Depression and substance use disorders are each a serious mental health condition on their own. When combined as comorbid disorders, or a dual diagnosis, depression and addiction can become downright dangerous. It is often difficult to pinpoint which condition emerged first. This is because the two disorders become entangled making it difficult to know which condition caused the other.
In some instances, the individual may use drugs or alcohol to self-medicate the unpleasant symptoms of undiagnosed depression, subsequently developing a dependency on the substance. When someone is struggling with persistent feelings of sadness and despair, it isn’t surprising that they may lean on drugs or alcohol in an attempt to lift their mood or soften the pain of depression. Unfortunately, abusing alcohol or drugs can swiftly escalate a depressive disorder by fanning the symptoms and increasing the likelihood of suicidal ideation.
In other cases, the individual may already be struggling with a substance use disorder and acquire the mental illness as a result of abusing the drug. As problems mount due to the consequences of addiction, depression can result. In these instances, depression arrives as a result of drug or alcohol addiction, not the cause of it. Whatever the cause or the order the disorders emerged, locating help for the dual diagnosis is an important first step toward recovery, although the co-occurring disorders creatse a steeper treatment hurdle to clear.
When the symptoms of depression begin to cause major impairment in daily functioning and persist for more than two weeks, you may indeed be experiencing a clinical depressive episode. According to the DSM-5, when a cluster of five or more of the following symptoms occurs, this is indicative of major depressive disorder (MDD). The symptoms of depression include:
- Feelings of sadness and despair persisting most of the time
- Extreme fatigue
- Slowed motor and cognitive functioning
- Sleep dysfunction, either hypersomnia or insomnia
- Sudden weight loss or gain
- Loss of interest in hobbies or activities once enjoyed
- Inappropriate feelings of guilt or shame
- Difficulty in concentrating or making decisions
- Obsessive thoughts of death or suicide
A mental health professional can first evaluate health status to rule out a medical condition that might be causing the depression symptoms. If no such condition is identified, the doctor will refer the individual to a mental health professional.
Depression and Substance Use Disorder as Co-Occurring Conditions
While understandable that an individual who is suffering from depression might turn to alcohol or drugs in an effort to mask the emotional pain, this remedy can soon turn against them. As tolerance for the drug increases, so does frequency of use and dosage, often resulting in addiction or chemical dependence. Many people are caught up in this vicious cycle and will need help for treating both the depression and the addiction.
In the event the depression emerged first, exploring the root issues that might have contributed to the depression is key to achieving a successful recovery. In addition to the factors can cause depression, including genetics, biology, and personality traits—things outside one’s control—feelings of despair and sorrow may be directly related to environmental factors. These might include unresolved childhood trauma, the death of a loved one, a job loss, or other life altering events.
The Connection Between Depression and Alcoholism
Although depression can be linked with any substance of abuse, there is a particularly common connection between depression and alcohol use disorders. About 20% of adults with alcoholism also suffer from clinical depression, according to an article on the subject in the Psychiatric Times. A similar article from the National Institute on Alcohol Addiction and Abuse explains that it is common for individuals to develop depression because heavy alcohol abuse directly impacts brain function and alters the neurotransmitters.
People who have co-occurring depression and alcoholism have an increased risk of suicide. In fact, according to the Substance Abuse and Mental Health Services Administration, nearly one third of all suicides involved individuals who had blood alcohol limits at or above the legal limit. In addition, half of those who committed suicide had a history of depression when they died. Alcohol addiction puts an individual at a ten-fold higher risk for suicide as compared to the general population. According to a study published in the International Journal of Environmental Research and Public Health, among alcoholics, the lifetime risk of suicide is 10%-15%, and that depression and alcoholism were comorbid in 85% of 100 cases of completed suicide.
Characteristics of Alcoholism and Coexisting Depression
Dual diagnosis is a complex and highly prevalent condition that impacts about one quarter of those with a substance use disorder, according to the Substance Abuse and Mental Health Services Administration. Of those, the most common is the dual diagnosis of alcohol and depression.
The fallout for this dual diagnosis can be exceptional. Struggling with both depression and alcohol dependency can result in a long list of negative consequences. This can be due to the increased impulsivity of the alcoholic, a higher propensity for engaging in risk-taking behaviors, and neglecting work and family obligations.
