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Dual Diagnosis: 9 Facts You Need To Know About Depression And Substance Abuse

Updated 09 December 2021 Written by Clint MallyMedically Reviewed by Sahar Wahed, RN

Table Of Contents

Does Substance Abuse Cause Depression Or Vice Versa?

Substance abuse can cause depression, and depression can also be a risk factor for substance abuse.

Depression and substance abuse can be cyclic. You might drink or use drugs as a short-term solution for depressive episodes. As you abuse substances, your brain chemistry changes, which can make you feel more depressed.

Conversely, you might begin drinking alcohol or using drugs first. You might have started due to peer pressure or to experiment. The longer you abuse substances, the more likely you will develop depression or another mental health issue.

When you abuse substances, you are less likely to develop healthy coping skills to manage stress.

When you use drugs or alcohol to self-medicate during stressful events or to cope with underlying mental health problems, you aren’t learning healthy coping skills. Without healthy ways to cope in life, you are more vulnerable to mental illness and stress.

You might not know which came first, depression or substance abuse. Treating both disorders at the same time is crucial to recovery from co-occurring mental health and substance use disorders.

How Does Substance Abuse Cause Depression?

Substance abuse can cause depression or worsen your symptoms of depression by changing your brain chemistry.

Drugs and alcohol hijack your brain’s natural reward system, where your brain releases chemicals to help you learn and regulate your emotions. Substance abuse is a shortcut to accessing this system.

As you abuse substances, your brain gets used to the chemical changes. Over time, your brain depends upon drugs and alcohol to regulate your emotions. You might need drugs and alcohol to feel calm or happy.

Substance abuse can intensify your negative emotions and feelings.

While you might abuse substances to feel good, they might cause bad feelings to feel even worse. When you abuse substances, you feel much worse when you aren’t drinking or using drugs. The after-effects of drug and alcohol use can make you feel depressed or anxious.

The cycle of depression and substance abuse continues because you might struggle to feel any emotions without drugs and alcohol.

Substance abuse depletes your brain’s reward system. You can struggle to feel normal when you aren’t using. When you aren’t under the influence, you might feel even lower than you would have before you began abusing substances.

Additionally, substances can alter your appetite, motivation, sleep quality, and other areas that are vital to your mental health.

Stimulant drugs like cocaine and methamphetamine can make it difficult for you to sleep. Marijuana and opioids can make you feel lethargic and sleepy. Although drinking might make you relaxed, alcohol use can disrupt your sleep patterns and serotonin levels.

According to information provided by the National Institutes of Health Clinical Center, “Serotonin is a chemical involved in the regulation of emotions, anxiety, sleep, stress hormones, and other body functions.” 

When you aren’t getting enough quality sleep, your serotonin levels can drop. You can be more vulnerable to stress and have difficulty managing negative emotions. Low levels of serotonin are associated with depression, anxiety, and other mental health disorders.

Antidepressants can help to restore your natural serotonin levels. However, if you continue to use substances while treating your depression, antidepressants will not be as effective. Substances can interfere with prescription medications and treatment outcomes.

Treating substance abuse and depression together is needed to get better from both issues.

If you are in therapy for depression, you might worsen your symptoms if you continue to drink or use drugs. Getting sober while you treat your depression will lead to better outcomes during your treatment and recovery.

While substance abuse can cause depression, you might have had depression before using drugs and alcohol. You might not have realized that you had a mental illness until you began substance abuse treatment.

Is Depression A Risk Factor For Substance Abuse?

Any underlying mental illness, including depression, can be a risk factor for substance abuse.

According to the National Institute on Drug Abuse (NIDA), studies “suggest that youth with substance use disorders also have high rates of co-occurring mental illness, such as depression and anxiety.”

Comorbidity, or the existence of two or more disorders in one person, is common among both adults and adolescents with substance use disorders. When you have undiagnosed depression, you might self-medicate with drugs or alcohol.

The risk factors of mental illness and substance abuse are similar. 

Since the risk factors of either disorder are similar, you are more likely to develop both disorders. Therefore, if you have depression, drug or alcohol abuse could also become an issue for you.

