Depression and Substance Use Disorder: Understanding the Connection

What is Depression?

Depression is a mood disorder that causes a persistent feeling of sadness or loss of interest.[1]

When you’re depressed, life doesn’t have the same zing, energy, and hope you usually enjoy. Depression is influenced by a disturbance in serotonin activity levels in your central nervous system.[2] Serotonin is responsible for feelings of happiness and well-being, and changes in appetite can also lead to significant weight loss or gain.

Sadness is a defining characteristic of most depressive cases, but you might also feel empty or irritable. Depression affects a person’s life more broadly by draining energy, disrupting functioning, and altering sleep patterns. Unfortunately, due to societal stigma, up to 60% of people who suffer from depression do not seek treatment.[3] Depression can also increase your risk for suicidal thoughts and ideations.

Some different kinds of depressive disorders include: [4]

• Disruptive mood dysregulation disorder (children/adolescent irritability)
• Major depressive disorder (Severe depression)
• Persistent depressive disorder (may present as mild depression)
• Premenstrual dysphoric disorder (Severe mood swings during a woman’s cycle)
• Depressive disorder due to another medical condition

Many sufferers attempt to blunt the experience of depression with substance abuse. Clinicians also distinguish primary depressive disorders from substance induced mood disorders when symptoms are driven by substance effects. Alcoholism is often a co-occurring disorder and can exacerbate the negative feelings that lead to depression in the first place.

Common Symptoms of Depression

To be clinically diagnosed with a depressive disorder, an official diagnosis must be made according to the criteria included in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and assessment may also need to distinguish major depressive disorder from bipolar disorder, which can include depressive episodes.[5] At least 5 out of 9 criteria must be present daily (“depressed mood” or “interest/pleasure reduction” is mandatory) for two consecutive weeks, and these symptoms must reflect only depression rather than being better explained by substance use or another medical cause.[6]

• Inconsistent sleep
• Loss of interest or pleasure in formerly satisfying activities
• Non-specific worthiness or guilt
• Tiredness
• Lack of focus
• Dietary disruptions, including significant weight loss or gain
• Changes in the way you talk, walk or move
• Thoughts of suicide
• Persistent negative mood

Depression Statistics

Major depressive disorder affects over 260 million people globally.[7]

In the United States, over 15 million physician office visits were conducted in 2019 in which various depressive disorders were the primary diagnosis].[8] In all physician visits, 11% of them listed depression on the medical record.[9] Out of the 1 billion total physician visits in 2019, approximately 110 million of them reported the presence of depression. Data cited by a national institute also show that among primary care patients, 43% screened positive for depression and 4% met criteria for substance use disorder through primary care screening. These findings suggest depression and substance use often overlap in medical settings and may worsen outcomes when co-occurring conditions are present.

Females are 1.5 to 3x times more likely than males to experience depression beginning in adolescence.[10] In the United States, depression accounts for nearly 40,000 cases of suicide every year.[11]

For comparison, in 2021, all opioid-related deaths accounted for about 80,000 deaths, meaning that there are half (50%) as many deaths attributed to depression as there are deaths attributed to the entirety of opioids.[12] Over 20% of individuals with alcohol addiction also have depression, including cases of concurrent alcohol use disorder alongside it.[13]

Depression and Substance Abuse

Depression and substance abuse often co-occur. Comorbid depression is common in people with substance use disorders, and this comorbidity complicates treatment and worsens outcomes. Depression symptoms can lead to substance abuse and vice versa. The experience of depression can lead sufferers to self-medicate with substances like alcohol or other drugs.

Depression and drug addiction can create a vicious cycle. Oftentimes alcohol is abused by depressive disorder sufferers due to its central nervous system (CNS) depressant effects, and about 20% of individuals with alcohol addiction also have major depression. About 40–60% of individuals abusing drugs also have a mental illness. Unfortunately, the euphoria from drinking is a fleeting sensation.

Despite the initial dopamine surge you get from drinking, your body will still feel the lack of serotonin needed to stay happy. The best way to address depression is with holistic, medical, and mental health treatment that addresses both substance or alcohol use and depressive disorders.

One helpful treatment for co-occurring disorders like depression and substance abuse is dual diagnosis treatment. A dual-diagnosis treatment program identifies each disorder and then applies unique interventions for co-occurring depression and other co-occurring conditions, addressing overlapping behavioral health conditions and related mental health concerns rather than treating one issue in isolation.

Co-occurring disorders tend to intensify the effects of the other, leading to a vicious cycle that is hard to escape. Programs will address each disorder as a separate diagnosis that needs its own individualized treatment plan.

Common dual-diagnosis therapies for depression and substance use disorder may include evidence based therapies for addiction and depression, including Cognitive Behavioral Therapy, which is effective for co-occurring disorders, and dialectical behavior therapy, which focuses on emotion regulation and mindfulness; Motivational Interviewing (MI) can also enhance personal commitment to recovery:

• Experiential Therapy
• Acceptance and Commitment Therapy (ACT)
• Cognitive Behavioral Therapy (CBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Family Therapy
• Psycho-education

Also, levels of care in which treatment for co-occurring substance use disorder and depression occurs may include, with medication-assisted treatment used when appropriate to stabilize brain chemistry in dual diagnosis patients, including those with opioid use disorder:

• Medical Detox under medical supervision
• inpatient treatment
• Partial Hospitalization Programs
• Intensive Outpatient Programs
• Outpatient Programs
• Aftercare

How Substance Use Worsens Depression

Substance use may seem like a way to get temporary relief from depression, especially when someone feels hopeless, numb, exhausted, or unable to enjoy daily life. Alcohol or drugs may briefly change mood, reduce distress, or make it easier to avoid painful thoughts through substance misuse or drug use. However, that short-term relief can make depression harder to manage over time.

Substance use can worsen depression by disrupting sleep, increasing emotional instability, lowering motivation, and making it harder to follow through with treatment. It can also create new consequences, such as conflict with loved ones, financial stress, shame, isolation, or physical health problems caused by ongoing use, which may deepen depressive symptoms. People with depression and co-occurring substance use disorders may experience more severe mood symptoms, higher risk of suicidal ideation or attempts, worse functioning, and greater overall disease burden than people with depression alone.[14]

This cycle is one reason integrated treatment is important. If depression is treated without addressing substance use, alcohol or drugs may continue to destabilize mood and recovery. If substance use is treated without addressing depression, untreated depressive symptoms and withdrawal induced depression during early recovery may continue to trigger cravings or relapse. Treating both conditions together can help a person build safer coping skills, stabilize mood, and address other mental health concerns and related conditions that may keep the cycle going.[15]

Cost of Treatment for Depression and SUD

The cost of treatment for depression and substance abuse can depend on several factors. Your needs, history, and desired lifestyle during treatment greatly affect the cost.

The higher the level of care you need, the longer your treatment may be and the more it will cost. The length of stay, intensity of care, and different kinds of therapies chosen will all play a part in determining the cost.

Our Mental Health facility in Tennessee provides depression treatment in Nashville.

Insurance may cover some or all of your treatment. For a customized cost evaluation, call us now.