Addiction is a chronic and relapsing disease involving regions of the brain related to motivation, reward processing, impulse control, and emotional regulation. Those who are addicted to drugs or alcohol cannot control their substance abuse, and behaviors and actions are therefore affected. The National Survey on Drug Use and Health (NSDUH) published that in 2013 approximately 8.6 percent of the American adult population (individuals over age 12) had a substance abuse or dependency issue that needed specialized treatment.
Depression is a mental illness characterized by intense sadness, isolation, hopelessness, and an inability to feel pleasure that may lead to self-destructive behaviors. Depression interferes with an individual’s ability to function on a daily basis. In 2013, the National Institute of Mental Health (NIMH) reported that 6.7 percent of adults in the United States (age 18 or older) had experienced one or more depressive episodes in the past year.
Both substance use disorder (SUD) and depression can interfere with how someone perceives and interacts with the world, create health problems, disrupt personal relationships, cause a drop in work or school production, lead to social withdrawal, and a reduced interest in activities that were enjoyed before.
About 20 percent of those who suffer from a mood disorder, such as depression, also may be dependent on or addicted to drugs, according to the National Institute on Drug Abuse (NIDA). The journal Current Opinions in Psychiatry publishes that a third of all individuals diagnosed with major depressive disorder also have a co-occurring substance abuse disorder. An individual who feels depressed may therefore be more likely to abuse drugs or alcohol, and similarly, someone who abuses drugs or alcohol may be more prone to feelings of depression. When an individual suffers from both addiction and depression, the two disorders are said to be co-occurring, or comorbid. Specialized and integrated treatment models provide the best recovery options for these individuals.
Depression, Addiction, and the Brain
Much research has been done to uncover what might cause mental health disorders and why some people may be more likely to develop an addiction when using drugs or alcohol. The most agreed-upon factors are typically that personal genetics and heritability are likely to play a role, as is the environment surrounding an individual, particularly during the development stage of life.
The specific biology of the brain may also indicate a vulnerability for mental illness and/or addiction. Someone with a family history of depression and/or addiction may be more prone to develop a substance abuse disorder or a mental illness than someone with no genetic predisposition, as twin and gene heritability studies published by the journal Psychiatric Clinics of North America indicate. This does not mean that an individual is guaranteed to develop an addiction or suffer from depression due to a family history of either; it just highlights a potential connection.
Specific regions of the brain, namely the prefrontal cortex, amygdala, and hippocampus, may not function exactly as they are meant to in someone who suffers from depression, as well as an in an individual addicted to drugs or alcohol. These brain regions help regulate emotions, develop working memory, mitigate impulse control and motivation, and are important for processing rewards and rewarding behaviors. The Mount Sinai School of Medicine Neuroscience Department reports that similar parts of the brain that have been tied to depression may also be involved in the onset of addiction.
There are also certain chemicals produced by the brain, known as neurotransmitters, that send messages throughout the central nervous system. These chemical messengers, including dopamine, serotonin, and norepinephrine, tell the brain when to feel happy and relaxed, and when to be stressed or anxious. When someone abuses drugs or alcohol, these neurotransmitters are either artificially increased or blocked from being reabsorbed back into the brain, creating a surge of these chemicals. This is why drugs or alcohol make people feel euphoric, or high, as well as less sad, anxious, or nervous.
Regular abuse of psychoactive substances like alcohol or drugs actually changes the natural production of these neurotransmitters and therefore alters the chemical makeup of the brain and the circuitry related to reward, motivation, and emotional regulation. A dependence on psychoactive substances may be formed as the brain may now rely on the disruption in order to continue to produce these important chemicals at the necessary levels. If the drugs and alcohol are then removed, levels of “happy cells” in the brain may drop drastically. As a result, individuals may suffer from anxiety, agitation, irritability, an inability to feel pleasure, and the onset of depression.
Chronic substance abuse, and subsequent addiction, may actually then trigger depression Psych Central postulates. Conversely, due to the way that abusing substances may elevate moods and seem to improve depressive symptoms, depression may also be the root cause of substance abuse and addiction. Drugs may increase feelings of pleasure in the short-term, and individuals may abuse substances as a coping mechanism or a way to feel better through self-medication. In the long-run, however, drugs and alcohol will actually make depressive symptoms worse and compound substance abuse withdrawal symptoms.
Environmental Influences on Depression and Substance Abuse
Environmental factors may be just as influential as genetic and biological ones when discussing potential root causes for depression and/or addiction. Childhood trauma, including abuse and neglect, may increase vulnerabilities for both disorders.
When an individual feels stressed, levels of certain chemicals in the brain, such as cortisol, may be elevated, and central nervous system functions may be on high alert. When feelings of stress are prolonged and continuous, regions of the brain may be negatively affected and may make it more likely for someone to turn to substance abuse in order to cope. High levels of stress at a young age can therefore be a predictor of future substance, the American Journal of Psychiatry publishes.
Abusing substances at a young age also increases the chances for later becoming addicted to drugs or alcohol. Substance abuse makes changes in the regions of the brain that are not yet fully formed in adolescents and may interfere directly with normal brain growth and development.
