How Are Depression and Addiction Related?

Depression and addiction are complex and can feel impossible to manage—especially if someone is dealing with them simultaneously. Fortunately, help is available for both disorders. Understanding the risk factors, symptoms, and treatment options can help people with dual diagnoses feel more empowered and engaged in their healing process.

Relationship Between Depression and Substance Abuse

Depression is one of the most prevalent mental disorders in the United States. An estimated 16.1 million American adults over age 18 experienced at least 1 major depressive episode in the past year in 2015. That’s equivalent to 6.7% of all adults in the country.¹

According to the 2014 National Survey on Drug Use and Health, 7.9 million Americans also have dual diagnoses. The term dual diagnosis refers to having a mental illness, such as depression, and a substance use disorder at the same time.²

Both disorders can affect one another. For instance, some people with depression may use substances to ease their symptoms. On the flip side, substance use can exacerbate mental illness symptoms or even cause them, in some cases.

Research shows that up to 1/3 of people with depression also meet the criteria for a substance use disorder. This comorbidity is associated with an increased risk of suicide, social/personal impairment, and other psychiatric conditions.³

Locating appropriate care and treatment for people struggling with a dual diagnosis is essential for recovery from both conditions.

Risk Factors

Depression doesn’t have a single cause. But several genetic, environmental, psychological, and biological risk factors are linked to its onset.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) outlines several risk factors for depression including: ⁴

• Adverse or traumatic childhood experiences.
• First-degree family members with depressive disorders.
• Chronic medical conditions, such as diabetes, obesity, and cardiovascular disease.
• A series of stressful life events and changes.

Substance abuse also has several risk factors. These can include: ^4,5

• Family members with a history of substance use.
• High levels of stress.
• History of poor coping skills.
• Poverty/financial distress.
• Early aggressive behavior.
• Lack of parental supervision and involvement.

As the United States continues to become more proactive in identifying and treating mental illness, research continues to improve our understanding of risk factors and preventive measures.

Signs

Everyone experiences sadness from time to time. However, major depression (or clinical depression) is a diagnosable condition characterized by low or depressed mood for most of the day, nearly every day, for at least 2 weeks. Symptoms of major depression include:^4,6

• Feelings of hopelessness.
• Persistent sadness and/or feelings of emptiness.
• Anger and irritability.
• Guilt or feelings of helplessness and worthlessness.
• Loss of interest and enjoyment in usual activities and hobbies.
• Decreased energy.
• Insomnia or hypersomnia (sleeping more than usual).
• Difficulty concentrating and paying attention.
• Restlessness and/or difficulty sitting still.
• Major increase or decrease in appetite and/or weight changes.
• Increased body aches, pains, or soreness without a clear medical cause.

Addiction refers to the problematic abuse of substances despite serious interpersonal, financial, or medical consequences.

When someone has an addiction, they may display or experience at least a few of the following signs, symptoms, and behaviors:^4,7

• Using larger amounts of a substance than intended
• Having a desire to stop or reduce use but being unable to do so
• Spending excessive time and energy attempting to obtain the substance, consume it, and recover from its effects
• Feeling strong cravings and a desire to use the substance
• Continuing to use despite adverse consequences, such as work, school, or family problems
• Recurrent fights with loved ones about substance use
• Taking risks to obtain the substance (e.g., lying, stealing, criminal behavior)
• Exhibiting secretive behavior and going out of one’s way to use the substance
• Using the substance in hazardous situations (e.g., drinking and driving)
• Developing tolerance (needing more to achieve the desired effect)
• Experiencing withdrawal symptoms when abstaining from the substance

By nature, addiction can be progressive, meaning these symptoms often get worse until the substance user gets help.

Depression After Using Drugs

Withdrawal from certain types of drugs and alcohol sometimes results in a set of symptoms that overlap with or resemble those seen in cases of depression.

• Alcohol withdrawal: Alcohol withdrawal symptoms can include agitation and anxiety. After the acute withdrawal phase, many people experience mood instability, insomnia, fatigue, lack of sex drive, and feelings of hostility and anger.⁸
• Stimulant withdrawal: Withdrawal from stimulants (such as cocaine and methamphetamine) can include depressed mood and a lack of pleasure that can last for several weeks. When a person “crashes” after stimulant intoxication, they may feel incredibly fatigued and struggle with strong cravings.⁸
• Hallucinogen use: Hallucinogens (such as LSD) can cause delusions, hallucinations, and feelings of depersonalization. Some people who use hallucinogens experience prolonged feelings of depression, psychotic reactions, and flashbacks.⁸
• Opioid withdrawal: Withdrawal from opioids (such as prescription painkillers and heroin) can result in severe agitation, body pain, and depression. Opioid withdrawal can also lead to sleep disturbances, anxiety, and severe cravings for several weeks.⁸

As indicated, the use and withdrawal of these common substances may also intensify preexisting mental illness symptoms—another reason it’s so important for people suffering from addiction and depression to be evaluated by an addiction professional for thorough diagnosis and treatment.

Recovery Process

Help and treatment are available for depression and addiction, and recovery is possible.

Ideally, both conditions should be treated simultaneously through an integrated treatment to avoid relapse.² Many symptoms of depression can return (and even worsen) after the drug user becomes abstinent.

Many physicians and clinical treatment teams recommend a combination of medication and therapy for the best outcomes.

Medications

Several types of medications may be used to help manage depression. Research and scientific advancements have improved the scope of treatment and decreased the side effects associated with the most commonly used medications.

