Addiction and Depression: The Vicious Cycle

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Addiction and depression often go hand in hand, but which came first is not always clear. In some cases, drugs or alcohol are turned to for relief from the mental pain of depression. In others, depression develops as a result of the emotional and physical damage done by addiction.

What is clear is this: When substance use co-occurs with mental illnesses such as depression, the issues can feed off each other, causing negative effects to multiply. And if one disorder is treated without the other, recovery becomes much less likely.

The Need for Integrated Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates close to 9 million adults have co-occurring mental health and substance use disorders, but only about 7 percent get help for both conditions. Many more, close to 60 percent, get no treatment at all. Among adolescents, studies note that between 55-74 percent of those who seek treatment for addictions also have mental health issues such as depression or trauma, but these are rarely factored in.

Without comprehensive treatment, there’s a much greater probability of negative outcomes such as poor physical health, the development of other mental health problems, a shorter lifespan, homelessness and incarceration.

Suicide also becomes a much more likely hazard. Those who use substances are already at greater risk of taking their own life. In fact, those with alcohol issues are at 10 times greater risk of suicide than the general public, and the figure climbs to 14 times greater risk for those who inject drugs. When substance use is combined with depression, a leading cause of suicide, the risk of self-inflicted death grows exponentially.

Even when the needed treatment help is forthcoming, those with co-occurring disorders face extra struggles. Alcohol and drugs can get in the way of mental health treatment, and depression is a key predictor of relapse back to substance use. And there is another complication: Those struggling with addiction are often unaware they are also dealing with depression. Addiction can take center stage and come to seem like the main problem when in actuality it’s often a symptom of underlying depression. A person whose life is crumbling around him because of his alcohol use, for example, may naturally assume his drinking is causing his low mood rather than recognizing that his low mood may have sparked his drinking. Treating only the addiction would, in essence, miss a crucial part of the puzzle.

Integrated treatment that aims to identify and heal the depression and the addiction simultaneously is not only associated with better outcomes but with lower overall costs to the person and to the community, SAMHSA notes. The public health group, which is one of many urging greater adoption and availability of integrated treatment, offers a series of informational kits to help states, communities and organizations establish their own evidence-based programs.

Catching problems early on is also key. Because depression makes a person more vulnerable to developing addiction and vice versa, treating each issue as soon as it appears can help prevent one problem from turning into two. Research has found, for example, that adolescents treated for their depression are much less likely to abuse drugs later in life.

Treatment Approaches

Because of the complexity of a dual diagnosis of addiction and depression, there is no single right way to treat it; but, there are strategies shown to be helpful. Medication such as naltrexone and acamprosate, for example, can block the high of some drugs and reduce cravings. Antidepressants such as Prozac, Zoloft, Paxil and Wellbutrin, to name just a few, can help regulate brain circuits that affect mood. Such drugs sometimes come with side effects, however, so weigh benefits against risks with your health care provider.

Medications are especially effective when used in conjunction with individual and family therapy, and with psychotherapies such as cognitive behavioral therapy (CBT), which teaches healthier patterns of thinking. Recent research gives biological proof of CBT’s effectiveness, showing it can change blood markers linked to depression in some. Mindfulness therapy is another popular treatment technique; research has shown it can be just as effective as CBT for depression.

Depending on the severity of the addiction and mental health issues, help can be found through a variety of sources: inpatient and outpatient rehabilitation, individual care from a counselor, therapist or psychiatrist, and mutual support groups such as SMART Recovery or Alcoholics Anonymous. No matter where you turn for help, however, look for those who understand the complexity of co-occurring issues and are prepared to help you tackle both. In that way, the cycle can begin to reverse. Instead of your depression and addiction making each other worse, they can begin to make each other better.

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