Addiction and Depression
Many people suffering from drug or alcohol dependency have co-occurring mental health conditions, and the links between addiction and depression are especially strong. Many depression sufferers turn to drugs and alcohol to help them cope with depression’s devastating symptoms, which unfortunately leads to addiction in far too many instances. Recovery from addiction and depression is possible, however, with an unshakable commitment to change and a diligent approach to treatment.
What Is Addiction and Depression?
As a condition that affects more than 16 million adults, major depression (or major depressive disorder) is the most commonly diagnosed mental health disorder in the United States. Depression is the leading cause of disability among those in the 18-44 age group, as those with the strongest forms of the disorder have difficulty managing their daily affairs or completing even the simplest of tasks.
Men and women who suffer from high-functioning depression seem to live relatively normal lives despite their feelings of emptiness and struggles with low motivation. But like people with severe depression, they can benefit tremendously from treatment, and if they don’t get it they may continue to suffer needlessly for years.
Unfortunately, many people with depression problems choose to self-medicate with drugs and alcohol, and far too often this leads to substance abuse and addiction.
Types of Depression
The different forms of depression include:
- Major depressive disorder. Major depression is a life-altering condition that affects sufferers on a daily basis. It is the most severe and debilitating type of depression, and also the most commonly diagnosed.
- Persistent depressive disorder (dysthymia). Dysthymia is a mild-to-moderate form of depression that manifests as a limited number of depression symptoms experienced persistently for a period of at least two years. Dysthymia can be partially debilitating and has a definite effect on energy levels, motivation, and emotional intensity.
- Seasonal affective disorder. This type of depression produces similar symptoms as major depression, but only during the wintertime when days are short and people are forced to spend most of their time indoors.
- Premenstrual dysphoric disorder. This is a more severe form of premenstrual syndrome that causes disturbing mood swings, some of which mimic major depression.
- Postpartum depression. Some women experience deep depression after giving birth, although symptoms may first appear during pregnancy. Postpartum depression is a serious condition that can impact a mother’s ability to care for herself and her newborn child.
- Depressive disorder due to another medical condition. Life-threatening or seriously debilitating conditions like cancer, HIV/AIDS, dementia, diabetes, or Parkinson’s disease can send sufferers into a tailspin of depression.
- High-functioning depression. Sufferers can experience a broad range of depression symptoms, of varying levels of severity. But despite their depression they are still able to hold down jobs, maintain personal relationships, handle parenting duties, and in general function in a way that seems normal. Nevertheless, high-functioning depression takes a heavy emotional toll on sufferers, who may not continue to function indefinitely.
Each of these conditions is associated with an increased risk for substance use disorders.
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Facts and Statistics
Overall, depression and addiction are both about equally common. In 2016:
- 6.7 percent of American adults suffered from major depression (including 8.5 percent of women and 4.8 percent of men).
- 5.7 percent of Americans aged 12 and above suffered from an alcohol use disorder, and another 2.7 percent suffered from a drug use disorder.
- In total, approximately 16 million people suffered from major depression and 20 million had a substance use disorder.
In the authoritative 2010 National Survey on Drug Use and Health, it was revealed that:
- 16.9 percent of Americans aged 12 and over who suffered from a substance use disorder had co-occurring major depression.
- 22 percent of major depression sufferers also reported past-year incidence of a substance use disorder, with an alcohol use disorder comprising about 78 percent of these cases.
Alcohol use disorder and major depression are responsible for more dual diagnoses than any other co-occurring combination.
Symptoms and Diagnosis of Addiction and Depression
Before making a diagnosis, mental health professionals evaluating patients for depression look for the following symptoms:
- Depressed mood (feelings of emptiness plus low motivation) experienced for most of the day, every day
- Loss of interest in daily activities and an inability to enjoy them if they formerly brought pleasure
- Significant weight loss or gain, accompanied by drastic changes in appetite
- Chronic insomnia or hypersomnia (excessive sleeping)
- Daily fatigue and low energy, making even the easiest chores difficult to complete
- Slowing of thought and movement, or its opposite (agitated thoughts and actions)
- Constant feelings of guilt or worthlessness
- Loss of ability to think clearly, concentrate, or make decisions
- Suicidal thoughts and actions
If five of these nine symptoms are present (including at least one of the first two), major depression can be diagnosed. Two symptoms are enough to make a diagnosis for dysthymia, while other types of depression will be diagnosed based on the situations in which they occur (i.e., during winter, after childbirth, etc.).
Addiction to drugs or alcohol is not a symptom of depression, but the two conditions co-occur so frequently that mental health professionals and addiction specialists are always on the lookout for both.
- Drinking or using drugs for longer periods or in larger quantities than intended
- Multiple unsuccessful attempts to stop taking drugs or drinking
- Much time spent using drugs or alcohol, or obtaining fresh supplies
- Cravings for drugs or alcohol that are experienced frequently
- Substance use that disrupts daily functioning, in numerous ways
- Social and interpersonal problems caused by drugs or alcohol that don’t lead to sobriety
- Important activities neglected or abandoned because of substance abuse
- Substance use that leads to frequent risky or impulsive behavior
- Physical illness and/or mental health problems caused by substance abuse that don’t cause the person to stop
- Tolerance for drugs or alcohol, which has grown significantly
- Withdrawal symptoms that are experienced after a few hours of not drinking or taking drugs
The presence of two or three of these symptoms is enough to diagnose a substance use disorder, and if six or more are detected the disorder will be diagnosed as severe.
Dangers of Overdose
Virtually any drug can lead to a hazardous or possibly even fatal overdose, and alcohol poisoning can be deadly as well. People suffering from depression often rely on prescription drugs to help them manage their symptoms, and combining illicit drugs or alcohol with these medications can be extremely dangerous and can increase the chances of overdose exponentially—as can addiction to drugs or alcohol in general.
Anytime a drug or alcohol overdose is suspected, emergency assistance should be requested as quickly as possible. To let even a few extra moments pass could make the difference between life or death.
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Causes and Risk Factors
People with depression suffer from chronic chemical imbalances in the brain, involving shortages of the neurotransmitters serotonin, norepinephrine, and dopamine, which help regulate mood and emotional equilibrium. Alcohol and drugs also affect the production of these neurotransmitters, which is one reason why substance abuse tends to amplify the feelings of depression over time.
In addition to neurological abnormalities, other risk factors for depression include:
- Genetics and family history of depression
- Gender (women are almost twice as likely to have depression)
- Suffering from sleep disorders
- Being diagnosed with a life-threatening or life-altering illness
- Being a victim of abuse, especially in childhood
- Social isolation, separation from family and lack of friends
- Previous history of anxiety disorders
- Sudden and stressful life changes (new job, divorce, financial losses, etc.)
There is an overlap between the risk factors for depression and substance abuse. Drug and alcohol dependency is also more likely to develop when there is a family history of such disorders, exposure to childhood abuse, sudden and shocking life changes, or life drama in general.
Withdrawal and Detox
Overcoming cravings and withdrawal can be a fierce struggle for recovering addicts and alcoholics, who must deal with the physical and psychological consequences of their prolonged substance abuse. In the case of alcohol withdrawal, symptoms can even be deadly if not monitored and managed carefully.
Medical detox services are often vital for those recovering from a substance use disorder, and will need to be provided before formal treatment can begin. In a clinical setting, prospective rehab patients undergoing detox will receive 24-hour care as they begin the process of tapering off drugs or alcohol, possibly with the assistance of medications that are designed to reduce stress and discomfort during this delicate process.
Detox is often administered inside addiction treatment centers and can include intervention for co-occurring mental health disorders as required. After the detox process is complete (normally in five to 10 days), patients with a dual diagnosis for addiction and depression will make the transition to inpatient or intensive outpatient treatment programs.
Depression frequently co-occurs with anxiety disorders. In fact, studies show that 60-70 percent of depression sufferers have problems with serious anxiety. Antidepressants are often used to treat anxiety disorders, which shows that depression and anxiety are closely related from a neurological perspective.
Unfortunately, people often turn to drugs and alcohol to help them cope with their anxiety symptoms, and that increases the risks of addiction even further for those who manifest the symptoms of depression.
Treatment and Prognosis for Addiction and Depression
Comprehensive, intensive treatment for a dual diagnosis of addiction and depression is the best way to maximize the chances of recovery.
Even a person with high-functioning depression can still benefit enormously from therapy and medication; in fact, such treatment is vital since they are unlikely to follow through on their attempts to get clean and sober as long as depression continues to lurk in the background. High-functioning addiction also requires treatment, since substance abuse is likely to become much worse over time regardless of how manageable it might seemt at any given moment.
Psychotherapy for addiction and depression will focus on the underlying factors for both conditions, to help patients identify their vulnerabilities and uncover the patterns of thinking, feeling, and behaving that led them to their current predicament. Practical strategies for coping with life and encouraging personal growth will also be introduced, along with complementary methods of healing like meditation, yoga, music and arts therapy, acupuncture, and biofeedback, based on the preferences and individual needs of each patient.
In addition to therapy, medication will likely be offered to the addiction and depression sufferer. The list of medications prescribed may include antidepressants for the depression, and withdrawal management drugs that can lessen the intensity of drug or alcohol withdrawal symptoms.
Therapy and medication will remain a part of the recovery regimen even after the person leaves rehab and enters continuing care, where all the valuable lessons of the initial recovery period will be reinforced as the patient works to avoid relapse and preserve their newfound sobriety. Depression responds favorably to long-term therapy and careful administration of antidepressants, and once recovery begins in earnest the use of medications may be discontinued.
While there is no cure for these disorders, millions of people suffering from addiction and/or major depression, high-functioning depression, or other types of depression have found relief from their life-altering conditions, with the trained assistance of mental health and addiction specialists. Recovery is not certain, but it is achievable with a diligent and committed approach to long-term healing.