Everyone has bad days. Whether it’s because of problems at home, at work or in our relationships, we all experience down periods in our lives. For most people, the down periods come and go in a reasonable, ordinary fashion and can be remedied by things that make us happy.
But for those who suffer from depression, the emotional low periods don’t go away so easily. Clinical depression is a serious mental disability with severe consequences for the individual and his or her loved ones.
Depression affects millions of people – keeping them from living normal, happy lives. The Centers for Disease Control and Prevention (CDC) estimates that 10 percent of Americans suffer from this psychiatric disorder.
The following groups have the highest risk of depression, according to data compiled by the CDC:
- Middle-aged adults between the ages of 45 and 64
- African Americans and Hispanics
- People who are unable to work or who are chronically unemployed
- People who lack private medical insurance or public health benefits
Substance abuse is common among people who are battling a depressive disorder. Because alcohol is a central nervous system depressant, the use of this drug tends to trigger depression symptoms like lethargy, sadness and hopelessness. However, many depressed individuals reach for drugs or alcohol as a way to lift their spirits or to numb painful thoughts. As a result, depression and substance abuse feed into each other, and one condition will often make the other worse.
When an individual has both depression and an addiction, it is called a Dual Diagnosis. A Dual Diagnosis can be made up of any combination of a mental disorder (anxiety, depression, bipolar disorder) and addiction (drugs, alcohol, sex, gambling). Dual Diagnoses that include depressive disorders are among the most common forms of the problem; in fact, the Journal of Clinical Psychiatry reports that one in three adults who struggle with alcohol or drug abuse also suffers from depression.
Clinical depression poses a high risk of accidental injury, self-harm and suicide. Depression can also suppress the immune system and weaken the body, making you more susceptible to physical ailments and chronic illness. When you add drugs or alcohol to the mix, the risks to your physical and emotional health increase exponentially. Enrolling in a specialized treatment program can help you avoid the devastating effects of depression and substance abuse and help you create the healthy, satisfying life you deserve.
Is It Depression or Just ‘the Blues’?
While most of us have been through periods of sadness, grief, irritability or frustration, there’s a difference between having clinical depression and suffering from a temporary case of “the blues.” According to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV), clinical depression lasts for at least two weeks, interfering with your ability to work, maintain healthy relationships and function socially.
People with depression may experience five or more of the following symptoms on a daily basis:
- Feelings of hopelessness
- Loss of appetite/weight loss
- Increased appetite/weight gain
- Sleeping too much or too little
- Ache and pains
- Loss of energy
- Feelings of guilt
- A sense of worthlessness
- General irritability
- Difficulty concentrating on daily tasks
- A loss of interest in activities or hobbies
- Suicidal thoughts or suicide attempts
Depression frequently manifests itself in feelings of sadness, low energy and hopelessness. However, some people, especially males, experience depression as irritability, hostility or anger. Regardless of how depression appears to others, it should be clear that this mental condition is different from the individual’s usual emotional state. Feelings of grief or bereavement after a serious loss, such as the death of a loved one or the loss of a home, are not considered to be the same as clinical depression unless these feelings continue for more than two months.
Unlike clinical depression, a sad mood or a case of “the blues” probably won’t interfere with your ability to go to work or pursue your usual activities.
When you’re depressed by the loss of a job or the end of a relationship, you can see a connection between the event and your emotions, and you know that this emotional state will come to an end after the crisis has resolved. With clinical depression, the basic tasks of day-to-day life may seem impossible, and the mood seems permanent. Drinking heavily, using drugs, gambling or having unsafe sex might seem like the only way to resolve the overwhelming pain and emptiness that you feel when you have a depressive disorder.
A Gateway to Addiction
Depression is all too often a gateway into drug and alcohol use. It’s easy to see why. Those who experience feelings of depressions take alcohol and drugs in order to escape their negative emotions. But those who are clinically depressed are going to stay depressed if they do not seek treatment. And if these individuals are using drugs and alcohol on a regular basis, chances are their usage will soon turn into full-blown addiction as they continue in a vain attempt to self-medicate.
The warning signs of addiction include:
- Tolerance. Your body becomes accustomed to the effects of the drug and requires larger amounts to achieve the same effects.
- Withdrawal. If you reduce your intake of the drug, you experience physical symptoms like nervousness, nausea, tremors, cold sweats or agitation.
- Remorse. You feel guilty or sad after you’ve used the drug, even though you take the drug in order to feel better.
- Relapse. Whenever you try to stop using the drug, cravings or withdrawal symptoms drive you back to your destructive habits.
For some individuals who have depression and a substance use disorder, giving up drugs or alcohol can actually make depression worse. If you’ve been using alcohol for years to bury your depressive symptoms, you may find that your depression rises to the surface in sobriety. That’s why it’s so important to receive integrated treatment for both depression and substance abuse at the same time.
Without treating the depression that drives your addiction, or vice versa, you’re likely to go back to your addictive behaviors or to experience a return of your depressive symptoms as soon as you finish rehabilitation. In many cases, people who have depression and substance abuse drop out of conventional rehab programs because sobriety is too much to handle without the right level of therapeutic support.
Recovering From Depression and Substance Abuse
What makes a Dual Diagnosis so hard to treat is that each disorder can intensify the symptoms of the other. Drinking excessive amounts of alcohol, for instance, is not going to make the depression better; in fact, it will make the condition more serious. And conversely, if a person is an alcoholic, their depression will likely keep them from attaining the proper mindset to overcome their addiction to alcohol.
There is a high level of complexity involved in treating the Dual Diagnosis patient. It is a well-known fact that those who have a Dual Diagnosis will not get the care they need in a traditional, one-dimensional rehab program.
Only those programs equipped to handle psychiatric problems as well as drug and alcohol addiction will be able to assist with proper detox, counseling and aftercare planning. An integrated Dual Diagnosis program incorporates counseling, peer support, education, and relapse prevention for both depression and substance abuse.
According to the Substance Abuse and Mental Health Services Administration, an integrated treatment plan includes these goals:
- Helping the client understand the nature of depression
- Teaching the client that recovery from depression and addiction is possible
- Motivating the client to make major changes in his or her life
- Giving the client practical skills for handling negative thoughts
- Helping the client identify and change addictive behavior patterns
Medication therapy is a core component of recovery for many Dual Diagnosis patients who are faced with depression. Antidepressant drugs have helped many individuals who struggle with this disorder cope with their symptoms and lead stable, fulfilling lives. Finding the right approach to pharmacological treatment can take time and patience, but with the help of qualified staff who are trained in Dual Diagnosis treatment, prescription drugs can provide valuable support.
Support, encouragement and motivation are essential tools in the battle against depression and substance abuse. Clinical depression can drain your energy and make you feel that rehab is a hopeless cause. Individual counseling, peer group support and family counseling can give you the strength you need to continue your recovery journey in spite of the challenges you face.
Where Can I Get Help?
Foundation Recovery Network treatment centers in California and Tennessee understand the complicated nature of Dual Diagnoses. Every day we welcome those who are struggling with depression and drug addiction into our facilities and start them on the road to recovery. At our residential centers — Black Bear Lodge, Michael’s House, Skywood Recovery, and Talbott Recovery Campus — we offer a variety of programs that are designed to help our clients achieve sobriety and simultaneously treat all co-occurring disorders.
Relevant Topics of Discussion
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton