According to the Journal of the American Medical Association, 29 percent of people with mental illness also suffer from substance abuse. People who suffer from both depression and substance abuse require special care, as they need proper coordinated treatment for two disorders to fully recover.
Drug Abuse, Depression and Dual Diagnosis
The combination of depression, drug abuse and/or alcoholism is often referred to as “dual diagnosis.” Dual diagnosis simply means that both depression and substance abuse are present, and that both conditions need to be addressed.
It is not always clear whether depression precedes drug or alcohol abuse or if depression arises out of substance abuse. People with untreated depression may use drugs or alcohol in attempt to control depression symptoms. This is called self-medication.
Although self-medication may provide some relief from depression, this relief is always short term. Drugs or alcohol mask symptoms of depression rather than control and alleviate them. Often, symptoms of mental illness return with renewed force as the effects of substance abuse wear off. Tolerance is also an issue: As substance abuse advances, increasing amounts of drugs or alcohol are required to provide relief from depression symptoms. Attempts to self-medicate are not a depression cure, and may lead to addiction.
Depression does not always precede substance abuse. Alcohol or drug abuse can trigger episodes of depression. Ultimately, determining which condition triggered the other is not as important as getting treatment for both.
Signs of Substance Abuse
Substance abuse diagnosis can be complicated by a person’s attempts to hide substance use, or to minimize the severity of the condition. Alcoholics and drug abusers commonly deny that they have a problem.
A person may have a substance abuse problem if she:
- Craves alcohol/drugs
- Develops increased tolerance of the drugÃ•s effects
- Develops physical dependence on the drug
- Engages in risky behavior, such as needle sharing or driving drunk.
- Experiences blackouts (periods of memory loss)
- Fails to complete family or work-related responsibilities
- Feels guilty about substance use
- Hides substance use from others
- Is unable to control substance use
- Lies about substance abuse
Medication, Depression and Substance Abuse
Before starting treatment for depression, substance abuse must cease. Depression treatment often requires the use of antidepressants, which can interact dangerously when mixed with alcohol, street drugs or other inappropriately used medication. A detoxification program for substance abuse is often the first step in depression/drug abuse treatment, followed by combined depression treatment and drug rehabilitation.
Society places a stigma on the victims of substance abuse. It is important to remember that, like depression, drug abuse and alcoholism are illnesses. People with alcohol and drug problems don’t have a “weak will” or a personality flaw. Like depression, substance abuse can affect anyone. Support groups that understand this important truth significantly improve the treatment of depression and substance abuse.
American Psychiatric Association Staff. (2010). Study of combined depression-alcoholism treatment shows higher abstinence rate. Retrieved May 8, 2010, from the American Psychiatric Association website: www.psych.org/MainMenu/Newsroom/NewsReleases/2010-News-Releases/Study-of-Combined-Depression-Alcoholism-Treatment-.aspx.
Depression and Bipolar Support Alliance Staff. (2009). Dual diagnosis and recovery. Retrieved May 8, 2010, from the Depression and Bipolar Support Alliance website: www.dbsalliance.org/site/PageServer?pagename=about_publications_dualdiag.
Healthy Place Staff. (2009). Co-occurrence of depression with medical, psychiatric and substance abuse disorders. Retrieved May 8, 2010, from the Healthy Place website: www.healthyplace.com/addictions/depression-and-addictions/co-occurrence-of-depression-with-medical-psychiatric-and-substance-abuse-disorders/menu-id-54/.
Mental Health America Staff. (n.d.). Factsheet: Co-occurring disorders. Retrieved May 8, 2010, from the Mental Health America website: www.mentalhealthamerica.net/go/co-occurring-disorders.
Mental Health America Staff. (n.d.). Factsheet: Dual diagnosis. Retrieved May 10, 2010, from the Mental Health America website: www.nmha.org/go/information/get-info/co-occurring-disorders/dual-diagnosis.
Regier, D.; Farmer, M., Rae; D., Locke, B.; Keith, S.; Jud, L.; Goodwin, F. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Retrieved May 10, 2010, from the Journal of the American Medical Association website: jama.ama-assn.org/cgi/content/abstract/264/19/2511.