A Dysfunctional Relationship: Why Depression and Substance Use Often Go Together

It’s truly a chicken-or-the-egg question:

Do people abuse alcohol and other substances because they’re depressed, or do the effects of substance abuse make people depressed?

It’s been known for years a link between mental health and substance use exists. The National Bureau of Economic Research estimates people with an existing mental illness tend to be active consumers of substances, consuming 38% of alcohol and 44% of cocaine in the US each year.

Meanwhile, SAMHSA’s (Substance Abuse and Mental Health Services Administration) most recent National Survey on Drug Use and Health found 9.5 million Americans had both a mental and a substance use disorder. Known as dual diagnosis, the combination is estimated to affect nearly 8 million Americans ... and according to the National Institute on Drug Abuse, over half of Americans never get help for it.

One of the most frequent mood disorders, depression affects just over 17 million Americans each year, says the Anxiety & Depression Association of America (ADAA). Occurring more often in women than men, the disorder interferes with sleep, eating habits and even activities the patient enjoys.

Depression seems to have a particular link with substance abuse.

Studies Show Potential Connections With Alcohol Use & Depression

Researchers call the link between depression and substance abuse “bi-directional,” meaning substance use appears to be more common in depressed people … and depressed people are more likely to use substances.

It’s a hard call to make. Many of the more noticeable symptoms of depression – slow speech, lethargy, mood changes – mirror the effects of substance use, or when the effects of a given substance wear off. Some depressants, like alcohol, can make the symptoms of depression even worse.

And yet, there’s a connection. In 2012, researchers found nearly 64% of their alcohol-dependent subjects also identified as depressed. An earlier study from New Zealand established alcohol use disorders increased a person’s chances of being depressed as well.

The connection holds true for children. While alcohol’s role in fetal alcohol syndrome (FAS) is well-known; research has also shown children born with FAS are more likely to become depressed later in their lives. Finally, multiple studies have found connections between adolescent alcohol use, self-harm, and suicide.

While there’s yet to be concrete evidence of a relationship between substance use and depression, the two occur with each other so often they’re a familiar combination in the treatment industry. When substance use occurs along with a mental disorder like depression, the result is a dual diagnosis. Although treatable, the conditions are much more dangerous when they’re allowed to play off each other without treatment.

Something else to be mindful of: Antidepressants and alcohol are a dangerous mix. Although safe to use on their own, many medications used to treat depression can have dangerous and unpredictable side effects when combined with alcohol (or other drugs). The Mayo Clinic says the dangers include:

• Increased feelings of depression

• Greater impairment of judgement and reflexes

• Increased blood pressure if you’re combining alcohol with a monoamine oxidase inhibitor (MAOI) like Azlect, Marplan or Parnate

Types of Depressive Disorders

More than a simple bad mood, the word “depression” describes a range of mood disorders marked by social withdrawal, difficulty with thinking and changes in sleeping, eating, and work habits. The National Institute of Mental Health outlines several different types of depressive disorder:

• Persistent Depressive Disorder: A depressive mood which lasts for at least two years, this type of depression has symptoms which can vary in severity.

• Postpartum Depression: One of the most serious and severe of all types of depression, this form affects women during and after their pregnancies. Far different from the so-called “baby blues,” postpartum depression can interfere with a mother’s bonding with her child, extreme anxiety and more.

• Psychotic Depression: This form of depression combines severe depression with delusions and/or hallucinations.

• Seasonal Affective Disorder: For some people, the reduction of sunlight during winter months can cause severe depression.

An additional disorder, bipolar disorder, is often included on lists of depressive disorders, but that’s a mistake. Although bipolar disorder’s well-known mood swings include both manic and depressive phases, it’s really not an exclusively depressive disorder.

How Do I Know If I Have Depression?

Because its symptoms can vary widely, both in type and severity, depression isn’t always easy to diagnose, especially by the patient. In general, depression isn’t diagnosed until the patient reports their symptoms as persisting for a period of time.

Typically, medical professionals will ask patients a series of questions about their moods and how long they’ve had them. This is in addition to conducting an examination to see if there aren’t any other causes. The many symptoms of depression can include:

• A lack of interest in activities previously enjoyed

• Changes in diet and/or weight

• Increased irritability

• Feelings of guilt, helplessness and/or worthlessness

• Problems with sleeping

• Thoughts of suicide

As for substance use, determining when an attempt to treat depressive symptoms becomes a problem on its own isn’t easy, either (although self-medication – which is what this example is – is a red flag all its own).

Fortunately, depression and dual diagnosis both respond to treatment. Great drug and alcohol addiction treatment doesn’t just focus on one or the other; it recognizes both disorders feed off each other, trapping the patient in a maze of harmful behaviors. Instead, the ideal treatment partner takes a holistic view of the patient, examining both addiction and the disordered thinking which may be driving it.

The Forge Recovery Center’s evidence-based approach makes genuine differences in the lives of our patients every day. Our Southern California drug & alcohol treatment center offers flexible schedules and a variety of plans to ensure everyone gets the treatment they need.

Don’t wait; find relief from mood disorders and substance use today. Call an expert now!

Written by

Brian Moore

Content Writer

Reviewed by

Jeremy Arzt

Chief Clinical Officer

April 18, 2022