Posted on November 10, 2017 by Walter Keenan, Ph.D. & David Cohen, M.D. here: https://www.inpatientdrugrehab.org/depression/
According to the Anxiety and Depression Association of America (ADAA), approximately one in five Americans suffering with a mood disorder like depression is also battling with alcohol addiction or some other type of chronic substance abuse.
Conversely, about 20 percent of all individuals addicted to alcohol or drugs also experience some level of depression, anxiety, or other mood-related disorder.
On their own, these issues can feel absolutely debilitating and dramatically lower your quality of life. But when they’re combined, the consequences can actually be fatal.
Case in point: The risk of suicide for someone struggling with both depression and addiction is one in four. This is much higher than the national average, which the American Foundation for Suicide Prevention puts at roughly 13 percent.
What is it about these two issues that makes them happen in unison? We’ll explore the answers to that question and more below.
Depression is part of the ‘negative’ effect area in red on the right side of the loop
Depression and Addiction: The Connection
Mount Sinai School of Medicine explains that while addiction is fairly complex, “it is, at its core, a biological process.” What does this mean?
Quite simply, the substance (alcohol or a narcotic) at the root of the addiction impacts the brain at a cellular level by binding to certain areas, thus creating that particular substance’s response. Depending on the drug, this can include feelings of euphoria, enhanced energy levels, or the feeling of slowing down.
However, when ingested continuously over time, these substances actually change some of the brain’s neural circuits. This ultimately alters the person’s reward and motivation systems, resulting in the person being in an “addicted state.”
These addiction-impacted areas of the brain are thought to be the same general areas responsible for depressive symptoms, many of which are also related to reward and motivation. Thus, it only makes sense that these two conditions—addiction and depression—would likely occur at the same time.
But what exactly is depression?
The National Institute of Mental Health (NIMH) defines depression as a “common but serious mood disorder” that ultimately impacts various areas of your life, from the way you feel and think to your behavior at home and work.
There are many different kinds of depression, but the general symptoms tend to include:
- Feeling sad or hopeless a lot of the time
- Being irritable or pessimistic
- No longer finding job in activities that you used to enjoy
- Having less energy
- Sleeping too little or too much
- Not thinking clearly or trouble remembering
- Physical aches and pains with no apparent cause
- Thoughts of hurting yourself, or actively trying
These symptoms would have to persist for two weeks or more to be labelled as depression.
Individuals who are at the greatest risk of developing some type of depressive disorder are those with:
- a family history of depression,
- individuals struggling with a sleep disorder,
- people who are facing a serious illness such as cancer, dementia, or Parkinson’s disease,
- those who are/have been abused,
- and people with a poor social support system.
Gender makes a difference as well. Women are two times more likely to experience depression compared to men. And sometimes, life circumstances are what tip off depressive thoughts, like the end of an important relationship or the loss of income.
Even the medications that you take can lead to depression. For instance, some blood pressure medications have been linked with depression, as have certain steroids, pain killers, sedatives, and sleeping pills.
Adding these depressive thoughts and behaviors to an addiction to drugs or alcohol can be extremely dangerous, but does one actually cause the other?
The National Institute on Drug Abuse (NIDA) shares that it’s important to understand that there is no one-size-fits-all causal relationship. In other words, the appearance of one does not necessarily guarantee the appearance of the other. We know this because not all addicts are depressed, and not all people suffering with depression are also struggling with an addiction.
The NIDA explains that there’s also a third option that occurs when these two issues appear at the same time because of something else entirely. For instance, there could be “underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma” leading to both the depression and addiction. In other words, one did not cause the other at all.
That being said, when depression and addiction occur simultaneously, it’s what is often referred to as a dual diagnosis. A dual diagnosis is when an individual has two different issues occurring at the same time, and both are negatively impacting his or her life.
Even though one does not necessarily cause the other, some people use alcohol and drugs as a way to “self-medicate” against their depression. They have difficulty coping with their feelings, so they take substances that help ease their emotions. In this way, it’s entirely possible that issues with depression can lead into issues with addiction.
Of course, this makes finding treatment a little more complex because more than one issue needs to be addressed. Plus, some people notice that they have feelings of depression long after they’ve started the addiction rehabilitation process.
Depression After Addiction Rehab
It’s common for individuals recovering from addiction to experience some level of depression while working toward their sobriety. The University of Wisconsin School of Medicine and Public Health refers to this as having Post Acute Withdrawal Syndrome. The syndrome encompasses a variety of recovery-level responses, such as difficulty dealing with stress and anxiety, and an inability to think clearly.
This can make the recovery process even more difficult and potentially lead the person to use again because they no longer want to feel these negative emotions. According to Narconon, this specific form of depression is both mental and physical in nature.
Physical causes of depression after addiction
Physically, the long-term use of the addictive substance may have inhibited the body’s natural processes. This means that the body may no longer be able to automatically feel certain pleasurable emotions without the help of the person’s drug of choice.
