Depression and Addiction

Examining The Relationship Between Depression And Addiction

What is Depression?

Depression is a mental health disorder that affects millions of people across the world. While many will experience fluctuations in mood and emotional responses to everyday challenges, depression is a serious health condition. A medical professional diagnoses depression, and it impacts a person’s ability to function normally in their day-to-day routine. This disorder can harm someone’s relationships, schoolwork, or professional life.

There is no single known cause for depression. Research suggests that depression can be caused by several contributing factors, including imbalances in mood regulation in the brain, genetics, traumatic life events, and various medical conditions and medications.¹

How Common is Depression?

Depression is the leading cause of disability worldwide, affecting more than 264 million people globally.²

It’s estimated that more than 17 million adults are affected by depression in a given year in the United States alone. According to the Centers for Disease Control and Prevention (CDC), nearly 5% of adults experience regular feelings of depression. Many of those adults will suffer from depression and addiction.

What is Addiction?

Addiction is characterized by the uncontrolled use of a substance despite potentially harmful consequences. Addiction can also be referred to as substance use disorder (SUD), and it includes an intense reliance on substances such as alcohol, tobacco, illegal drugs, or prescription drugs. Substance use disorder can severely impact a person’s day-to-day life, and it can have prolonged negative health effects.

Addiction can change one’s brain’s structure and function to reveal short and long-term effects, such as personality changes, physical changes, and an increased tolerance for the addictive substance. This could potentially lead to a physical dependence on that substance.

How Common is Addiction?

Addiction is surprisingly common, and studies indicate that 10% of American adults have had a substance use disorder at some point in their lifetimes. Studies on addiction and substance use have also revealed that nearly 75% of those American adults have never sought treatment for their addiction.²

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How are Depression and Addiction Connected?

Depression and addiction are often co-occurring disorders. For people with depression, using certain substances to help cope with their emotions can quickly snowball into a serious addiction and create a vicious cycle of emotional ups and downs.

Certain medications, including the prolonged use of opioids, are also linked to increased new-onset depression.

It is common for those dealing with substance use disorders to receive a dual diagnosis of depression or another mental health disorder, and vice versa. Nearly one-third of individuals with major depressive disorder were also found to have substance abuse disorders. The presence of these co-occurring disorders also increases the likelihood of further psychiatric impairments and suicide.³

Depression Leading to Drugs

Millions of adults living with depression, whether diagnosed or undiagnosed, might not know how best to cope. For some, getting the help of a professional may feel too vulnerable, or they may not know how to find the help they need. For others, professional treatment may be too costly. Many more who are undiagnosed may not recognize that they require professional help.

Regardless of the reason, many individuals with depression turn to unhealthy coping habits to deal with its effects. This can include leaning on substances such as drugs and alcohol.

DAD Effect

Depression and addiction can take over the lives of many, and they may not feel in control or even be aware of the impacts. This can lead to the DAD effect.

The DAD effect is when someone with depression (D) also struggles with addiction (A) and experiences denial over this fact (D). The DAD effect can occur when someone is ashamed of their depression or addiction. Others may not even be aware of the fact that they need help.

Depression, Addiction, and Denial

When individuals with depression avoid processing their emotions and their addictions, this can negatively impact them long term and prevent them from getting the necessary help.

By avoiding treatment, the effects of depression can be long-lasting, and the health impacts of substance abuse can be detrimental. When these co-occurring disorders go untreated, they can lead to further mental/physical health complications, self-harm, and suicide.

The DAD Effect and High Functioning Depression

With high functioning depression, the depression symptoms do not always interfere with one’s day-to-day responsibilities. It’s common for those with high functioning depression to experience the DAD effect because they feel more in control of their emotions and can easily deny the need to seek treatment.

How is Depression Diagnosed?

Depression impacts each individual differently, and there are several methodologies used to determine a diagnosis effectively.

Beck Depression Inventory (BDI-II) – Created by Dr. Aaron T. Beck, the Beck Depression Inventory is one of the most commonly used tools for diagnosing depression and determining its severity. It features 21 multiple-choice, self-reporting questions designed to measure the emotional impact of depression and determine how severe certain symptoms are.⁴

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) – The DSM-5 was published by the American Psychiatric Association. It is a manual used by health care providers in the United States to diagnose mental health disorders like depression. The DSM-5 contains symptoms and other criteria that serve as a guideline to ensure a proper diagnosis.

International Statistical Classification of Diseases and Related Health Problems (ICD-10) – ICD-10 is the World Health Organization’s foundation for the identification of global health trends and statistics. Based on a great deal of compiled clinical input and research, ICD-10 has become a trusted resource for monitoring disease symptoms and diagnosing disorders including depression.⁵

Signs and Symptoms of Depression

While it’s common for everyone to experience sadness or grief, those diagnosed with depression have symptoms for an extended period. These symptoms can severely impact the ability to accomplish day-to-day tasks, including going to work or school or maintaining relationships.

