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Dual Diagnosis: Depression And Substance Use Disorders

Depression, and other mood disorders, frequently co-occur with substance use disorders. The relationship is complex: one disorder can fuel the other, either can develop first and suffering from both conditions complicates diagnosis and treatment.

For treatment to be effective, both depression and substance use disorders must be treated at the same time. Untreated dual diagnosis, or treating one condition and not the other, can lead to worsening both disorders and increasing the risk for suicide.

How Common Is Comorbid Depression And Addiction?

In 2014, almost eight million people suffered from a dual diagnosis, which is also called co-occurring disorders and comorbidity. Many people suffering from addiction struggle with depression or other mental health disorders. Compared to the general population, people suffering from addiction are twice as likely to develop depression. The reverse is also true, as people with depression are more likely than the general public to struggle with addiction.

The Relationship Between Depression And Substance Abuse

Mood disorders, like depression, are the most common mental health conditions to co-occur with substance use disorders. In many cases, these two conditions are intertwined and can make the other disorder worse.

There is often an ongoing interaction between depression and addiction. A depressed person may use drugs to self-medicate their symptoms. Or, a person abusing drugs can develop depression as a result of abuse. The relationship is complex and can be difficult for clinicians to diagnose.

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Symptoms of drug abuse are often similar to symptoms of depression. It’s important to understand each disorder and identify the symptoms to effectively address each condition.

Symptoms Of Depression

Depression is a medical illness causing severe symptoms that affect a person’s feelings, thoughts and how they handle daily activities like working, eating or sleeping. Not everyone who is depressed will experience the same symptoms, with only one or two symptoms warranting the need for treatment. Symptoms of depression include:

  • aches or pains without a clear physical cause
  • feelings of guilt, worthlessness or helplessness
  • feeling very tired
  • loss of interest in favorite hobbies or activities
  • not being able to sleep or sleeping too much
  • ongoing sad, anxious or empty moods
  • overeating or not eating at all
  • thoughts of suicide or death

More than 19 million Americans struggle with depression. These thoughts and feelings don’t go away and interfere with everyday life. Due to these nagging symptoms, depression often triggers substance abuse, which can lead to a substance use disorder (SUD).

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Symptoms Of Substance Use Disorders

Like depression, a substance use disorder (SUD) is a complex illness. SUD is characterized by compulsive use, intense drug cravings, a lack of control over using the drug and continuing to use drugs despite harmful consequences in all aspects of life.

Symptoms of substance use disorders include:

  • doing illegal things to get drugs
  • doing risky activities while on drugs
  • drug use causes problems in relationships or at work/school
  • losing interest in favorite activities; favoring drug use instead
  • spending a lot of time looking for drugs, doing drugs or recovering from them
  • taking large amounts of drugs for longer than intended
  • the need to use drugs regularly (daily or multiple times a day)
  • withdrawal symptoms occur after stopping the use

Substances include alcohol, marijuana, heroin, prescription medications and other illegal drugs. Addictions to these substances disrupt regular functioning in the brain and can increase a person’s risk for depression and other mental illnesses.

Why Do Substance Use Disorders And Depression Co-Occur?

It’s not always the case that one disorder causes the other, and it can be difficult to determine why they co-occur. There are several theories, however, as to why depression so often co-occurs with substance abuse and addiction. Consider these theories and risk factors:

  • Disorder fosters disorder: Depression increases the risk for a substance use disorder, and substance use disorders increase the risk for depression. People may use drugs or alcohol to cope with the negative symptoms of depression. Conversely, prolonged substance use can trigger increases in symptoms of depression to the point where it becomes a full-blown disorder.
  • Involvement of similar brain areas: Brain systems are changed after the prolonged use of drugs or alcohol. The areas in the brain most affected by substance use respond to reward and stress, which are the same areas disrupted by depression and other mood disorders.
  • Underlying genetic factors: Someone’s genetics, or biology, can predispose them to develop substance use disorders or depression or increase the risk for developing a second condition after the first one appears.
  • Underlying environmental factors: Trauma ( physical or sexual abuse), stress and early exposure to drugs or alcohol can increase the risk of developing addiction or depression.
  • Depression and addiction are developmental disorders: This means depression and addiction often begin when someone is a teenager or younger, an important time during the brain’s developmental process. The early use of drugs can lead to depression, and early symptoms of depression can lead to an increased risk for addiction.

Depression, Addiction, And Suicide

In general, people with depression have a 10% lifetime risk for committing suicide, which is roughly the same for those with a substance use disorder. When someone suffers from both, the negative effects of each condition multiply and the risk for suicide increases to around 25% or 1 in 4.

Suicidal thoughts can be a symptom of both depression and a substance use disorder. What’s more, the despair and lowered inhibitions caused by drug or alcohol intoxication can set the stage for impulsive and self-destructive actions, including suicide.

Treatment For Depression And Substance Use Disorders

Treating co-occurring depression and substance use disorders requires an integrated, or multidisciplinary, approach. This means treatment is comprehensive and uses a variety of professionals, like psychiatrists and addiction counselors, to address and treat both conditions at the same time. Treating one, and not the other, can worsen each disorder.

Medications, Therapy And Inpatient Rehabilitation

For addiction, medications can be used to alleviate symptoms of withdrawal, reduce drug cravings and promote engagement in treatment. Other medications can also be used to treat depression, which is likely combined with behavioral therapy.

Behavioral therapy has shown to be effective for treating both depression and substance use disorders. Therapy is tailored to the unique needs of the individual. Common therapies useful for treating co-occurring disorders include cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), which can help change destructive patterns of thinking.

Inpatient rehabilitation, or inpatient rehab programs, are best suited for people with the dual diagnosis because they will live in a structured environment with around-the-clock medical care and supervision. Inpatient rehab programs typically provide medications, therapy, support and other health services to address and treat both substance use and depressive disorders.

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