It is critically important for people in recovery to understand that addiction is usually co-occurring with other disorders. In fact, even though addiction can be diagnosed on its own, it is frequently the end result of some other pre-existing causal disorder, such as anxiety, posttraumatic stress disorder, and most often, depression.
According to the National Center for Biotechnology Information, almost 64% of individuals with an addiction to alcohol meet the qualifications for a clinical diagnosis of depression.
Why is this the case?
First, both conditions – depression and addiction – are influenced by similar genetic and environmental factors that, when coupled, increase the chances of developing both disorders. Some of those factors might include:
- Heredity – Recent research has suggested that an individual’s genetic makeup can predispose them to both mental health disorders and substance abuse.
- Development of the Brain – Drug use/alcoholism while the brain is still developing – i.e. the teenage years – increases the chances of a subsequent co-occurring disorder.
- Neurology – When a person has a deficiency in the neurotransmitters that affect emotional stability, it can cause both substance abuse and mood disorders.
- Trauma/Stress – When a person survives an extremely traumatic event – divorce, death of a loved one, physical/emotional/sexual abuse – that person can be thereafter prone to mental illness/addiction.
Second, having either disorder can be a causal factor in developing the other. Having either condition increases the likelihood of eventually having the other. Simply put, addiction predicts depression, and depression predicts addiction.
For example, alcohol use disorder – the most common addiction – and clinical depression each are associated with a double risk of either disorder.
The symptoms of many mental health disorders so closely resemble those of addiction that sometimes, even a trained psychiatrist can have difficulty judging where one illness begins and the other ends.
Let’s take a closer look at the self-perpetuating cycle of depression and addiction–
- A person suffering an addiction will often experience other unpleasant consequences as a result – problems with money, strained personal relationships, difficulties at work, legal entanglements, health issues, etc. Each of these can have a profound negative impact upon a person’s self-esteem, resulting in depression.
- Chronic substance abuse can lead to changes within the brain, resulting in mental instability, wild mood swings, impulsiveness, poor decision-making, confusion, and memory loss, all of which can leave a person vulnerable to depression.
- Conversely, many people who suffer from depression will try to help themselves by self-medicating with illicit or prescription drugs, excessive amounts of alcohol, or other addictive behaviors.
The study also found that substance abuse – specifically alcohol abuse – was more commonly a causal factor in developing depression than the opposite.
Another important finding of the study was the fact that when a person with depression uses multiple drugs, it can interfere with recovery and trigger a relapse. Marijuana, for example, can be particularly problematic when used by a person in treatment for dependence on alcohol, because it robs a person of their motivation to change.
Warning Signs of a Dual Diagnosis
Although addiction and depression are different disorders, they share many symptoms, and this can confuse an accurate dual diagnosis. However, there are some signs of co-current illnesses that can help determine if treatment on multiple fronts is warranted –
- feeling hopeless, sad, or tearful for an extended period – more than two weeks – even when there has been no drug or alcohol use
- using drugs/alcohol to deal with painful memories or unpleasant feelings
- becoming increasingly isolated because of alcohol or drugs
- relying on drugs just to get through the day
- difficulties in professional and personal relationships because of a drug or alcohol abuse
- past treatment for depression or another mental disorder
- a personal history of trauma or abuse that has never been discussed with a professional mental health specialist
None of these signs are, in and of themselves, and the absolute indicator of co-current disorders. However, since the two sides – mental disorders and addiction disorders – are so intertwined, it is, in fact, a good idea to assume a dual diagnosis until it can be actually ruled out by a professional.
The Partnership for Drug-Free Kids agrees because they recommend that the treatment of co-occurring disorders needs to be approached as a separate discipline that combines the best practices of addiction treatment with the most effective practices in psychiatry.
The treatment of concurrent disorders – typically, mental (ex. anxiety or depression) and chemical (ex. drug addiction or alcoholism) – is one of the fundamental principles of substance abuse rehabilitation therapy, according to the National Institute on Drug Abuse.
When treating co-occurring disorders, the most effective plan is a “dual-treatment” technique, where both conditions are regarded as the primary disorder. Stated another way, the treatment plan is devised to offer the sufferer relief and healing from both illnesses.
