Reviewed By: Barbara Rexer, DSW, LCSW, LCADC, CCS, ICCS, DRCC
For many people with a substance use disorder (SUD), feelings of anxiety and depression are a familiar part of the struggle. Here's how addiction and mental health disorders are linked, and why one often fuels the other.
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According to the National Institute on Drug Abuse (NIDA), about 50% of people who develop an SUD will experience mental health issues at some point in their lives. Likewise, 50% of people who start with a mental health issue will go on to develop a substance abuse disorder. But what’s the link between depression and addiction?
When a person experiences a mental health issue alongside substance abuse, it is called a co-occurring disorder. The 2016 National Survey on Drug Use and Health (NSDUH) reports that 8.2 million Americans suffer from co-occurring mental health and substance abuse disorders, or about 3.4% of the population. A 2017 report published in the Journal of the American Medical Association offers a deeper look:
- 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness
- Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs
For those who suffer, it’s often difficult to tell which comes first: addiction or mental health issues. Research suggests that substance abuse and mental health disorders are, in fact, part of a vicious cycle. The presence of one issue increases the risk of developing the other.
A mental health disorder, for example, can triple one’s risk of developing a substance abuse disorder, according to the Anxiety and Depression Association of America (AADA). In turn, NIDA reports that long-term drug use can change the brain in ways that lead to a host of mental health issues, including depression and anxiety.
To understand how the cycle of addiction and depression can begin, it helps to understand how depression works.
What is Depression?
Clinical depression, also called major depressive disorder (MDD), is a diagnosable condition characterized by low or depressed mood for most of the day, nearly every day, for at least two weeks. Affecting about 14.8 million people, or 6.7% of the population, MDD is the most common mental health issue in the United States. Symptoms include:
- Feelings of hopelessness
- Persistent sadness and/or feelings of emptiness
- Anger and irritability
- Guilt or feelings of helplessness and worthlessness
- Loss of interest and enjoyment in usual activities and hobbies
- Decreased energy
- Insomnia or hypersomnia (sleeping more than usual)
- Difficulty concentrating and paying attention
- Restlessness and/or difficulty sitting still
- Major increase or decrease in appetite and/or weight changes
- Increased body aches, pains, or soreness without a clear medical cause
People with depression may also experience low levels of the neurotransmitters serotonin and dopamine. Serotonin regulates sleep, appetite and mood. Dopamine, which is part of the brain’s reward center, affects mood, motivation and emotional response.
Can Substance Abuse Cause Depression?
Although mental health issues exist separately from substance abuse, long-term drug use can lead to feelings of depression, anxiety and paranoia. Many drugs, including alcohol, interfere with the brain’s dopamine production. Drugs like cannabis and heroin mimic dopamine, tricking the brain into thinking it has more dopamine than it does. Stimulants like cocaine and amphetamines excite the brain into producing more dopamine than it needs at a given time. In both of these scenarios, the dopamine “overdrive” triggered by drugs signals the brain to stop producing more. As the brain becomes less able to naturally produce dopamine, it becomes increasingly dependent on drugs to counteract the feelings of depression and anxiety that result from low dopamine.
This partly explains tolerance, or the need for higher and higher doses to achieve the same effect. Each time the brain gets an artificial dopamine boost, it receives a signal to produce less — driving a need for drugs to fill the void.
An important part of the detox process is restoring the brain’s ability to naturally produce dopamine. When balance is restored, feelings of depression and anxiety that resulted from drug use are often reduced. People who have co-occurring clinical depression will still need separate, dedicated mental health treatment to address any chemical imbalances that are likely to persist after recovering from addiction.
Treating Co-Occurring Disorders
When a mental health problem goes untreated, the associated substance abuse problem usually gets worse. Likewise, when alcohol or drug abuse increases, mental health problems usually worsen as well. It is therefore important to acknowledge both issues when you seek addiction treatment. Choosing a facility that is certified to treat co-occurring disorders is one way to make sure you receive treatment that addresses both issues. Since no two people experience addiction or mental health issues in the same way, it’s also important to find a treatment center that offers individualized care. Personalization is a major therapeutic element in the diagnosis and treatment of co-occurring disorders.
Understanding the need to treat substance abuse and mental health issues separately is another important consideration. This often means ongoing mental health treatment after detox. One well-established, highly effective, and lasting treatment for depression is cognitive-behavioral therapy, or CBT. The cognitive model focuses on identifying harmful thought patterns so clients can develop a healthier mental narrative. Some mental health disorders may also require medication through psychiatric treatment. The most effective treatment will vary based on an individual’s medical history, substance abuse history, support system and overall physical and mental health.
Beyond Treatment: The Importance of Aftercare
For most people, an addiction treatment program is just the first step toward recovery. Aftercare is an important part of making the transition into everyday life. Although this phase may differ from person to person, the best aftercare programs will offer comprehensive services that address a number of factors, including:
- Housing and transportation
- Legal involvement
- Medical status including HIV/AIDS testing and treatment
- Mental health
Aftercare is particularly important for individuals with co-occurring disorders because of the stress that a mental health disorder can add to recovery. Establishing a new routine, new habits and even new social behaviors after addiction treatment is difficult enough without depression. A thoughtful approach to aftercare can make the transition feel less jarring.
As Sprout, individualized care is a cornerstone of the treatment we offer. Our clinicians look at each client from a global perspective. Through our personal assessment, we seek to know: What is your medical history? What is your substance abuse and treatment history? What is the state of your current health? Who is in your support system? What are your goals for treatment? All of these questions create a viable, living medical and psychological history, and ultimately, a customized, personal treatment plan in which you are an active participant.Have questions about addiction?
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Written By: Susan Kime, MA, PCP, NCC
Susan Kime, MA, PCP, NCC, is a certified counselor who has worked directly in the fields of addiction recovery and mental health. A professional health & wellness writer, she has written for myriad publications about the intersection of mental health, wellness, and lifestyle.