Substance use disorders (SUDs) are typically linked to high levels of depression and anxiety. To be more specific, it is related to severe depression and anxiety. There is an apparent association between the presence of depression and anxiety on one hand and the severity of SUDs on the other hand. Depression is commonly present in patients with substance use disorders.
What’s A Dual Diagnosis?
Mental health conditions and substance use disorders occur together so often that experts have given the combination a specific name: dual diagnosis. In fact, about half of the people who have a mental disorder will also have a substance use disorder at some time in their lives and vice versa. The interplay of depression and addiction can make each of them worse.
Though depression and addiction often occur together, it doesn’t mean that one caused the other, even if one of them appeared first. It can actually be very difficult to figure out which one happened first. It is believed by researchers that there are three possibilities for why they occur together:
There are common risk factors that may contribute to both disorders. These factors can include genetics, stress, or trauma. Mental disorders can contribute to drug use and SUDs. For example, individuals with mental disorders may use drugs or alcohol in an attempt to temporarily relieve their symptoms of depression. This is known as self-medication. In addition, mental disorders may alter the brain to make it more likely that the individual becomes addicted.
Substance use and addiction can add to the development of a mental disorder. Substance use may change the brain in ways that make an individual more likely to develop a mental disorder.
A person with a dual diagnosis will find that their symptoms are harder to manage than if they had either SUD or depression alone. Compared to people with a single diagnosis, people with a dual diagnosis are likely to have more severe symptoms of depression, are more likely to relapse when trying to stop using substances, and have a generally lower quality of life.
How Depression Leads to Addiction
The most commonly diagnosed mental health condition among people with a dual diagnosis is major depression. A review of clinical data from 1990 to 2019 found that 25% of people with major depressive disorder (MDD) also had a SUD. Alcohol use disorder (AUD) was also found in 20.8% of people. 11.8% of individuals with MDD had illicit (illegal) drug use disorder. Cannabis use disorder was found in 11.7% of individuals with MDD.
Furthermore, the evidence suggests that those with depression are nearly twice as likely to self-medicate with alcohol rather than drugs. Common reasons people want to self-medicate include:
- To ease unwanted emotions: For many people, drinking alcohol may help them relax, take a break from the distress, or numb their pain.
- To lift their mood: Some individuals might believe that they can only feel good (or feel anything at all) when under the influence of alcohol or other substances.
- To get some sleep: Insomnia and depression frequently go hand in hand.
- To increase energy: Depression often depletes energy, partly because of a lack of sleep.
Drugs and alcohol may relieve symptoms temporarily, but they can’t get rid of the symptoms completely. And they can’t treat the underlying condition. When the use is stopped, the depression symptoms will return.
Besides that, a person may find themself developing a tolerance for the drug. This means that they need to use more of it to get a similar effect. In time, they become dependent on the drug just to function as they usually would. Dependence increases the chance of addiction.
Symptoms of Depression
The National Survey on Drug Use and Health (NSDUH) revealed in 2016 that about 16.2 million adults in the United States deal with MDD. That makes up about 6.7% of all adults. Still, only about 44% of adults with MDD receive treatment from a healthcare professional.
Five Warning Signs of Depression
Depression doesn’t only affect a person’s mental health. It can also impact a person’s physical well-being negatively.
Everyone experiences forgetfulness and brain fog occasionally. But people who are living with depression often experience an extreme lack of focus.
Not getting enough sleep or getting too much is another warning sign of depression.
Depression can cause people to eat significantly more and it may cause a marked decrease appetite for some others.
Exaggerated or unexplained irritability is another possible sign of depression. If a person gets agitated more often than usual and the little things set them off, they may be suffering from depression.
How Addiction Leads to Depression
SUDs can also play a role in depression, just as depression can be a factor in substance use. And more serious substance use disorders are more likely to contribute to depression. Substance use contributes to depression in four primary ways:
Many substances, especially alcohol, can spur the short-term release of dopamine in the brain. This release of dopamine can produce feelings of pleasure. However, it can also increase inflammation in the brain. In turn, this inflammation makes it harder for your brain to produce mood-elevating chemicals like dopamine and serotonin on its own.
Drugs and alcohol don’t just reduce levels of mood-boosting chemicals in the brain, they also increase the levels of chemicals related to stress, such as cortisol.