Common medications for depression include:⁹

• Selective serotonin reuptake inhibitors (SSRIs) such as Zoloft, Prozac, and Celexa.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Pristiq, Cymbalta, and Effexor.
• Tricyclic antidepressants (TCAs) such as Elavil, Anafranil, and Tofranil.
• Monoamine oxidase inhibitors (MAOIs) such as Nardil, Parnate, and Emsam.

Today, several medications are also used to treat alcohol and opioid dependence and reduce substance cravings.

Common medications include:

• Naltrexone: This medication blocks opioid receptors and, in doing so, decreases some of the reward involved with both opioid drugs and alcohol.¹⁰
• Disulfiram: Commonly known by its brand name, Antabuse, use of this medication will result in unpleasant reactions, such as nausea and flushing, if a person drinks alcohol.¹⁰
• Topiramate: This medication, while not FDA-approved for treating alcohol addiction, has been shown to improve several drinking outcomes in certain studies.¹⁰
• Methadone: Methadone is a synthetic opioid agonist used to treat opioid addiction by reducing cravings and the severity of other withdrawal symptoms. Methadone maintenance—in which a person takes methadone over a long period of time—is widely used throughout the United States.¹¹
• Buprenorphine: Buprenorphine is another synthetic opioid that can help reduce withdrawal symptoms of opioids. This medication is often used for detoxification and maintenance.¹¹

No single medication has been approved to simultaneously treat both depression and substance abuse. But those with dual diagnoses appear to respond well to a combination of medications in conjunction with psychotherapy.

Therapies

Many evidence-based therapies are used to manage depression. These include the following: ⁹

• Cognitive behavioral therapy (CBT): CBT helps people alter negative patterns of thinking that contribute to depression. The technique helps people to examine their environment and their behaviors and interactions within it to then reframe them more positively. Patients are encouraged to look at the consequences of certain behaviors and use self-monitoring and action to recognize distressing situations and feelings and develop proactive coping strategies. CBT works well for both depression and substance use disorders.
• Interpersonal therapy (IPT): IPT helps patients work through impaired interpersonal relationships. IPT focuses on changing behavior and exploring major issues, such as grief or difficult transitions, which can impact depression.
• Problem-solving therapy (PST): PST helps patients cope with difficult life stressors and experiences. Using a step-by-step process, therapists help patients pinpoint problems and come up with effective and realistic solutions.

Several evidence-based therapies are also used for addiction treatment. These include: ¹²

• Contingency management (CM): CM provides patients with tangible rewards to reinforce positive behavior. For example, patients may receive vouchers for drug-free urine samples that they can use for food items or other prizes, goods, and services.
• Motivational enhancement therapy (MET): MET provides resolution and clarity for those struggling with ambivalence about sobriety and treatment. This approach aims to create rapid, internal change by strengthening one’s motivation and hope.
• The Matrix Model: The Matrix Model helps people with stimulant addiction achieve abstinence through structured support. Treatment combines elements of relapse prevention, family and group therapy, addiction education, and peer support groups.

Other Tips

In addition to medication and therapy, those with depression can improve their well-being and mood through their daily actions. The National Institute on Mental Health recommends: ⁶

• Increasing exercise and physical activity.
• Setting realistic and obtainable goals.
• Spending time with loved ones.
• Avoiding isolation.
• Postponing major decisions.
• Continuing to learn about depression, its effects, and its treatment options.

Treatment Programs

There are many types of treatment available for people struggling with dual diagnoses. The most appropriate type of treatment will depend on the severity of the conditions and one’s history of treatment (e.g., any previous courses of treatment, any previous treatment complications).

• Inpatient care: Those with severe addictions may require inpatient care. This level of care provides 24-hour support, structure, and monitoring in a residential setting. Inpatient care can be short-term or long-term, depending on the client’s needs.
• Outpatient care: Those with relatively less severe addictions might benefit from outpatient care, which entails visiting a behavioral health counselor or facility on a regular schedule. Patients typically receive both group and individual counseling.
• 12-step programs: Twelve-step groups such as Alcoholics Anonymous and Narcotics Anonymous encourage active engagement in sobriety and fellowship. These groups promote normalizing addiction, accepting powerlessness, and surrendering to a higher power for hope and healing. They are often incorporated into inpatient and outpatient treatment programs.

If you or a loved one is struggling with depression or addiction, help exists. Reach out today to receive the support and care you need.

If you are feeling actively suicidal or at risk of hurting yourself, please contact the National Suicide Prevention Lifeline.

Sources

1. National Institute of Mental Health. Major Depression Among Adults.
2. National Alliance on Mental Illness. (2017). Dual Diagnosis.
3. Davis, L., Uezato, A., Newell, J., & Frazier, E. (2008). Major depression and comorbid substance use disorders. Current Opinion Psychiatry, 21(1),14-8.
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: American Psychiatric Publishing.
5. National Institute on Drug Abuse. (2003). Preventing Drug Use among Children and Adolescents (In Brief).
6. National Institute of Mental Health. Depression.
7. National Council on Alcoholism and Drug Dependence, Inc. (2017). Signs and Symptoms.
8. Substance Abuse and Mental Health Services Administration. (2005). Substance Abuse Treatment For Persons With Co-Occurring Disorders.
9. National Institute of Mental Health. Depression: What You Need to Know.
10. National Institute on Drug Abuse. (2012). Alcohol Addiction.
11. National Institute on Drug Abuse. (2012). Opioid Addiction.
12. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.