Consequences of the dual diagnosis of alcoholism and depression includes:
- Divorce or interpersonal relationship issues
- Loss of custody of children
- Loss of a job
- Failing school
- Financial consequences due to job loss or legal fees
- Legal problems, such as getting a DUI
- Health problems, such as liver disease, pancreatitis, heart disease, cancer
- Accidents that result in injury to self or others, or damaged property
An article published in Psychology Today estimates that for individuals who are being treated for depression, almost 40% will also struggle with an alcohol use disorder at some point in their life.
How to Treat Depression and Substance Use Disorder
When someone with a dual diagnosis initiates treatment there is often a need to undergo a medically monitored detox program first. Detox can take one to four-week depending of the substance of abuse. In most cases, alcohol detox is completed in 5-7 days, where opiate detox may take two weeks, and benzodiazepine detox can take 2-4 weeks. During the detox process the individual will be closely observed, allowing the detox professionals to quickly intervene should withdrawal symptoms become intensified. Various medical interventions are provided that will substantially reduce the discomforts associated with the detox process. Following detox, the individual will transition to the addiction recovery program.
There is ample evidence that dual diagnosis treatment should involve both disorders being addressed simultaneously once detoxification is completed. This will require a treatment program that specializes in dual diagnosis programming, which requires psychiatric expertise on staff. Managing the recovery of someone with a dual diagnosis takes special training, as unpredictable issues may arise during treatment.
Depression and Substance Use Disorder Treatment Elements
To successfully treat both disorders, a comprehensive dual diagnosis program that addresses the mental illness and the addiction is warranted. Prior to beginning recovery, drugs or alcohol were used to soothe the symptoms of depression. Once sober the individual may find it very difficult to manage stress and emotions without the numbing properties of the substance. These challenges elevate the difficulty of treating a dual diagnosis, finding that perfect balance between medication for the mental illness, an effective mode of psychotherapy, peer support, and any adjunct therapies that will treat the combined aspects of both conditions.
Treatment elements include:
In rehab the depression piece of the diagnosis will likely be treated with antidepressants. Antidepressant drug therapy takes 4-6 weeks for noticeable changes to emerge, so it requires patience. Additionally, it may take multiple attempts to get the medication and dosing just right. There are potential side effects from the medication, which the psychiatrist will explain to the individual.
Meanwhile, the psychotherapy sessions will allow the therapist to guide the individual toward examining and processing any underlying emotional issues that might be contributing to both the depression and the addiction. Cognitive behavioral therapy is helpful in changing the distorted thought patterns and reflexive self-destructive behaviors that have fueled the addiction and/or the depression.
Forming intimate groups where peers can openly share about their personal recovery experiences can be a good source of social support. The therapist leads the discussions by introducing topics and encouraging participation.
The 12-step program from Alcoholics Anonymous is an important source of support for addiction recovery. The meetings are usually integrated into the outpatient programming, and participation is encouraged following completion of rehab as well.
MEDICATION ASSISTED TREATMENT (MAT)
Some individuals may benefit from the assistance of certain medications that can support recovery, such as naltrexone or buprenorphine. In many cases, these drugs can enable individuals the ability to live normal, fulfilling lives as long as they also continue to participate in 12-step meetings and individual and group outpatient counseling.
Dual diagnosis programs that incorporate holistic and experiential treatment elements compliment the psychotherapy by encouraging self-exploration, stress reduction, and relaxation. These types of activities might include aromatherapy, mindfulness meditation, yoga, art therapy, or journaling. With professional dual diagnosis intervention, addiction and depression can be overcome. An integrated approach can help the individual battling the dual diagnosis learn how to manage stress with new coping tools learned in therapy, and relaxation techniques learned through holistic therapies.
Phoenix Rising Behavioral Healthcare Leading Dual Diagnosis Outpatient Center Orange County
Phoenix Rising Behavioral is an intensive outpatient program providing a diverse menu of addiction recovery services in Orange County California. Our dedicated team of professionals will guide you or a loved one out of the grip of substance use or addition and toward a fulfilling new life in recovery. Phoenix Rising Behavioral offers evening therapy sessions for increased scheduling flexibility, and offers resources for sober living housing as well. For more information about the program, please connect with our team today at (877) 299-5694.