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People with depression may turn to drugs or alcohol to medicate their pain.


Mood disorders like depression and substance abuse go together so frequently that doctors have coined a term for it: dual diagnosis. People who have suffered recent episodes of major depression have higher rates of alcoholism and drug addiction compared with the rest of the population, according to the U.S. Department of Health and Human Services. More than 21 percent of adults who experienced a depressive episode within the previous year engaged in substance abuse, compared with 8 percent of those not dealing with depression.

But it isn’t always clear which one came first. Depression can cause substance abuse, but substance abuse also can lead to depression. In some cases, both are triggered by some external factor.

Depression and Substance Abuse: What’s the Connection?

A person dealing with depression might try to self-medicate using drugs or alcohol, says David MacIsaac, PhD, a licensed psychologist in New York and New Jersey and faculty member of the New York Institute for Psychoanalytic Self Psychology.

Depression often leads people to drink, which usually makes things worse. “In trying to self-medicate with alcohol, people don’t realize they’re using a depressant,” says Dr. MacIsaac. “In point of fact, it will intensify their depression.” The same goes for drugs, which some depressed people take to alleviate their symptoms. MacIsaac says they misidentify their depression as just some sort of down feeling and get in the habit of taking uppers.

Conversely, an addict or alcoholic whose substance abuse problem is out of control can develop mental problems. He might experience symptoms of depression or begin to hallucinate. If his depression deepens, he might try to commit suicide.

Depression and Substance Abuse: Shared Triggers

Depression and substance abuse can spring from the same sources. Research has found a number of connections between depression and substance abuse, including:

  • Shared brain regions affected by both substance abuse and depression. For example, substance abuse affects the brain areas that handle stress responses, and those same areas are known to be affected by some mental disorders.
  • Genetic factors can make a person more likely to develop a mental disorder or addiction. Genetic factors make it more likely that one condition will occur once the other has appeared — for example, alcoholism sparked by a bout of depression.
  • Environmental factors such as stress or trauma are known to prompt both depression and substance abuse.
  • Brain developmental issues that can lead a child to depression or substance abuse later in life. Early drug use is known to harm brain development and make later mental illness more likely. The reverse also is true: Early mental health problems can increase the chances of later drug or alcohol abuse.

Depression and Substance Abuse: Simultaneous Treatment

Both depression and substance abuse should be treated for the patient to have a good chance at recovery. If a patient only treats one condition, he’s less likely to get well unless he follows up with treatment for the other.

Treatment for current drug or alcohol users must begin with detoxification, or detox. Detox allows a person to manage withdrawal symptoms, while the body works to remove all traces of the drug or alcohol in its system. Users must kick their habit before the serious work of recovery can begin. “Most of the time, it’s very difficult to treat depression if [individuals are] addicted to a drug,” MacIsaac says. “You might treat them, but they’re really not going to be able to deal with the depression if they’re addicted.” He says that until they are free of these substances, they only can confront psychological issues on a superficial level because the drugs and the alcohol are masking the condition.

After detox, patients will then begin dual treatment. They enter a rehabilitation program to deal with their drug or alcohol problems. They also will need to receive concurrent treatment for their depression. This treatment could involve therapy, antidepressants, and interaction with a support group. Some recovery groups do not support prescribing medication because they believe it challenges recovering addicts’ sobriety — however, dual diagnosis treatment, including antidepressants, is meant to manage symptoms in order to provide stability and regulate brain chemicals.

“At that point, recovery all depends on the motivation of the patient, and the degree to which they want to work out their problems,” MacIsaac says. If you or someone you know is dealing with depression and substance abuse, be sure to get help to deal with both issues — only then will you begin the journey to successful recovery.

By Dennis Thompson Jr.

Medically reviewed by Christine Wilmsen Craig, MD
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