Depression is a complex and potentially devastating mental health disorder. As a result, some people use drugs and alcohol in an attempt to numb the distressing symptoms that accompany the mental health disorder or to otherwise self-medicate its negative effects. Research examining the complications and potential dangers of these often-co-occurring phenomena has revealed some warning signs to look for and has further provided evidence that supports targeted treatment interventions to effectively address both conditions.
What Does Depression Look Like?
Depression is a mood disorder that can present on a continuum from mild to severe. Unlike normal mood fluctuations and emotional responses, depression can create tremendous suffering, lead to impairment in many areas of functioning, and be a contributing factor in suicide. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), depressive disorders include:1
- Major Depressive Disorder.
- Disruptive Mood Dysregulation Disorder.
- Persistent Depressive Disorder (formerly known as Dysthymia).
- Premenstrual Dysphoric Disorder.
- Substance/Medication-Induced Depressive Disorder.
- Unspecified Depressive Disorder.
While the severity, intensity, and frequency of symptoms varies by person and by specific diagnosis, most depression includes a persistent low mood, lack of energy, and lack of pleasure in day-to-day activities.
Additional symptoms of depression may include:1,2
- Persistent feelings of sadness or emptiness.
- Feelings of hopelessness.
- Feelings of guilt or worthlessness.
- Difficulty concentrating and paying attention.
- Difficulty sleeping (early waking, sleeping more than usual, insomnia).
- Increased or decreased appetite; weight changes.
- Increased body aches and pains.
- Suicidal thoughts or attempts.
The World Health Organization estimates that more than 300 million people struggle with depression across the globe; about 7% of the US population currently meets the criteria for a diagnosis.2,3 While depressive episodes can occur at any age, the onset typically occurs between puberty and the late 20s.1 Research suggests that a combination of genetic, biological, environmental, and psychological factors can lead to the disorder—no single cause has been identified.2
Given the possible symptoms someone with depression may experience—and the associated distress they often bring—it may not be surprising to learn that many people with this mental health disorder use drugs and alcohol to self-medicate or “numb out.” In fact, a recent, large-scale study of more than 40,000 subjects found that as many as 1/4 of people with depression tried to alleviate negative symptoms with drugs or alcohol.They also found that depressed men were twice as likely as depressed women to self-medicate.4 Another study, with more than 2,000 depressed patients, highlighted a correlation between those who reported depression and those who also reported opioid abuse.5
When someone with depression self-medicates with drugs or alcohol, they may exhibit certain signs, including:
- Isolating from family and friends and social events: suddenly changing the hobbies they engage in or the acquaintances they spend time with.
- Becoming more secretive about how they spend their time.
- Letting their physical care decline: not showering or eating.
- Becoming more reactive, suddenly lashing out in anger.
- Showing difficulties in other areas of functioning, such as school or work performance.
- Having new, unexpected, or uncharacteristic financial problems due to the cost of some drugs and alcohol.
While depression impacts each person differently, the risk of addiction problems should always be taken into consideration.
When Does Substance Abuse Become a Bigger Problem?
In a nutshell, the difference between normal use and problematic substance use lies in the clinical, behavioral, and functional impairment the user experiences due to drug use. A person with a substance use disorder (SUD) may experience impaired control and continue to use drugs in risky ways despite knowing the consequences (e.g., legal issues, financial distress, interpersonal problems or arguments, and academic or occupational problems).
Mental health professionals and physicians diagnose people with substance problems based on the frequency, intensity, and number of symptoms they exhibit, which may include:1
- Spending a great deal of time using their substance of choice.
- Persistent use despite social, academic, or legal problems.
- The presence of withdrawal symptoms when abstaining or reducing use.
- An increased tolerance or using larger amounts than intended.
- Strong cravings and desires to use.
- Using substances in physically hazardous situations.
- An inability to stop using despite attempting to do so.
A co-occurring disorder is present when a person has both a mental illness and a substance use disorder. The Substance Abuse and Mental Health Service Administration (SAMHSA) estimates that nearly 8 million people have them.6 To put this into perspective, the lifetime prevalence for any non-SUD mental health disorder hovers around 22.5%, and the lifetime prevalence of an alcohol use disorder is 13.5%.7
But for those with a mood disorder, such as depression, 32% of them also meet the criteria for a substance use disorder. For people with lifelong major depression, 16.5% had an alcohol use disorder and 18% had a non-alcohol SUD.7 So, while it is difficult to decipher if depression “causes” substance use or vice versa, these statistics show a strong correlation between these two disorders.
Treating Both Disorders
To treat co-occurring disorders, SAMHSA recommends an integrative approach, addressing both the substance abuse and the mental health components simultaneously.8
Typical treatment goals may include:9
- Abstaining or reducing substance use.
- Improving behavioral functioning.
- Decreasing suicidal ideation.
There are also several evidence-based dual diagnosis treatment options for people struggling with depression and substance use:9
- Medication. Some people take antidepressants to treat their depression, depending on the severity of their symptoms. Medications are also frequently used for treating substance use disorders since they have shown to help reduce cravings and the discomfort associated with withdrawal symptoms.
- Cognitive Behavioral Therapy (CBT). This mode of psychotherapy helps people find solutions to their problems by identifying the thoughts and feelings associated with behavioral patterns and replacing negative ones with positive ones.
- Motivational Enhancement Therapy (MET). This mode of psychotherapy facilitates internally motivated change by focusing on the client’s internal resources and strengths.
- Peer Support Services. People struggling with co-occurring disorders often need pro-social recovery support. Peer support groups and community integration help with socializing and with improving overall health and wellness.
In addition to evidence-based, professional treatment, it can help to focus on positive lifestyle changes to help sustain long-term recovery. The following suggestions may help for those struggling with mood disorders or substance use disorders:
- Exercising regularly/engaging in physical activity
- Spending time with loved ones
- Avoiding isolation
- Delaying impulsive and important decisions until feeling better
- Receiving psychoeducation about depression
- Practicing realistic goal-setting
There are many resources and tools for people seeking to recover from depression and substance abuse, including:
- American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Substance Abuse and Mental Health Services Administration. (2017). Depression.
- World Health Organization. (2017). Depression.
- Bolton, J., Robinson, J., & Sareen, J. (2009). Self-Medication of Mood Disorders with Alcohol and Drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Affective Disorders, 115(3), 367–75.
- Goseling, J., Henry, M., Moser, S., Rastogi, M., Hassett A., Clauw, D., Brummet, C. (2015). Symptoms of Depression Are Associated With Opioid Use Regardless of Pain Severity and Physical Functioning Among Treatment-Seeking Patients with Chronic Pain. Journal of Pain, 16(9), 844–851.
- Substance Abuse and Mental Health Services Administration. (2017). Mental and Substance Use Disorders.
- Quello, S., Brady, K., & Sonne, S. (2005). Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Science Practitioners Perspective, 3(1).
- Substance Abuse and Mental Health Services Administration. (2009). The Evidence-Integrated Treatment for Co-Occurring Disorders.
- Substance Abuse and Mental Health Services Administration. (2017). Behavioral Health Treatments and Services.