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Dual Diagnosis: Major Depressive Disorder And Addiction

John Schaffer, LPCC

Medically reviewed by

John Schaffer, LPCC

March 25, 2019

Although many people feel depressed at some point in their lives, some people experience major depressive disorder, or depression, on a daily basis. It can be mentally and physically disruptive, and can (and often does) occur with anxiety as well. Depression is treatable but can drive a person to seek solace through other avenues, like substance abuse, which may lead to addiction.

Dual Diagnosis: What You Need To Know

People who struggle with major depressive disorder may find that drinking alcohol or taking other substances may make their symptoms worse. Unfortunately, these same people are more likely to abuse substances because of their depression—two to three times more likely, according to the Anxiety and Depression Association of America (ADAA). In fact, approximately 20% of people who have a mood disorder, like depression, also suffer from substance abuse.

Substance abuse disorders and major depressive disorders often occur independently, but having both can produce a vicious cycle. In part, this is because symptoms from one disorder may affect or even worsen symptoms of the other. Further, people who have a mood disorder tend to report that substances help to lessen their symptoms, or relax them. What is dangerous, and what they may not realize, is that in the long run, the substance abuse actually negatively affects their symptoms.

However, it is important to note that both major depressive disorder and substance abuse are treatable. Finding treatment which identifies the unique needs of each disorder is key to a full recovery.

Depression Defined

In short terms, depression is a mental health condition which causes a person to experience extreme feelings of:

  • Discouragement
  • Guilt
  • Helplessness
  • Hopelessness
  • Irritability
  • Lack of interest in life
  • Lack of motivation
  • Sadness
  • Worthlessness

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In contrast to previous stigmas associated with major depressive disorder, depression is not merely feelings of sadness, or a person being in a bad mood. These symptoms must be present in the capacity that they interfere with a person’s day-to-day activities, such as spending time with family and friends, schoolwork, job responsibilities, and other obligations.

Major depressive disorder is defined by ADAA as having a number of symptoms for an extended time of two weeks or more. Some symptoms are:

  • Sleep pattern changes—people with the disorder tend to have issues with their normal sleep schedule, and can have trouble falling asleep, staying asleep, sleeping too much or too little, waking up very early, or not being able to sleep.
  • Appetite changes—people may also experience severe weight loss or weight gain, as some people with depression utilize food as a way to cope.
  • Cognitive changes—when depression becomes too severe, a person may struggle to concentrate or make decisions. Additionally, they may have problems with their memory.
  • Changes in energy levels—many people are plagued with fatigue, and have trouble staying on top of their daily routines.
  • Disinterest in life—in addition to losing interest in regular activities, people may no longer enjoy activities they used to find pleasurable, including sex.
  • Decreased self-esteem—this is a direct result of the depressive thoughts which can control a person’s mind during depression.
  • A sense of hopelessness—persons experiencing depression may feel that what they are going through is larger than life. Depression can make a person feel like he or she will never feel fulfilled or hopeful again.
  • Changes to physical activity—depression can affect how a person moves. Someone who is typically very active may become noticeably less so, or a person who is typically calm may exert themselves more than usual (pacing).
  • Displacement of problems—though depressed people may be experiencing emotional issues or stressors, they may also experience physical ailments, such as aches, pains, or digestive disturbances, that do not respond to typical medical treatment.
  • Thoughts of death or suicide—depression may be so stifling as to cause a person to contemplate suicide.

Depressive episodes may be triggered by an event, such as loss of a loved one, a separation, or another significant, emotionally charged event. It is important to realize however, for people suffering from major depressive disorder, episodes may occur, and keep occurring, with no trigger at all. The strain of depression may lead a person to abuse substances, or self-medicate, in an attempt to find relief from their symptoms. For this reason, it is important to seek help and secure proper treatment.

Who Is At Risk For Major Depressive Disorder?

Depression can claim any person of any age, according to the National Institute of Mental Health. They continue to tell us that many factors play a role in contributing to depression: brain composition, biology of the brain, chemistry of the brain, or traumatic events. However, people tend to get depression in either the teen years, or within their 20s and 30s. Also, anxiety may foster depression in some people. People who had anxiety as children are more likely to develop major depressive disorder as adults.