Some of the risk factors of depression and substance abuse include:

  • Family history of mental illness and substance abuse
  • Adverse childhood experiences (ACEs) or “potentially traumatic events that occur in childhood” and other trauma disorders
  • Low self-esteem
  • Poor relationships with family members
  • Poverty
  • Being the victim of bullying
  • Victim of sexual assault or abuse
  • Stress at home, like parental conflicts or siblings with behavioral health issues
  • LGBTQA+ youth are more likely to have mental health and substance use disorders than heterosexual youth

These risk factors can cause you to feel sad for long periods of time, developing into depression. You are more likely to use substances to cope with these issues.

What Are The Symptoms Of Depression?

According to the National Institute of Mental Health (NIMH), symptoms of depression include:

  • Feelings of sadness and emptiness
  • Irritability
  • Low energy and fatigue
  • Feelings of guilt, hopelessness, and worthlessness
  • Loss of interest in activities and hobbies
  • Trouble concentrating and focusing
  • Restless and unable to sit still
  • Sleeping too much or too little
  • Changes in appetite
  • Reporting health problems, like pain or stomachaches, without physical causes
  • Thoughts of death or suicide
  • Self-harm and suicide attempts

While you might feel sad once in a while, when your sadness doesn’t seem to go away, you might have depression. A diagnosis of clinical depression means you have these symptoms for two weeks or more.

You can treat your depression by talking to your doctor or health care provider about your symptoms. Interventions for depression include support groups, therapy, and medications.

Not all depression is the same, and there are different depressive disorders, including:

  • Major depression disorder (MDD): You might think of this disorder when you think of depression. MDD is also called clinical depression and can be episodic or chronic.
  • Dysthymia: If you have had a depressed mood for more than two years, you might have dysthymia also called persistent depressive disorder. Symptoms of dysthymia tend to be less severe than other types of depression.
  • Seasonal Affective Disorder (SAD): The low levels of sunlight during the winter can cause you to feel depressed during this season. Your symptoms will likely improve during the spring and return every winter.
  • Psychotic depression: When you lose touch with reality or experience delusions and hallucinations, you could be diagnosed with psychosis. Psychotic depression means that psychosis accompanies your symptoms of depression.
  • Bipolar Disorder: Another type of mood disorder that includes periods of extreme highs (mania) and extreme lows (depression). During the low phase, you might have the same symptoms as other depressive disorders.

Mood disorders like these can be treated by mental health professionals. Sometimes, having another mental health issue, like anxiety, attention-deficit hyperactivity disorder (ADHD), or post-traumatic stress disorder (PTSD), can co-occur with depressive symptoms.

For example, if you have a social anxiety disorder, you might struggle to fit in with others, leading to low self-esteem and depression. Any of these mental health disorders are likely to co-occur with a substance use disorder.

What Are The Signs Of Substance Abuse?

According to Youth.gov, the following warning signs could indicate substance abuse in teens and young adults:

  • Mood changes like irritability, temper tantrums, and getting defensive
  • Problems at school, like failing grades, skipping class, and getting into trouble
  • Change in friend group and not introducing new friends to parents
  • Acting like “nothing matters” (low energy, poor hygiene, sloppy appearance)
  • Finding evidence of substance abuse:
    • Vaping devices
    • Drug paraphernalia
    • Alcohol
    • Pills
  • Physical symptoms like slurred speech and trouble with coordination
  • Difficulty thinking, concentrating, or focusing

If you suspect that your loved one is abusing substances, talk to them in a straightforward manner. You want to speak from a place of concern and not judgment, shaming, or blaming. Signs of substance abuse can look similar to mental health issues like depression.

What Is The Difference Between Substance Abuse And Substance Dependence?

Substance abuse might lead to dependence and addiction.

Substance abuse does not always mean that you have a substance dependence. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) considers substance abuse and addiction on the spectrum of substance use disorders.

According to the Centers for Disease Control and Prevention (CDC), teen substance use includes some of the following statistics:

  • “Alcohol, marijuana, and tobacco are substances most commonly used by adolescents.
  • By 12th grade, about two-thirds of students have tried alcohol.
  • About half of 9th through 12th grade students reported ever having used marijuana.
  • About 4 in 10 9th through 12th grade students reported having tried cigarettes.
  • Among 12th graders, close to 2 in 10 reported using prescription medicine without a prescription.”

Having a substance use disorder means that you use drugs or alcohol despite adverse consequences. You continue to use drugs and alcohol despite getting into legal troubles, disrupting relationships, failing school, or developing mental and physical health problems.

When you have a substance use disorder, you are more likely to experience dangerous or life-threatening events.

