Understanding the Link Between Depression and Addiction

You may not be surprised to learn that a significant number of people suffering from depression are also impacted by substance addiction. Mental health conditions and substance use disorders can both heavily disrupt a person’s ability to lead a fulfilling life.

Anxiety and depression can cause significant stress and worry for the loved ones of those affected. Understanding these conditions and knowing where to get support is an important step towards a healthier, happier life.

How Common Is Substance Addiction?

Substance addiction, also called Substance Use Disorder (SUD), is surprisingly common among people experiencing depression. The 2023 National Survey on Drug Use and Health reported that 35% of U.S. adults with a mental health condition also experience SUD. Another study estimated that 1 in 4 people with depression suffer from substance addiction. ^[1][2]

But Why Do So Many People Seem to Be Impacted by These Conditions Together?

Well, it’s not unusual for health conditions to co-occur. This can happen for several reasons, including: ^[3]

• Biological: Problems that affect one body system can often affect other structures. An individual’s genetic makeup can also increase the risk of many linked health conditions.
• Psychological: Although often poorly understood by healthcare professionals, mental health has wide-reaching effects on other aspects of an individual’s health. Actions and behaviors guided by a person’s psychological state have the potential to lead to linked health conditions.
• Social: Wider lifestyle circumstances can increase the risk of developing a variety of health conditions. These factors may increase the likelihood of two or more health problems appearing together.

The relationship between depression and substance abuse is complex and involves biological, psychological, and social factors.

The Cycle of Depression and Addiction

To properly understand how drugs and depression are linked, it can be helpful to see both concerns as a ‘self-feeding’ cycle.

The Cycle of Addiction

The cycle model of addiction is a well-known and heavily researched tool used to understand substance misuse. Using any substance (including alcohol, nicotine, or narcotics) leads to an initial ‘reward’ feeling. However, after a while, this can give way to unwanted effects or negative emotions. This can quickly lead to constant thoughts of needing the substance again to provide relief from these physical or psychological experiences, restarting the cycle of substance abuse. ^[4]

The Cycle of Depression

A similar cycle occurs in depression. Depression can lead to a lack of energy and decreased motivation. This can impact an individual’s ability to undertake normal daily tasks, leading to feelings of guilt or hopelessness about their situation. These negative feelings fuel and worsen the experience of depression. ^[5]

Combining the Cycles

Linking these two cycles together, we can see how each condition can ‘feed’ and worsen the other. People may seek substances to provide temporary relief from depressive feelings. However, the ‘come-down’ only adds to feelings of guilt or hopelessness, leading to a worse experience of depression and driving the need to seek further relief through drugs.

Treatment and recovery must focus on both aspects of these co-occurring conditions to fully ‘break the cycle.’

Symptoms of Co-Occurring Depression and Addiction

As depression and addiction frequently overlap, their complex range of symptoms can be difficult to pin down. Recognizing and understanding the signs of both of these conditions is essential for an accurate diagnosis and effective treatment.

Symptoms of Depression

Recognizing the signs and symptoms of depression is an important first step on the road to a healthier life. The DSM-5 is used by healthcare professionals to accurately diagnose a variety of mental health conditions. Depression is characterized by: ^[6]

• Low mood. This may include feeling sad, empty, hopeless, or tearful.
• Loss of interest in daily activities or loss of pleasure from situations that would usually bring joy.

And at least 3 of the following:

• Significant weight changes.
• Sleep difficulties such as excessive sleepiness and constant tiredness.
• Agitated or lethargic movements.
• Feelings of worthlessness or misplaced guilt.
• Difficulty concentrating.
• Thoughts of suicide.

Symptoms of Addiction

Symptoms of addiction can vary depending on the substance involved. People experiencing substance use disorder have two or more of the following symptoms: ^[7]

• Wanting the substance in larger amounts to use for longer than intended.
• Wishing to cut down or stop but feeling unable to.
• Spending a lot of time seeking and using substances.
• Experiencing cravings.
• Having a negative impact on daily activities such as work or school responsibilities, household tasks, etc.
• Seeing a negative impact on relationships.
• Giving up important activities due to substance use.
• Continuing to use even when it causes physical or psychological harm.
• Continuing to use even when it creates dangerous situations.
• Increasing tolerance to the substance, needing more to produce the same effect.
• Withdrawal symptoms (sweating, shaking, and other physical signs) on stopping use.

Co-Occurring Symptoms

As you may be able to see, there is some overlap in the symptoms of depression and addiction. This is particularly the case when looking at the impact of each condition on the ability of a person to undertake normal daily activities.

This overlap can make accurate diagnosis tricky. Specialists can use assessment tools to prevent misdiagnosis and arrange the correct treatment for both conditions. It is important that both conditions are treated together, focusing on each individual’s unique needs. ^[8]

Risk Factors and Causes of Co-Occurring Depression and Addiction

To better understand the link between depression and addiction, it’s important to be aware of the risk factors and underlying causes of each condition.

Does Depression Cause Substance Abuse?

Well, not exactly.

There are many reasons why someone may develop a substance use disorder. Mental health conditions, like depression, are a major risk factor for addiction. Individuals may try to ‘self-medicate,’ seeking substances to provide temporary relief from negative emotions or psychological experiences.