Some signs and symptoms of depression include:

Prolonged, deep feelings of sadness, hopelessness, or feeling “blue”
Difficulty completing normal activities, or a loss of interest in things that are typically enjoyable
Changes in energy levels and sleep patterns, including insomnia or excessive sleep
Neurological changes, such as the inability to concentrate or focus
A marked increase or decrease in appetite
Changes in social activity, such as becoming withdrawn from friends and loved ones
Thoughts of suicide

Most Common Types of Depression

Just as depression varies from person to person, so does the diagnosis. There are many types of depression including:

Bipolar disorder – Formerly referred to as manic depression, bipolar disorder is characterized by periods of mania and extreme happiness, followed by periods of depression. Severe cases of bipolar disorder can also involve delusions or hallucinations.

Atypical depression – Atypical depression is characterized by depression feelings that temporarily dissipate if a positive event happens. Despite its name, it is a common form of depression and can be particularly tricky to diagnose because a person may not appear depressed or consistently display symptoms.

High functioning depression – While all types of depression are severe, high functioning depression can be harder to recognize because this disorder has less impact on a person. Someone with high functioning depression can get through their day-to-day routine without obvious signs of depression.

Psychotic depression – Psychotic depression is characterized by depressive symptoms that include some form of psychosis, such as hallucinations or delusions. Individuals diagnosed with psychotic depression are typically experiencing things not aligned with reality.

Situational depression – Situational depression has many of the same characteristics and symptoms as major depression. The only difference is that it’s brought on by triggering events such as the death of a loved one, a serious illness, or a stressful event. Situational depression will have symptoms that extend beyond a normal reaction.

How are Substance Abuse Disorders Diagnosed?

Similarly to mental health disorders, substance abuse disorders can be diagnosed with a variety of tests and methodologies. Diagnosis requires a thorough evaluation by a healthcare practitioner such as a psychiatrist, psychologist, or a licensed drug and alcohol counselor.

DSM-5 and ICD-10 are both considered useful resources for diagnosing substance abuse disorders and identifying the severity of symptoms. Lab tests such as blood drawing or urine samples can also identify and assess drug use, although they are not definitive tests to diagnose addiction.⁶

Signs and Symptoms of Addiction

People with substance use disorder can have changes in personality, intense cravings, and impaired decision-making abilities. Other common signs and symptoms of addiction include:

Psychological symptoms: obsession, risk-taking, overconsumption, and an inability to stop using the addictive substance.
Physical symptoms: changes in appetite, changes in appearance, increasing tolerance, experiencing withdrawal, and additional damage or disease to other parts of the body resulting from substance use.
Social signs: a lack of interest in hobbies or activities, sudden financial difficulties, secrecy, social withdrawal or solitude, and even legal issues.

Depression Co-Occurring With Common Addiction

Depression and addiction frequently go hand in hand. Many individuals with depression can struggle with substance use disorders as a way to cope with their depression, which in turn exacerbates it and results in an unhealthy cycle.

Typical co-occurring addictions include the use of alcohol, cocaine, amphetamines, or opioids, which inhibit the brain’s pain receptors and alleviate many of the negative side effects of depression.

Treating a Dual Diagnosis of Depression and Addiction

Just as there are many different methods for recognizing and diagnosing depression and addiction, there are also many treatment methods for dual-diagnosis.

Cognitive Behavioral Therapy (CBT) – Cognitive Behavioral Therapy, or CBT, is a psycho-social treatment modality that typically focuses on helping an individual change their thought patterns and behaviors.

Dialectical Behavioral Therapy (DBT) – Dialectical Behavioral Therapy, or DBT, is a type of Cognitive Behavioral Therapy that focuses on high-risk patients with suicidal thoughts or self-destructive behaviors. DBT also focuses on changing negative thought patterns through acceptance.

EMDR Therapy – EMDR, or Eye Movement Desensitization Reprocessing, is a method of psychotherapy that helps individuals to recover from traumatic events by helping the brain to process traumatic memories and overcome them.

Medications – For some individuals, treatment beyond psychotherapy is needed to address depression and addiction. This can include being prescribed medications such as SSRIs, antidepressants, and antipsychotics. These medications can be explored through the help of a medical professional.

Inpatient and outpatient detox – For individuals struggling to overcome their addiction and the subsequent mental health issues such as depression, detox programs can be hugely beneficial. There are many different options for detoxification programs including inpatient stays and outpatient programs like individual and group therapy.