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 which 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.
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 this 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.