Depression and Addiction By Amina Javed

Approximately 15 to 30 percent of addicts suffer from both addiction and underlying depression. This is sometimes called a dual diagnosis. People who have both depression and addiction often have a repeating pattern of staying sober for a while and then relapsing because they feel awful. There is a strong connection between alcoholism and major depression. In a nationwide study of 43,093 adults age 18 years and over, for those found suffering from a current alcohol addiction, the was evidence that over 20 percent of them also met the criteria for that of a comorbid major depressive disorder. Alcohol is a central nervous system depressant that may initially function as a stimulant, but then quickly intensifies feelings of lethargy, drowsiness, and depression.

Alcohol use, which lowers inhibitions and impairs judgment, also increases the risk of suicide in depressed person. At least half of individuals who attempt suicide have some form of depression, and people with depression are 25 percent more likely than non-depressed individuals to display suicidal behavior. Alcohol and drug abuse can worsen the course of a depressive disorder by vexing the symptoms of depression, increasing the likelihood of hospitalization, and interfering with the course of treatment. Individuals whoare being treated for depression while using drugs or alcohol are unlikely to see positive outcomes from therapy. Substance abuse spoils motivation and decreases the effectiveness of therapeutic interventions. In addition, alcohol or drugs can have dangerous interactions with the medications used to treat depression.

Clinical depression is one of the most common co-occurring conditions found alongside a wide variety of mental health issues, however, depression and addictive disorders are particularly common concurrent diagnoses. This occurs for several reasons:

• Addictive disorders typically sustain multiple negative consequences including loss, relationship problems, decline in job performance and poor self-esteem.
• Addictive disorders cause mood instability and vulnerability to depression.
• Individuals with symptoms of depression may seek relief in the use of substances or other compulsive behaviors involving such mood-altering activities as gambling, sex and eating.

Co-occurring Addiction and DepressionAddiction and depression are closely related for many people and the two conditions interact in various ways. One condition may cause or significantly exacerbate the other. Those with the dual diagnosis of addiction and depression develop the co-occurring conditions in various ways as well. For some, depression came first and for others, addiction was the original illness. Despite how addiction and depression came to co-exist, all individuals with these dual conditions require treatment that will address both simultaneously in order to achieve full recovery.

Addiction as an Attempt to Self-Medicate DepressionIndividuals with depressive symptoms naturally seek relief from their debilitating effects and many will use addictive behavior in an attempt to cope with depressive symptoms. Any depressive illness–whether endogenous or situational –can be worsened and prolonged by the use of addictive behaviors. Typically, a ‘synergy’ of symptoms occurs. Both depressive symptoms and addictive symptoms begin to build and fuel each other when addictive behaviors are used during depression. Momentary relief found in the use of addictive behaviors will, over the long run, exacerbate and prolong a depressive episode. If addictive behaviors are relied upon to relieve symptoms over a prolonged period, eventually the effects of addictive behaviors themselves become a second and equally significant problem.Ingestive addictions (drugs, alcohol and food) as well as process addictions (such as gambling, sex and shopping) can both be used to ‘self-medicate’ the problematic symptoms of depression.

Anxiety, dysphoria and sleep problems are common depressive symptoms individuals attempt to alleviate with addictive behaviors. The inappropriate use of mood-altering behaviors or substances to cope with such symptoms significantly increases the risk for developing an addictive disorder during an episode of depression. This occurs because of a ‘rebound’ effect: addictions are used to ‘medicate’ depression/depression worsens with addiction and more addictive behaviors are used to ‘medicate’ the worsening depression. A ‘vicious cycle’ of dual disorders begins to feed itself until appropriate dual diagnosis treatment breaks that cycle.

Depression as a Reaction to AddictionAny addiction triggers a multitude of negative feelings such as guilt, sadness, shame, hopelessness, helplessness, powerlessness, anger, anxiety and fear. These emotional experiences are very similar to those found in episodes of depression that occur without addiction. Addictions progress in their debilitating effects and begin to erode one’s resiliency and sense of well-being. Additionally, depression builds with the increasing unmanageability of life and the subsequent sense of powerlessness that accompanies addiction. Consequently, many addicted individuals will develop a clinical depression as a direct result of their addiction.

In this type of dual diagnosis experience, both disorders the addictive condition and the depression must be treated at the same time if full recovery is to occur.Unlike ordinary sadness or grief, which occur temporarily after a loss, the symptoms of depression occur nearly every day for weeks sometimes months or years interfering with all aspects of an individual’s life. Depression can increase the risk of chronic illness, including the disease of substance abuse. These chemical intoxicants can become a form of self-medication for soothing the feelings of low self-worth, hopelessness, and despair that characterize this psychiatric illness.Although substance abuse may be used to relieve symptoms, chemical intoxication can actually make depressive episodes more severe, increasing the frequency and intensity of negative thoughts and self-destructive behavior.

It is important to remember that a mood disorder like depression is not the result of bereavement or a personal setback, such as the death of a loved one or loss of a job, but a chronic, progressive illness that may get worse without treatment. People experiencing a depressive episode may have trouble getting out of bed in the morning due to a lack of energy, fatigue, and a loss of motivation. They may lose interest in hobbies or pursuits that they were once passionate about or avoid activities that used to give them pleasure. They may be frequently tearful, talk about harming themselves, or become obsessed with thoughts and images of death.

TreatmentThe treatment of co-occurring depression and addiction requires a dual treatment approach that views both as a primary condition. The most effective approach to treating depression is a program that integrates mental health and recovery services at the same facility, with a staff of professionals who are cross-trained in both fields. Dual diagnosis treatment implements and co-ordinates a plan for relief from symptoms of both disorders.

The overall goal of such treatment is to resolve both the depressive illness and the addictive disorder so that a successful recovery from both occurs. Individuals trained in treating dully diagnosed individuals understand each condition and can create individualized treatment plans to address both simultaneously. Therapies used for each disorder are combined into one manageable and effective treatment plan. Those with co-occurring depression and addiction may use antidepressants, psychotherapy and traditional substance treatment modalities such as education, addiction counseling and self-help groups to create a comprehensive plan for resolving both. Relapse prevention planning for dual disorders involve strategies to keep both acute episodes of addiction and depression from recurring.