Depression & Substance Abuse

By Team RehabAid

Last Updated March 22, 2024

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If you’ve ever had an extremely bad day or suffered through a severe loss or the death of a loved one, you’ll almost certainly have felt depressed. Troubling life events or ongoing personal stresses can also cause us to experience the blues from time to time. However, for people with clinical depression, those down-in-the-dumps feelings are not only intensified, but they’re also long lasting and can greatly affect their ability to carry out basic daily tasks.

According to Our World in Data, 264 million people worldwide have clinical depression. Because of the ongoing low moods associated with depression, it is no surprise that this condition often leads to substance abuse. Research indicates that one-third of people who are diagnosed with depression also have a drug or alcohol addiction. The issue with substance abuse is that it can also cause depression and its symptoms, which is why this co-occurring condition is so complex.

However, despite the prevalence of these two concurrent issues, there is ample hope for recovery. In this article, we outline what depression is, how it relates to substance abuse, and what types of treatments are available.

What Is Depression?

Depression — otherwise known as “major depressive disorder” or “clinical depression” — is a serious mood disorder that influences how a person thinks, feels, and behaves. People with depression will suffer from characteristically low moods, low energy, and feelings of hopelessness. They can also experience physical symptoms, such as aches and pains, digestive problems, migraines, and slow speech.

Like most mental health issues, depression exists on a spectrum and it presents in many different forms, as outlined below.

Major Depressive Disorder (MDD)

Major depressive disorder is one of the most common types of depression. Affecting roughly 7% of the U.S. population, MDD is often characterized by symptoms such as extreme sadness, irritability, lack of energy, sleep disturbances, suicidal thoughts, or feelings of low self-worth for a period of 2 weeks or more.

Persistent Depressive Disorder (PDD)

Persistent Depressive Disorder (also known as “Dysthymia”) is a depressed mood that lasts for at least two years. This type of depression may involve episodes of major depression, as well as periods with less severe symptoms. However, symptoms must last for two years to be considered PDD.

Postpartum Depression

This type of depression occurs alongside childbirth and is much more serious than the standard “baby blues.” Postpartum depression is exemplified by extreme sadness, anxiety, and exhaustion during pregnancy or after delivery. While the baby blues are relatively mild and typically clear up after a couple of weeks, postpartum is defined by full-blown major depression. New mothers with this condition find it incredibly difficult to properly care for themselves and their newborn babies.

Psychotic Depression

Psychotic depression occurs when a person experiences severe depression along with some form of psychosis. This includes delusions such as disturbing beliefs or upsetting hallucinations that others cannot see or hear. The psychotic symptoms experienced by the individual will also typically have a depressive theme, such as delusions of guilt, poverty, or illness.

Seasonal Affective Disorder (SAD)

This type of depression is influenced by the seasons and is characterized by depression during the winter months. People with SAD will often see their symptoms disappearing over spring and summer; however, winter depression symptoms, such as withdrawal from daily life, weight gain, and increased sleep usually return each year.

Bipolar I and II

Bipolar disorder is slightly different in that it is characterized by extreme highs and lows. People with this mood disorder will cycle between periods of mania where they feel on top of the world followed by periods of extreme depression. Depressive states in bipolar disorder differ from regular depression in that individuals are more likely to feel irritability, guilt, unpredictable mood swings, and feelings of restlessness. Individuals may also speak slowly, sleep a lot, and gain weight during this period.

Signs of Depression

While there are varying types of depression, here are some of the most common signs:

• Persistent sadness, anxiety, or “empty” moods
• Feelings of hopelessness or pessimism
• Irritability
• Tearfulness
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause
• Hallucinations, delusions

Underlying Risk Factors

There is no definitive cause of depression, but there are risk factors that can contribute to it. These include:

Trauma

Individuals who have witnessed or experienced a traumatic event are at a higher risk of developing mental health conditions such as depression.

Brain Structure

Some studies indicate that the brain structure of individuals with depression may differ from persons without it. For example, some MRI studies have shown that there is a unique appearance to areas responsible for cognition, mood, and metabolic function in people with serious mood disorders.

Genetics

While there is no single gene determining a condition like depression, some research suggests that there may be genetic links. For example, people who have siblings or family members with depression are 20% to 30% more likely to develop it themselves.

Situational Factors

Individuals that grow up in dysfunctional, abusive, or depressed families can be more prone to developing bipolar disorder through exposure. Other triggers such as bereavement, loss, or traumatic life events can also lead to depression.