Early onset of depression may also increase the odds for an individual to abuse substances as well. NIDA states that both addiction and depression can be considered developmental disorders, and the onset of either at a young and vulnerable age can lead to the development of the other and therefore to a dual diagnosis of depression and addiction.
Other environmental influences may play a role in the likelihood that someone may feel depressed or engage in substance abuse. A lack of a strong support system, isolation, financial problems, peer influences, and school, work, or family issues may all be risk factors for substance abuse and also depression. Again, heightened stress levels due to outside factors can increase the odds that someone may turn to drugs or alcohol to self-medicate difficult or depressive feelings and emotions.
Signs of Depression and Addiction
Both depression and addiction can take years off a person’s life and decrease overall quality of life. The World Health Organization (WHO) publishes that depression is the number cause of disability on a global scale. Of the 350 million people around the world affected by the disorder, potentially less than half will get the proper treatment that could make all the difference.
When you add addiction and substance abuse to the mix, all potential risk factors and health concerns increase. Suicide is a real risk factor for both addiction and depression separately (around 10 percent lifetime risk for each disorder), and together, the risks may be multiplied. Psychology Today estimates that one out of every four individuals with comorbid depression and addiction may be at risk for attempting or completing suicide.
Mood disorders, such as depression, pose the biggest risk for suicide, which is the 10th leading cause of death in America. Individuals who battle a substance use disorder are around six times more likely than the general population to commit suicide. Drug poisoning accounts for 75 percent of all suicide deaths, Psychology Today reports.
Suicide is a preventable cause of death. Both addiction and depression, and the combination of the two disorders, are highly treatable. It is therefore helpful to recognize and understand the signs of depression and addiction in order to be able to get the necessary care and treatment to avoid a tragic outcome.
Signs of depression, as defined by the Statistical and Diagnostic Manual for Mental Disorders Fifth Edition (DSM-5), and published by the National Alliance on Mental Illness (NAMI), include:
- Impaired or slowed psychomotor skills
- Disrupted sleep patterns
- Decreased appetite and potential weight loss
- Loss of energy and fatigue daily
- Lack of interest in activities and/or no pleasure gained by participation
- Indecisiveness and trouble concentrating
- Extreme feelings of unnecessary guilt and worthlessness
- Repeated thoughts of suicide and death
- Prolonged episodes of depressed mood indicated by sadness or irritability
When at least five of these symptoms are present and interfere with daily life within a period of two weeks, depression may be diagnosed.
DSM-5 defines the following as symptoms of addiction, as published by NIDA:
- Inability to control amount of substance abused
- More than one attempt to stop abusing substances without success
- Using substances in situations that are physically risky or dangerous on multiple occasions
- The use of substances in spite of any physical or emotional damage it causes
- Cravings for the substance
- Decreased interest in activities enjoyed in the past
- Inability to be counted on to complete work, school, or family obligations
- Knowledge that substance abuse causes personal and social issues, but continuing abuse
- Development of a tolerance to drugs or alcohol, requiring more or higher doses to be taken each time
- Withdrawal symptoms when the substance leaves the bloodstream
- Substance abuse, recovery from abuse, and obtaining drugs take up much of individual’s time
Those who struggle with addiction may have financial difficulties related to spending money on obtaining drugs or alcohol, and they may also be more likely to suffer an injury due to impairment or intoxication, or even a potentially life-threatening overdose. Individual with drug or alcohol problems may also have related legal problems or be at risk for being involved in criminal or violent behavior related to their substance abuse. Mood swings, disrupted sleep patterns, decreased physical health, and weight fluctuations may be common in those who may be addicted to drugs or alcohol as well.
It’s Never Too Late to Get Help
Treatment for depression, and also for addiction, may involve medications. It is important for all medical and mental health professionals to be on the same page and working together to treat these comorbid disorders simultaneously, in an integrated and comprehensive manner. Some medications may interact with others or be habit-forming and not ideal for an individual with a history of addiction, for example.
Medical detox may employ pharmacological methods to minimize withdrawal symptoms and prevent a return to drug or alcohol abuse, or relapse. Antidepressants are the most commonly used medications in the treatment of depression, which may also be helpful for depression experienced as a side effect of substance withdrawal as well. Commonly prescribed antidepressant medications, as published by NIMH, are usually serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac, Serefam), paroxetine (Paxil, Pexeva), escitalopram (Lexapro), and citalopram (Celexa); or serotonin and norepinephrine reuptake inhibitions (SNRIs), such as duloxetine (Cymbalta) or venlafaxine (Effexor). Another medication that is usually considered an atypical drug is buspirone (Buspar). These medications generally work by enhancing the levels of dopamine, serotonin, and/or norepinephrine in the brain. Treatment for comorbid depression and addiction may be handled either in a residential or outpatient setting, depending on what may benefit the individual most.
Medications are useful in the treatment of depression and comorbid substance abuse; however, they are only part of the answer. Therapy and counseling sessions that work to improve mental health from an organic perspective can be just as, if not more, beneficial for recovery. A comprehensive recovery plan for addiction and depression often includes medications, as well as traditional and alternative treatment methods.