate drug withdrawal symptoms from mental illness.
Furthermore, a person with a dual diagnosis tends to have more severe symptoms than a person with depression alone. These include:
- Severe mood swings.
- Worse functioning.
- Higher chances of psychiatric comorbidities.
- More suicidal thoughts.
The DSM-5 provides criteria for the diagnosis of depression. According to it, a person must exhibit at least five depression symptoms that must last for at least two weeks. One of the symptoms should be low mood or loss of interest in daily activities.
Similarly, the DSM-5 provides 11 diagnostics points under four categories (including impaired control over substance use, risky behavior, social impairment, and pharmacological effects) and three severity levels for substance use disorder. Two or three symptoms indicate a mild addiction. Four and five show a moderate addiction, while six and above indicate severe substance use disorder.
Treatment Options for Co-Occurring Depression and Addiction
The most effective treatment for depression and addiction is one that targets both conditions and can include medications and therapy. For instance, bupropion can help with depression and addiction to nicotine.
Medications, such as antidepressants, provide relief from depression and drug withdrawal symptoms. But therapy helps with long-term coping strategies. Both are necessary for effective treatment. The mental health specialist can find one or multiple types of therapies to help a patient learn new coping skills. These include:
- Behavioral therapy. Behavioral therapy focuses on identifying negative behaviors and replacing them with healthier ones. This process recognizes that behaviors can lead to emotional distress. The most commonly used type of behavioral therapy is CBT (cognitive behavioral therapy) that also helps analyze negative thinking patterns and identify how they affect one’s mood and behavior.
- Support groups. These gatherings help peers with similar issues support each other in a safe and non-judgmental environment. They understand the challenges of recovery and can provide encouragement through personal experiences.
- Alternative therapies. These include yoga, meditation, and acupuncture. They can also help reduce stress and promote a sense of calm, benefiting individuals struggling with depression and addiction.
Getting Help for Co-Occurring Substance Abuse and Depression
Most often, depression co-occurs with substance use disorder. Depression can lead to substance use disorder when people resort to drugs and alcohol to cope with the symptoms. On the other hand, drug addiction can lead to depression because of the changes the drugs create in the brain structure.
Although diagnosis and treatment for this comorbidity are complex, a qualified mental health professional can help. If you or someone you love is struggling with co-occurring depression and substance abuse, it’s crucial to seek help from a reputable healthcare provider.
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