Substance Use Withdrawal

Drug misuse or weaning the body off medications or street drugs can cause depression due to the way it alters brain chemistry.

Co-Occurring Mental Health Issues

Other psychiatric conditions, such as anxiety, psychosis, bipolar disorder, and attention-deficit disorder (ADHD) also occur with depression and can augment the symptoms.

Depression & Substance Abuse Stats

According to the Anxiety and Depression Association of America, over 15 million adults experience an episode of clinical depression in any given year — which is close to 7% of the population. They also report that about 20% of Americans with anxiety or depression also have a substance abuse problem and that 1 in 5 with a substance addiction have an anxiety or depression disorder.

Other stats include:

• The leading cause of disability in the U.S. is depression among people aged 15-44.
• Roughly 1/3 of all individuals with depression also have a substance abuse problem.
• Data from the National Comorbidity Survey reveals that the lifetime prevalence of major depression is 24.3% among men with alcohol addiction and nearly 48.5% among alcohol-addicted women.
• While depression can develop at any age, the average age of onset is 32.5 years old.
• According to the Centers for Disease Control, the population groups with the highest risk of depression are females, middle-aged adults between 45 and 64, and people who are unemployed or who lack medical insurance.

What Is the Relationship Between Depression and Substance Abuse?

Substance abuse and bipolar disorders are common co-occurring conditions. For instance, it is estimated that among people with recurring major depression, 18% to 20% have a drug use disorder and 16.5% have an alcohol use disorder. The two conditions are intimately connected for several reasons that we outline below.

Self-Medicating Behavior

People who struggle with mental health conditions such as depression will often resort to self-medicating by using substances to cope. Whether it’s alcohol, prescription medications, or street drugs, individuals who are desperate to escape the symptoms of depression will often turn to substances. The problem with using substances to achieve relief is that they also tend to exacerbate depressive symptoms, sometimes worsening them when the drugs wear off.

Biochemical Imbalances

Neurological factors also play a role in substance abuse and mood disorders. The reason is that neurotransmitters such as dopamine, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) are thought to be connected to anxiety, depression, and addiction. These chemicals are responsible for regulating mood and various bodily and mental functions. If an individual has an imbalance in these neurotransmitters, it is thought that they are more prone to both depression and addictive behaviors.

Substance Use & Addiction Withdrawal

Due to the way that drugs alter the biochemistry of the brain, substance use can initiate depression. Depressants such as alcohol, for example, can enhance depressive symptoms even though they initially help to numb those feelings. Stimulants, on the other hand, can cause agitation, restlessness, irritability, and obsessive or irrational fears. Also, stopping long-term drug use can cause increased depressive symptoms due to the change in brain chemistry during the withdrawal period, creating the potential for worse feelings of depression prior to drug use.

How Does Substance Abuse Affect Depression?

Another factor when it comes to depression and substance abuse is how they affect each other. In this section, we’ll explore some of the substances most commonly abused by individuals with depression and describe what the effects are.

Alcohol & Depression

It is estimated that nearly one-third of individuals with alcohol addiction also have a mood disorder like depression. While drinking on occasion isn’t a bad thing, using it as a crutch can lead to long-term health problems. If you find yourself in a cycle of drinking to cope with depression, you could also end up with extended, and more extreme symptoms of depression.

While alcohol triggers the release of dopamine (the brain’s pleasure chemical), with chronic use, this neurotransmitter becomes depleted, leading to cravings and a depressed mood. Therefore, people who drink excessively and for long periods will likely experience more frequent and severe instances of depression. Another danger with alcohol is that it can sometimes block the effects of anti-depressants.

Stimulants & Depression

Stimulants are another commonly abused substance among those with depression, largely because they temporarily boost mood, energy, and alertness. In general, stimulants excite the entire nervous system, resulting in increased heart rate, blood pressure, temperature, etc.

Some of the stimulants typically used by individuals with depression include:

• Prescription stimulants (e.g., Adderall)
• MDMA (Ecstasy)
• Cocaine
• Amphetamines
• Methamphetamines

However, stimulants are also known to promote and increase symptoms of depression once the drugs wear off. This “comedown” phase can make someone physically depressed due to the drop in dopamine levels, as well as psychologically depressed because the energetic happy high has gone.

Opioids & Depression

Another substance that is commonly abused by people with depression are opioids, such as Oxycontin or heroin. Like the other substances on this list, opioids trigger dopamine production in the brain, the disruption of which can lead to increased depression and anxiety.

