It’s no secret that there is a strong connection between substance use and mental illness. The National Bureau of Economic Research reports that people who have been diagnosed with a mental illness at some point in life consume 69 percent of the nation’s alcohol and 84 percent of the national’s cocaine.1 When a person struggles with substance abuse and a mental illness, this is known as a dual diagnosis or co-occurring disorder.

Depression is a mental illness frequently co-occurring with substance use. The relationship between the two disorders is bi-directional, meaning that people who abuse substances are more likely to suffer from depression, and vice versa. People who are depressed may drink or abuse drugs to lift their mood or escape from feelings of guilt or despair. But substances like alcohol, which is a depressant, can increase feelings of sadness or fatigue. Conversely, people can experience depression after the effects of drugs wear off or as they struggle to cope with how the addiction has impacted their life.2

Article continues below

Do you feel depressed?

Take our 2-minute Depression quiz to see if you may benefit from further diagnosis and treatment.

Take Depression Quiz

Signs of Depression

Roughly one-third of adults who have a substance use disorder also suffer from depression. Among individuals with recurring major depression, roughly 16.5 percent have an alcohol use disorder and 18 percent have a drug use disorder.3 Because drug use symptoms can imitate the symptoms of depression, it can be difficult to diagnose depression when a person is actively using. Depression can look different depending on the person experiencing the disorder. Though some may exhibit more recognizable signs like fatigue and low mood, others may appear more irritable or angry. Other signs of depression can include:4

  • Lack of interest in activities
  • Changes in sleep patterns
  • Changes in appetite
  • Feelings of guilt or despair
  • Lack of energy
  • Trouble concentrating
  • Suicidal thoughts

If you’re not sure whether you have a substance use disorder, you can ask yourself the following questions:5

  • Do you use drugs or alcohol for longer or in larger amounts than you anticipated?
  • Have you tried to cut back your use unsuccessfully?
  • Do you spend a lot of time using, obtaining, or recovering from drugs or alcohol?
  • Do you experience cravings to use or drink?
  • Does substance use interfere with work, school, or home life?
  • Do you continue using even though substance use causes problems in relationships?
  • Do you use drugs or alcohol in situations where it is physically hazardous to do so?
  • Over time, do you need more of the substance to create the desired effect?

Finding Treatment

Comprehensive treatment is available for both depression and substance use and is usually the best course of action. Antidepressants can do a great deal to reduce depressive symptoms, and some medications are available to treat alcohol use disorder, opioid use disorder, and others.6 Research shows that medication frequently is more effective when an individual seeks counseling and behavioral support as well. Many people find that intensive outpatient or inpatient treatment is necessary to curb addiction and learn healthy coping strategies for depression.

When seeking treatment for substance use and depression, you first may need to seek immediate medical attention to address the withdrawal symptoms of drugs or alcohol. Some period of abstinence may be necessary before a clinician can conduct an accurate diagnostic assessment. Also, talk to your doctor about programs that address the dual diagnosis simultaneously. If you simply end the substance use, which has largely served as a way of coping with depression, then your depression may worsen and increase your risk of relapse.

Some with a dual diagnosis can cope well with counseling, medical support, and peer support for addiction. Others may find that intensive inpatient or outpatient treatment programs work best. Effective treatment programs typically utilize peer support (often in the form of group counseling), individual counseling, pharmacotherapy, individualized treatment plans, onsite medical assistance, family involvement, and follow up support to prevent relapse.7 While relapse may and often occurs, people generate the greatest odds for long-term recovery when they treat both the depression and the substance use.

If you have been diagnosed with depression, talk to your doctor about the risk of substance use. You may want to closely monitor your intake of alcohol and seek alternative coping strategies for stress and low mood. If you have an active substance use disorder or a history of substance, it’s possible that you have undiagnosed depression. A combination of regular communication with your physician, counseling, and peer support can help you develop protective coping skills to reduce the risk of relapse or developing depression.


Article Sources
Last Updated: Nov 11, 2020