This can render the person unable to experience happiness without the addictive substance, leaving them feeling emotionally void or, in the case of depression, feeling down. In an effort to feel better, they return to regular use.
Another physical consideration associated with depression and recovery is that the person likely didn’t take care of him or herself when in an addictive state, which can lead to nutritional deficiencies. This can create other physical effects that then impact the level of depression experienced, such as a lack of energy (vitamin B3 deficiency) or a more negative mood (vitamin B1 deficiency).
Mental factors to consider
Depression may also occur after rehabilitation begins because of actions the person took when actively addicted. The following are two examples of such instances.
The person lost his or her family because of the addiction, and is now going through the feelings of loss without the alcohol or drugs to ease the pain.
The person engaged in illegal or immoral behaviors, such as prostitution or theft, in order to obtain the addictive substance, and is now experiencing negative feelings to their character or integrity.
Treatment Options for Depression and Addiction Dual Diagnosis
We understand that all of this information may make recovery sound bleak, like depression combined with addiction cannot be beat. Fortunately, the opposite is true. It is possible to overcome both issues at the same time, and there are many different ways to do it.
One of the first options to consider is inpatient treatment at a dual-diagnosis treatment center. This approach involves living on-site at a particular location while working to overcome both the addiction and the depression.
The benefits of engaging in inpatient treatment include:
- More help while going through the physical withdrawal process, which increases patient safety and improves levels of comfort.
- Being removed from the home environment, which reduces exposure to triggers that could normally incite use.
- Being able to focus solely on one’s self because he or she is not dealing with work, family, or any of the other common stressors that exist in home and work environments.
- More intense and time-intensive treatment, which provides added support for remedying the dual conditions.
Inpatient treatment often involves behavioral counseling coupled with some type of medication regimen. Depending on the specific addiction and program chosen, this may involve personal therapy and group therapy sessions in addition to prescription drugs that aim to help overcome withdrawal symptoms and reduce the likelihood of relapse.
The specific drugs used are dependent on the substance at the center of the addiction. For example, NIDA shares that opioid addiction is often treated with methadone, buprenorphine, or naltrexone. However, someone battling addiction to alcohol or other drugs is often prescribed naltrexone, disulfiram, or acamprosate.
Taking this multi-level approach to treatment is critical. According to researchpublished in the journal Addiction, some studies estimate the following:
- Only 21 to 43 percent of individuals facing alcohol addiction specifically are able to abstain short-term once they decide to quit.
- That amount then increases to 40 percent if sobriety is sustained for a year, but that still means that 60 percent of addicts will likely relapse. And that’s even if they’ve been in recovery for more than 365 days.
Again, these numbers are not shared to make you feel hopeless. As NIDA says, “Addiction is a treatable disease.” They also mention that it’s not always curable, which means that it can take constant and consistent management.
Relief from both depression and addiction can be achieved on an outpatient basis, which begins with finding a dual-diagnosis treatment program. The program must offer outpatient services for the exact addiction you face while also providing effective treatment options for your depression.
They generally provide the same approaches to behavior and medications as inpatient treatment centers, though not quite as intensely because you’re not in their care 24/7. Additionally, because you’re remaining in your home or work environment, it’s important to know that this approach may require more focus because you’re also dealing with the stressors in your life.
Additional At-Home Treatment Remedies
There are some things you can do when not actively engaged in treatment sessions that may provide relief from your addiction and depression. These at-home remedies include:
- Increase your physical activity. Research has consistently shown that exercise can help ease depression, but it can also be beneficial to addiction recovery. For instance, one study published in the Journal of Counseling & Development found that yoga improved how the participants handled their “strong and threatening emotions” and negative social situations, both of which can aid in the recovery process.
- Create a “brighter” physical environment. When you’re struggling with addiction and depression, it can be tempting to close all of the curtains and blinds to hide in the darkness, far away from the rest of the world. However, an 8-week study of 122 adults published in JAMA Psychiatry revealed that increasing your exposure to light has positive effects. Keep your curtains and blinds open, turn on the inside lights, and take walks outdoors during daylight hours. These small steps will put you in a better frame of mind to more effectively handle your addiction recovery.
- Set recovery goals. This can help you stay on task while also helping you realize the progress you’re making along the way. Effective goals have five basic components: specific, measurable, attainable, realistic, and timely (or SMART). As long as your goals encompass all of these, you’re giving yourself a good start.
Long-Term Treatment Is Best
Whichever type of treatment you choose, NIDA stresses that you should not expect a quick fix because “participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes.” Thus, effective treatment relies on you making a commitment to stay in it for the long haul.
This may seem daunting, especially if you’ve been struggling with addiction for a long time and feel like there is no hope. Fortunately, the reality is that you don’t have to walk through this alone. And with the right treatment program, your chances of success will surely increase, giving you the opportunity you need to battle both of these issues and win.