While under the influence of drugs or alcohol, you might engage in risky behaviors, like unsafe sex or reckless driving. If you continue to abuse substances, you can develop a dependence.

A substance dependence means that your brain and body now need drugs or alcohol to function.

You might have cravings or have withdrawal symptoms if you try to quit. If you need more substances for the same effects, you could be developing a tolerance. If you use substances frequently or “binge” in large amounts, the more likely you will become dependent.

Substance use disorders and dependency usually go hand in hand, making it difficult to quit without support or treatment. Detox at a treatment facility can help you safely manage withdrawal symptoms when you are dependent on drugs or alcohol.

Is My Child Self-Medicating For Their Depression?

Your child might be self-medicating for their depression with drugs or alcohol.

Teens and young adults might not know how to reach out for help. They also might not even realize that they have a mood disorder like depression. Young people go through many changes that can cause mood swings and other behavioral issues.

However, if you notice depressive symptoms or signs of substance abuse, these changes might mean your child has an underlying mental health disorder.

If you are concerned about your child’s mental health, speak to your doctor or other trusted health care professional. They can make an evaluation and determine what is going on with your child.

When your child uses substances to self-medicate for symptoms of depression, they are at a greater risk of developing a substance use disorder. Your teen might need addiction treatment to address both issues at the same time.

Does Addiction Treatment Address Depression And Other Mental Health Disorders?

Many addiction treatment centers also address co-occurring mental health disorders with dual diagnosis treatment.

Due to the strong connection between mental health and substance use disorders, most treatment programs will address both. Getting dual diagnosis treatment for both disorders at the same time will give you the best outcomes in recovery.

According to the 2019 National Survey on Drug Use and Health (NSDUH), “Adolescents aged 12 to 17 who had a past year MDE [major depressive episode] were more likely to use substances compared with their counterparts who did not have an MDE in the past year.”

Treatment facilities that address a dual diagnosis will help you end the cycle of substance abuse and depression. Treatment options include inpatient rehab, intensive outpatient programs (IOP), virtual IOP or telehealth, and outpatient therapy.

Support groups can also play a vital role in treating dual diagnoses.

Many young adults and teens struggling with a dual diagnosis benefit from peer support. You can learn from your peers as each person shares with the group. Peer support is an essential part of your dual diagnosis treatment plan.

What Causes Depression In Teens And Young Adults?

Teens and young adults deal with a lot of significant life changes that can cause stress and depression.

Young people are more vulnerable to depression and stress for several reasons. Teens are under a lot of pressure to make big decisions as they approach adulthood. Young adults need to navigate relationships, career paths, and living on their own.

In addition, teens deal with hormone changes that make their emotional experiences much more powerful than adults. Teens are more likely to have trouble regulating both positive and negative emotions.

The intensity of emotions and the underdeveloped adolescent brain coupled with the pressures of young adulthood contribute to depression in young people.

The human brain is not fully developed until around the age of 25. Yet, teens need to make adult decisions as they grow up. Managing these changes can create mental health issues in young adults if they do not have support and guidance.

Young people might need support from adults and others to manage these issues and develop skills like decision-making, emotional regulation, impulse control, and planning. Kids need help from the adults in their lives to successfully transition to adulthood themselves.

The COVID-19 pandemic might have added to the stressors that young people now face.

With school closures, lockdowns, uncertainty, and fear, the pandemic has increased mental health symptoms in teens and young adults. Teens might turn to substances to cope, which can add to the cycle of depression.

According to the CDC, “Stress, anxiety, and depression caused by isolation and other changes to your way of life during the COVID-19 pandemic can also increase your risk for a substance use disorder.”

While substance abuse can cause depression or stem from underlying depression, it is essential to help young people find healthy ways to cope with stress. Healthy coping mechanisms can lessen your child’s chance of developing or worsening depression.

However, some teens and young adults can develop depression or mental illness regardless of the presence of adults in their lives.

While parents play a vital role in protecting their kids from developing a mental health disorder, you can’t always control these issues. Depression could be caused by genetics and biological factors. Your teen can get treatment and learn to manage these symptoms.

For teens and young adults with depression, you can help them by encouraging and supporting them through mental health treatment. With help from family members, therapy, psychiatry, and support groups, teens can recover from depression.

Young adult and teen substance abuse can cause or worsen symptoms of depression. Sandstone Care is here to support teens and young adults with substance use and mental health disorders. Call (888) 850-1890.