When alcohol and drugs are used regularly, the brain begins to depend on the substance to function. If the substance use is suddenly stopped, it can take a while for the brain to adjust and produce the levels of serotonin, dopamine, and other important chemicals that it would normally. Meanwhile, the person may feel numb, down, or have trouble finding pleasure or interest in their daily activities, which can also happen with depression.
Being isolated and secretive makes it more difficult to get sympathy, encouragement, and affection. These types of emotional support can be very important in helping someone manage and cope with mental health symptoms. This may partly explain why loneliness can increase the likelihood of developing depression.
Symptoms of Addiction
A survey of American adults showed that substance use disorder is common, it co-occurs with a variety of mental health disorders and it often goes untreated.
SUDs have a range of psychological, physical and social effects that can greatly reduce a person’s quality of life. An individual may experience a few of these symptoms or many of them. SUD can have a different effect on every individual.
- An inability to stop using
- Abuse of substances continues despite causing health problems
- Individuals may become obsessed with the substance and end up spending more and more time and energy on getting the substance and how they can use it
- Taking risks to acquire the substance and engaging in risky behavior while using it
- Taking a large dose initially
- Cutting back on hobbies and activities that used to be enjoyable
- Secrecy and isolation
- Excess consumption or abuse
- Hidden stashes around the house or car in unlikely places
- Legal issues occur because of impaired judgment and risky behavior
- Financial problems
Which Came First?
If you’re not sure whether the depression happened on its own, known as primary depression or as a result of substance use, known as substance-induced depression, it can often help to think about how and when your depression symptoms appeared.
Primary depression is more likely to:
- Involve a history of depression before beginning substance use
- Appear during a time of stable substance use, or no use
- Continue even after substance use is ended
Substance-induced depression is more likely to:
- First appear after using a new substance
- Appear after using a lot more of the substance or during withdrawal
- Get better when you reduce the amount of the substance or stop using it
How is Dual Diagnosis Treated?
It is important for a person with a dual diagnosis to treat both conditions at the same time. You don’t need to quit using substances before getting help for depression and you don’t need to wait until your depression gets better before getting treatment for SUD. Common treatment includes behavioral therapies and medications.
Medication helps address the physical causes of depression and SUDs. Antidepressants can help even out the neurotransmitters that are involved in depression. They may also help by reducing the symptoms of depression that contribute to the desire to use substances.
Individuals with alcohol or opioid use disorder (OUD) can benefit from medications that can help reduce cravings and withdrawal symptoms. Medications commonly used for AUD include:
Medications for OUD include:
Although it’s possible to take antidepressants at the same time as these medications, some are not recommended together. Guidance by a doctor or psychiatrist is important when taking medications.
Psychotherapy (talk therapy) helps explore the social and emotional roots of your mental health issue. Common approaches include:
- Cognitive behavioral therapy–addresses distorted thought patterns
- Dialectical behavioral therapy–helps you learn to regulate emotional distress
- Group therapy–support and sharing from others in the same situation
- Individual therapy–Delving into deep-seated reasons for substance abuse
In addition, support groups can provide emotional and social support. In support groups, people can share tips about how to deal with daily challenges.
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Where to Find Treatment in New Jersey
You can find the professional medical help you need at Achieve Wellness & Recovery. We can start you on your recovery journey through our partnered supervised detox center. Drug withdrawal can be life-threatening depending on the substance, and severely uncomfortable at best. Many people don’t make it through withdrawal on their own.
In addition, we can provide three levels of care in our center in Northfield, NJ. This includes a dual diagnosis treatment program. Our licensed, professional therapists are experienced in individual, group, and family therapy, because addiction is a family disease that needs to be addressed as a family.
You owe it to yourself and your loved ones to find out how we can help you get your life back on track. Or maybe you have a loved one that needs help. Give us a call today. We are happy to answer your questions and ease your mind. It’s the most important thing you can do today.
Megan began her career working in substance use treatment at an inpatient setting where she found her calling for helping the young adult population. Megan has a Master of Science degree in Clinical Mental Health Counseling from Monmouth University with a specialty in Addiction Studies. She is currently a Licensed Associate Counselor and is awaiting her credentialing to become a Licensed Clinical Alcohol and Drug Counselor. Megan has a history working in the mental health and addiction field utilizing CBT and MI approaches within her clinical practices.