One study at St. Louis University, for example, discovered that 10% of patients who were prescribed opioids developed depression after using them for over a month. These individuals also did not have a diagnosis of depression prior to taking opioids. Another associated danger with prescription opioid use is the risk of turning to more dangerous versions, like heroin. Heroin is much stronger than prescription opioids and addiction to this substance can lead to increased feelings of despair, guilt, and depression.

Cannabis & Depression

Cannabis (marijuana) is a more complicated substance, because it can act as both a depressant and a stimulant. While the drug can be effective at easing symptoms, cannabis can also increase negative emotions, such as anxiety and depression, once the drug wears off. This is especially the case if the individual has been using cannabis in high doses or for extended periods. High levels of THC in the body are also linked to negative effects, such as anxiety, paranoia, increased heart rate, and hallucinations, so this substance is best avoided.

Signs of Addiction

If you’re struggling with depression and are concerned about your alcohol or drug use, these are some key signs to watch out for, as they can be clear indications of addiction.

Tolerance

This occurs when your body is used to the drug and requires larger amounts to achieve the desired effects.

Withdrawal

These symptoms present as physical and emotional discomfort, such as nausea, tremors, nervousness, cold sweats, or agitation when stopping drug use.

Remorse

This emotional state occurs if your drug use has led you to feel guilty or sad, even though you are taking the substance to feel better.

Relapse

This happens if you try to stop taking the drug but find yourself going back to it due to intense cravings or withdrawal symptoms.

Depression & Substance Abuse Treatment Options

The good news is that despite the high rates of substance abuse and co-occurring conditions like depression, treatment is available. While these conditions can be treated separately, they are best managed simultaneously, using multiple levels of care that begin with detox and continue through to inpatient/residential, outpatient, and aftercare programs.

If you need to seek help, many of these treatment programs are found in rehab facilities or drug treatment centers across the country.

Dual Diagnosis

Centers that offer dual diagnosis treatment are recommended, as they are set up to diagnose and treat concurrent mental health conditions and substance abuse. This kind of treatment is especially useful for people who have underlying issues, such as bipolar disorder and depression. Dual diagnosis programs allow clinicians to safely address these conditions while an individual withdraws from alcohol or drugs. Dual diagnosis can be found in both inpatient and outpatient clinics.

Key Therapies

Other key treatments to be aware of when it comes to anxiety and substance abuse are:

Cognitive-Behavioral Therapy (CBT)

One of the most effective therapies for bipolar disorder and substance abuse is cognitive-behavioral therapy (CBT). CBT helps individuals change negative cycles of thought and behavior into more positive ones and this has shown to be especially effective for addiction and mental health conditions. Clients receiving CBT for addiction often learn how to recognize “automatic thoughts” and dysfunctional thinking patterns, how to understand the behavior and motivation of others, and how to develop a greater sense of self-understanding and confidence.

CBT also helps clients find solutions to triggers that might encourage drug use. CBT is known to be effective and long-lasting, as clients can continue utilizing these strategies once their therapy sessions have ended.

Dialectical-Behavior Therapy (DBT)

Dialectical-behavior therapy is a type of cognitive-behavioral therapy that focuses on mindfulness, how to live in the moment, cope with stress, and improve relationships. DBT also helps clients better regulate their moods and learn how to develop healthy coping skills. This kind of therapy is useful for people who have co-occurring conditions, especially those who have depression or bipolar symptoms. DBT is also effective for PTSD and for people who exhibit self-destructive behaviors.

Eye Movement Desensitization and Reprocessing (EMDR)

Since a history of trauma and abuse can lead to or exacerbate depression, treatments such as EMDR that focus on trauma are also effective. Consisting of 8 phases, EMDR is led by a therapist who guides an individual through a series of rapid eye movements to help redirect negative or traumatic memories. This redirection helps the person form new connections or associations so that the memory is less emotionally distressing over time. This therapy is therefore useful for individuals with mood disorders as it helps them overcome the emotional suffering associated with traumatic events.

Motivational Interviewing (MI)

Motivational Interviewing (MI) is a type of collaborative therapy between a therapist and the client. During these sessions, the client and therapist work together to define sources of motivation and achieve self-defined goals. MI is known for its positive, client-centered approach and has shown to be effective in treating addiction and mood disorders.