Low self-esteem and feelings of hopelessness can reduce awareness of the risks associated with prolonged substance use. Mental health conditions can also alter a person’s brain chemistry, enhancing the rewarding effects of drug use and making it more likely for that use to continue.

So, Do Drugs Make You Depressed?

Again, not exactly.

There are many risk factors for developing depression. The ‘come-down’ from substance use can trigger or exacerbate negative emotions associated with depression. The vicious cycle of addiction can bring significant difficulties to a person’s ability to function day-to-day. Often, hopelessness about the situation someone is facing can manifest as depression.

Prolonged substance use can also cause changes in brain function that make it more likely for a person to develop a mental health condition.

Risk Factors for Co-Occurring Depression and Addiction

Substance addiction and depression can run in families. This means that there is a genetic reason behind why some people are more likely to suffer from both of these conditions. There are also several social and environmental factors (such as harmful childhood experiences or poor living conditions) that increase the risk of developing substance misuse or a mental health condition. ^[8]

Treatment Approaches for Co-Occurring Depression and Addiction

For the effective treatment of co-occurring depression and addiction, a comprehensive and integrated treatment plan is required, which may include a combination of psychotherapy, medication, and behavioral interventions. However, it’s also important to understand how each condition is treated individually.

Treating Depression

Successful treatment of depression involves several different approaches. Psychological therapies are commonly used to explore a person’s experience of depression, identify triggers, and develop coping strategies. Cognitive behavioral therapy (CBT) is a widely used approach.

Medication also plays an important role in the treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are one of the most commonly prescribed antidepressants. They work by prolonging the effect of the body’s natural mood-boosting brain signaling molecules. ^[9]

Treating Addiction

The treatment of addiction also involves multiple important therapies. Specialized addiction treatment programs make use of counseling and behavioral therapies to support recovery. These strategies focus on the triggers of substance use and breaking the cycle of addiction.

The role of medication in substance use disorder depends on the drug involved in the addiction. Treatment of opioid (heroin, morphine, etc.) addiction involves the use of ‘replacement’ drugs that lessen cravings and symptoms of withdrawal. Alcohol use disorder is commonly treated with medication that produces unpleasant side effects when alcohol is consumed, discouraging its use. ^[10]

Treating Co-Occurring Depression and Addiction

Effective treatment of co-occurring depression and addiction must involve strategies that address both conditions, often through integrated care models. Behavioral therapies that seek to address the root cause of these issues can be highly effective in promoting long-term recovery and well-being. Physicians will take great care to ensure that prescribed medication is suitable for use in both conditions and, where possible, will choose medication that has beneficial effects for both depression and substance use disorder. ^[8]

How to Help Someone Struggling with Depression and Addiction

Supporting a loved one struggling with depression and addiction can be emotionally draining and overwhelming. However, there are things you can do to support them and help them overcome their challenges.

Supporting Loved Ones

Depression and substance misuse can be scary, isolating experiences. Symptoms of both conditions often cause significant problems with work, family life, education, and socializing. Individuals may struggle to leave the house, take care of themselves, or hold down a stable job.

For the loved ones of an affected person, seeing these struggles can be frightening and difficult to understand. Families often feel helpless when these problems persist despite offering their love and support.

It’s important to recognize that both of these conditions are serious medical disorders. People affected aren’t able to just ‘snap out of it.’ As such, one of the best ways of supporting someone is to acknowledge their struggles, understand the impact it is having on them, and verbalize that support throughout the recovery process.

Getting Support

No one has to go through drug addiction or mental health difficulties alone, and that includes the families of those affected. Recovery involves specialist treatment and support. No one is expected to have the expert knowledge needed to face this alone.

Reaching out to support organizations and programs can make a difference in being able to help someone in need. However, loved ones are often worried about how to bring up the need for support, especially if those affected have been resistant to treatment before. Such organizations can provide information and resources on how to approach these conversations, as well as provide advice on other ways of supporting those suffering from substance misuse and depression.^[11]

Support Organizations

• National Suicide Prevention Lifeline
• National Institute of Mental Health
• Dual Recovery Anonymous
• Substance Abuse and Mental Health Services Administration

How to Prevent Relapses into Depression and Addiction

Substance use disorder and depression can appear throughout a person’s life. One of the main concerns for those affected, as well as their loved ones, is preventing relapse. As such, it’s important to be aware of how to address these challenges if they begin to appear again.

Professional support and accredited treatment programs should play an important part in preventing relapses during the recovery process. This generally involves the following concepts:^[12]

• Awareness that depression and substance misuse can be lifelong difficulties.
• Identification of triggers that may lead to the conditions re-emerging. This may include life instability (for example, loss of housing or job) or emotional turmoil (such as a death in the family).
• Creation of a safety plan. This will include strategies and ways to access support when facing triggers that are likely to bring on a relapse.
• Development of a supportive social network. This may include organized recovery groups.
• Ongoing medication or behavioral therapy support.

The goal is to be able to work through these concerns, lead a fulfilling life, and overcome the burdens of depression and substance misuse. Exactly what recovery looks like is unique to each individual.

Summary

Co-occurring depression and addiction can be highly impactful. Each condition has the potential to worsen the experience of the other. However, they can be successfully treated with the appropriate expert help and support. People living with these mental health concerns have the potential to live a productive, happy life if they seek proper assistance in the right places.