The converse of that is also true – unless addiction treatment is combined with treatment for the co-occurring disorder, a complete, healthy recovery probably will not happen.
Is There a Link Between Substance Abuse and Depression in Teens?
Yes, there is, and it is a very strong link. The National Institute on Drug Abuse indicates a study that was done by researchers at the University of Southern California. They found that negative urgency – or acting impulsively during times of negative emotions – is what links depressive symptoms and the start of abusing substances.
Depression symptoms can quickly become overwhelming for teens. But because of their age, they are often reluctant to share these types of concerns with authority figures. They may already be experiencing a breakdown in communication with their parents. That can make talking about their mental health a subject that is completely taboo.
Instead, they will often self-medicate using drugs or alcohol. While this is extremely dangerous because of their still-developing brains, there are other risks as well. For example, and teen may begin by smoking cigarettes. They may gradually switch to alcohol, marijuana or even harder drugs just to continue getting relief for their symptoms.
How Many Teens are Abusing Alcohol?
Underage drinking has been a serious problem in the United States for decades. Alcohol is the most commonly used substance of abuse among teens, and it poses huge health and safety risks.
The National Institute on Alcohol Abuse and Alcoholism reports that:
- By the age of 15, around 29.8% of teens have consumed at least one alcoholic drink.
- But by the age of 18, that percentage goes up to around 58%.
- In 2018, more than 7.1 million youth between the ages of 12-20 admitted to having an alcoholic drink in the last month.
- 11% of all alcohol that is consumed in the United States is by people ages 12-20.
- Most of the time, the alcohol they drink is consumed through binge drinking behaviors.
- In fact, more than 90% of the alcohol young people drink is consumed this way.
- 4.3 million young people admit to binge drinking at least once during the last 30 days.
- More than 860,000 people say that they have participated in binge drinking on five or more occasions during the last 30 days.
Why Do Teens Drink?
There are several reasons why teens may be tempted to start drinking. They include:
- They may have had the behavior modeled for them.
- The media appears to make it seem very popular.
- They use it to self-medicate and escape their reality.
- They are bored.
- It is an act of rebellion.
- They crave the instant effects.
- They do not have enough self-confidence.
- They are misinformed about the dangers of drinking.
Depression and Alcohol Abuse for Teens Increases the Risk of Suicide
Depression can quickly accelerate in teens, leading to almost consistent suicidal thoughts. A lot of young people will drink alcohol as a way to cope and help themselves feel better for at least a little while. But what they often do not realize is that once they get sober again, their symptoms are likely to be much worse than they were. This puts them at an even greater risk of committing suicide.
It is important for parents to understand the connection between teen suicide and alcohol abuse. By intervening quickly, they may be able to save their children’s lives.
How Many Teens are Abusing Drugs?
The National Institute on Drug Abuse reports that in 2019:
- 25% of 10th graders had tried some form of vaping.
- 30.9% of 12th grades had tried it, and the majority of them do it regularly.
- 82% of high school seniors reported that vaping products were easy to get.
- 6.6% of 8th graders, 18.4% of 10th graders and 22.3% of 12th graders admit to using marijuana within the last month.
- 11.8% of 8th graders, 28.8% of 10th graders and 35.7% of 12th graders admit to having used marijuana within the last year.
- 86.4% of teens say that when they use marijuana, they smoke it.
- The number of youth abusing prescription opioids has decreased down to just 2.7%.
- Heroin use is also decreasing among youth. Only 0.3% of 10th graders and 0.4% of 12th graders admit to using this drug within the last year.
- The use of other illicit drugs, such as cocaine, methamphetamine or synthetic cannabinoids has remained steady across all grade levels. These numbers are relatively low.
Why are Teens Abusing Drugs?
There are a number of reasons why teens feel the need to use drugs, according to NIDA:
- They believe that everyone is doing it, so they want to fit in.
- It evokes feelings of pleasure and gives them relief from their mental health symptoms.
- They enjoy the euphoric feelings that result.
- They want to do better in school, which can lead to the misuse of prescription stimulants.