Family Systems Therapy (FST)

Family Systems Therapy (FST) is a type of psychotherapy that treats the client’s entire household. In this type of approach, depression and addiction are seen to affect the family unit so treatment includes goals for everyone involved. This can include educating loved ones about depression and addiction, improving communication, setting realistic boundaries, and learning how to establish an alcohol and drug-free home that supports sobriety.

Medications

There are many different types of medications that are prescribed to treat depression. Below are a few of the most common.

Serotonin Reuptake Inhibitors (SSRIs)

Perhaps the most common medication for depression is serotonin reuptake inhibitors (SSRI). These anti-depressants work by increasing the amount of available serotonin in the brain, a neurochemical that stabilizes mood. SSRIs are also a popular treatment for depression because they tend to have fewer side effects compared with other anti-depressants. Common SSRIs include Prozac, Celexa, and Zoloft.

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs improve serotonin and norepinephrine in the brain, which can help reduce depressive symptoms. Common SNRIs include Pristiq, Cymbalta, Fetzima, and Effexor. Cymbalta is also known to help with pain relief, which can prevent depression in individuals with chronic pain issues.

Tricyclic Antidepressants

TCAs are often prescribed when other SSRIs or SNRIs fail to work. It is not fully understood how these help with depression, but some of the common ones are Anafranil, Tofranil, and Pamelor.

Other Anti-depressants

Along with the popular medications above, other anti-depressants are sometimes used, such as dopamine reuptake blockers, tetracyclic anti-depressants, and monoamine oxidase inhibitors (MAOIs).

Natural Herbs

One of the most popular natural remedies for depression is a herb called St. John’s Wort. Another supplement is S-adenosyl-L-methionine (SAMe), a type of amino acid that helps the brain produce and break down neurotransmitters, such as serotonin, melatonin, and dopamine.

Alternative or Holistic Therapies

Holistic therapies are also effective at treating addiction and mood disorders. The purpose of holistic therapies is to treat the whole person and not just the symptoms. These can be incredibly beneficial for providing calmness, spiritual support, emotional expression, improving physical health, and teaching valuable skills. Some of the popular holistic therapies include:

• Relaxation techniques
• Nutritional therapy
• Animal-assisted therapy (e.g., emotional support dogs)
• Massage
• Adventure therapy (e.g., hiking or rock climbing)
• Mindfulness and meditation
• Art therapy, Music therapy
• Yoga, Tai-Chi
• Equine-assisted (horse) therapy

Long-Term Recovery

Alongside these treatments, there are other ways to enhance your recovery by making personal lifestyle adjustments like the ones below:

Exercise

Vigorous activity can stimulate your endorphins, which can help with anxiety, depression, and low mood. Examples include low- and high-intensity exercises such as walking, running, swimming, cycling, or yoga.

Meditation

This can help calm anxious or racing thoughts and improve cognitive function, which is useful when recovering from bipolar disorder and addiction.

Eating Well

The right diet can help repair damage incurred following sustained drug use and lead to improved immunity, cognitive function, and energy.

Avoiding Triggers

Learning to avoid triggers like certain people, situations, or circumstances can help prevent a desire to take drugs.

New Hobbies

While cravings can be difficult to manage, hobbies such as sports, art, music, or crafts can be useful distractions.

Resources

If you or a loved one are struggling with depression and substance abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also find a list of treatment centers near you on our website to help get you on the path to recovery.

Key Sources

Benazzi, F. (2006). Various Forms of Depression. Dialogues in Clinical Neuroscience. 8(2), 151–161. https://10.31887/DCNS.2006.8.2/fbenazzi

Conner, K.R., Pinquart, M., Gamble, S.A. (2009). Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Subst Abuse Treat. 37(2), 127–137.  https://linkinghub.elsevier.com/retrieve/pii/S0740547208002201

Davis, L., Uezato, A., Newell, J.M., Frazier, E. (2008). Major depression and comorbid substance use disorders. Curr Opin Psychiatry. 21(1), 14-8. https://10.1097/YCO.0b013e3282f32408..

Editorial Staff. (2021). Depression. Anxiety & Depression Association of America. https://adaa.org/understanding-anxiety/depression

Editorial Staff. (2021). Depression and Addiction. Dual Diagnosis.org. https://dualdiagnosis.org/depression-and-addiction

Editorial Staff. (2021). Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression/index.shtml

Smith, K. (2021). Substance Abuse and Depression. Psycom.net. https://www.psycom.net/depression-substance-abuse

Medical Disclaimer

At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

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