No one will experience depression the same way. Some people will have many or all of the symptoms, while others may have just a few. Some people may only fall victim to depression once, while others may struggle with it for the long-term. The intensity of the symptoms and the amount of times they occur depend largely on the person experiencing them, the stage of the disorder, and the treatment (or lack thereof).

Is Major Depressive Disorder Treatable?

Yes, treatment is available for those suffering from major depressive disorder. The first step is seeking help. Once a person has resources, they can get a referral from a doctor to a psychiatrist or psychologist, or even a family counselor, who can help them work through the stressors, concerns, and symptoms that revolve around their depression.

This mental health professional will also try to determine if the individual is currently abusing substances, so an appropriate plan of care may be implemented. If necessary, the individual may be prescribed certain, non-addictive types of medications, called antidepressants, to help ease some of the more severe symptoms.

There are also several types of therapy which may aid in recovery, and are specific to individual need, some examples include:

  • Cognitive behavioral therapy: focuses on changing a person’s thinking from negative to uplifting, as a means to better control their behaviors
  • Interpersonal therapy: focuses on teaching a person to work through the relationships in their life which may be detrimental to healing from depression.
  • Problem-solving therapy: allows the individual to name their problems and discover proactive and positive ways to solve them.
  • Computer/Internet therapies: a newer form which is available online for those who cannot seek help in person.

In general, treatment for depression must be comprehensive, and address all needs of the individual’s symptoms. If a person struggles with substance abuse, this treatment should cooperate with these needs and treatment as well. Fortunately, good drug rehab programs understand this need, and offer comprehensive care for these dual diagnosis concerns.

Addiction Defined

Addiction is a disease which affects many people. Essentially, it involves compulsive drug seeking, and may involve withdrawals and relapse, even after treatment is sought, according to the National Institute on Drug Abuse. Addiction changes the way a brain works, stimulating the part of the brain which is responsible for pleasure (called “reward” by scientists). Substances affect this reward circuit repeatedly, resulting in the “high” or euphoric feelings experienced by persons afflicted with addiction.

An addiction can negatively affect a person’s life and health in innumerable ways. To start, once a person has become addicted, when not using a substance, he may undergo withdrawal symptoms. Withdrawal can range from moderate symptoms, such as nausea or headaches, to severe symptoms, such as seizures. Certain withdrawal, such as that from alcohol, can even cause death. Prolonged substance abuse can cause serious illness or disease, depending on the substance, including many forms of cancer or communicable diseases.

Though there are many different types of substances, some may include inhalants, opioids (prescription drugs or heroin), cocaine, and alcohol. Whatever the substance, continued use can result in addiction, and can affect overall health, or worsen existing conditions (like depression).

Treating Co-Occurring Disorders

As we’ve discussed above, co-occurring disorders, such as depression and addiction, if left untreated, can aggravate each other, making each disorder worse. Due to this, as with any comorbid disorders, comprehensive treatment should first incorporate an appropriate diagnosis of each disorder, so that a treatment plan may be constructed that addresses the individual’s unique needs.

Within this plan, the provider should take into account treatment methods for other disorders the individual may have, ensuring that the person receive the most comprehensive care. After they’ve thoroughly assessed an individual, they can develop a combination of treatment methods, such as medication and therapies, which target the individual’s specific symptoms.

Even if a person seeks drugs or alcohol as a result of major depressive disorder, treating depression alone will not necessarily rid the person of substance abuse. Therefore, it is important to simultaneously treat both disorders. Dual treatment also decreases the risk of relapse. In example, if a person finds sobriety, but fails to treat their depression, their sobriety may be threatened at a time when their depression worsens. Thus, to ensure the most long-lasting results and best chance at a drug-free life, good treatment should treat any co-occurring disorders that a person struggles with along with addiction.

Getting Help For Your Dual Diagnosis

Nearly one fifth of people with major depressive disorder are also struggling with substance abuse. Because one can largely affect the other, having this dual diagnosis may seem like an endless cycle with grim prospects. It doesn’t have to be that way. Treatment is available for you or your loved one, if you are struggling with comorbidity, treatment that can help you have a more positive and fulfilling life.

Contact us today at to have your concerns heard, find out about resources near you, and to hear about diligent treatment plans that will treat both of your disorders.

Anxiety And Depression Association Of America - Depression

National Alliance Of Mental Health - Depression

National Institute On Drug Abuse - DrugFacts: Treatment Approaches For Drug Addiction

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