- They are curious and they want to experience the effects.
The Dangers of Youth Drug Addiction and Depression
There is always the concern of ever-increasing tolerance levels in teens when it comes to drug abuse. Many teens may not realize that their bodies will get used to the drugs they use over time. To compensate, they will need to increase their dosage, add new drugs or alcohol into the mix, or switch to more potent drugs.
This results in an ongoing cycle that is extremely difficult to stop. That is why professional treatment is highly recommended at the first sign of depression in teens.
Accommodating, Individually-Tailored Treatment
Any person seeking to enter rehab should first investigate to see if the facility offers treatment that is specific for patients who have been dually-diagnosed. Ideally, the staff should be fully-credentialed for co-occurring illnesses. At a minimum, there should be licensed addiction specialists and licensed psychiatrist specializing in the mental disorders most commonly affecting your alcoholics/addicts.
When treating co-occurring disorders such as addiction and depression simultaneously, the facilities that follow the best practices should always consider medication-assisted detox and rehab.
In addition to the typical 12-Step approach that is used by most drug and alcohol rehabilitation facilities, a center that specializes in dual diagnosis should also offer therapy sessions and group settings that can meet the needs of individuals with diagnosable mental illnesses.
Some of the symptoms that could be addressed are:
- extreme social anxiety
- extended periods characterized by a difficulty in focusing
- a crippling lack of motivation
- the intrusion of negative or harmful thought patterns
For a dual-diagnosed treatment plan designed at treating people with co-occurring disorders, the treatment plan used, by necessity, must be individually tailored to each patient. A cookie-cutter approach will not work, because one person’s addiction is not another’s, one person’s causal trauma is not another’s, and one person’s mental disorder is not another’s.
Some requirements of a proper program might include:
- a thorough pre-evaluation and case history of the patient’s psychiatric health – both past and present – and a detailed history of their past and current drug use
- medication therapy that can alleviate the most severe symptoms of the existing mental disorder
- individual counseling sessions to address the link between the mental disorder and the addiction
- group therapy with other patients who are dually-diagnosed
- the use of holistic therapies such as the size, yoga, acupuncture, or exercise to restore a person’s mind/body/spirit balance
- the inclusion of counseling and education for spouses and children
- most importantly, supportive aftercare that continues past the conclusion of rehab
If your loved one is battling the twin demons of addiction and a mental disorder such as depression, the first and the very best thing you can do to help them is to educate yourself about co-occurring disorders.
Help for the Family
Most often, substance abusers of all stripes, especially those with co-occurring disorders are deeply in denial about the state of their lives and the absolute necessity for help. Therefore, family interventions are frequently necessary in order to compel the addict/alcoholic into rehab.
Unfortunately, at this point, some facilities will then stop including the family in the treatment program. The family is left to figure out how to proceed all on its own.
This is a mistake.
The best addiction/depression rehab facilities will first offer classes designed to educate families about the separate diagnoses of addiction and depression, and then step it up to illustrate how the two combine.
Counseling sessions, both individual and group, should be offered to show the long-suffering spouses and families how to gain serenity and sanity no matter what their loved one is doing.
Finally, there should be private sessions that include only the addict/alcoholic and the family, as the focus is moved to the reintegration of the now “recovering” addict back into the folds of his/her loved ones. The dynamic will definitely have changed, and adjustments will need to be made.
Living with any sort of addiction can be hellish. So can living with a mental condition such as depression. When a person can be dually diagnosed with both, it becomes all that more imperative that the proper treatment, medications, and support need to be incorporated into any treatment plan.
Only when the approach is both comprehensive and individualized can the chances of a lasting recovery be maximized.
Help is Available: The Imagine Program at Northpoint
Imagine by Northpoint is the name of our outpatient teen mental health and addiction treatment program. We are located in Nampa, Idaho and we work with young people aged 12-17.
Our clients and their families are always treated as individuals when they come to us for help. We aim to provide targeted therapy and treatment that is based on their unique needs. They participate in multiple forms of care, such as group therapy, family therapy, and psychiatric evaluations.
This is a very intensive program because it is a day treatment center. It is an environment where teens can heal and thrive.