How Depression, Anxiety, and Addiction Go Together and Why it Matters

More than 1 in 5 U.S. adults live with a mental illness, according to the National Institute of Mental Health.¹ Worldwide, 1 in every 2 people will develop a mental health disorder in their lifetime.²

Take a moment to let that sink in. Then ask yourself, How much do we really know about these conditions that impact most of us at some point in our lives?

Mental health issues are not “side issues.” On the contrary, they affect millions of people every single day. Now is the perfect time to focus on depression and anxiety, interrelated mental health conditions that often precipitate addiction.

Depression and Anxiety By the Numbers

According to the 2021 National Survey on Drug Use and Health (NSDUH), approximately 21 million adults (8%) in the U.S. had at least one major depressive episode in the previous year.³ Anxiety disorders are another common mental health concern in the U.S., with more than 40 million adults (19%) having an anxiety disorder.⁴ According to the NSDUH, more than 46 million people had a past-year substance use disorder (SUD).³

Depression, anxiety, and addiction are on the rise, and they’re all interconnected. But before we talk about why depression and anxiety contribute to drug addiction, let’s define these terms.

Defining Depression and Anxiety

Traditional textbook definitions of depression and anxiety describe symptoms, not causes. If you Google “depression,” you’ll get this: “A mental health disorder characterized by persistently depressed mood.” If you search for “anxiety,” you’ll find this: “A mental health disorder characterized by feelings of worry, anxiety, or fear.” These definitions are accurate, but they’re not exactly illuminating. They don’t reveal the root causes.

We like to define depression as “anger turned inward.” This definition is just 3 words long, but it gets straight to the heart of the matter. Depression is anger you haven’t allowed yourself to feel or express. While depression manifests as sadness or numb apathy, it starts as anger. Likewise, we define anxiety as “emotional energy bouncing back and forth, trapped between internal walls.” Anxiety is the sensation you get when you refuse to feel your “off-limits” emotions, such as hurt and anger.

We teach a framework that clarifies the relationship between depression, anxiety, and addiction. It’s called the “Anger-Hurt-Loving” model and points to healing.

Depression, Anxiety, and Addiction

The Anger-Hurt-Loving model peels back the curtain and allows us a glimpse of what’s usually driving addictive behaviors: untreated mental health issues. Here’s what it looks like:

Here’s an explanation of how it works:

• Behind every feeling of anger, there is an underlying hurt. We get angry when something we can’t tolerate is present, or something we need is absent. Either way, we’re angry because a part of us is hurting.
• However, many of us were socialized not to feel or express our anger, so we buried it. The first diagonal line in the model represents how we cut ourselves off from the feeling of anger. As you now know, anger turned inward and becomes depression.
• Now we’ve refused to feel our anger, chances are we don’t want to feel our hurts, either. (Who wants to feel hurt? It hurts!) So we cut ourselves off from that uncomfortable experience, hence the second diagonal line on the model.
• Since we’re not feeling our hurt or anger, our emotional energy (the up-and-down arrows in the model) is bouncing between our internal walls.

And what do we call emotional energy bouncing back and forth? That’s right, anxiety. Similarly, we define panic as the “acceleration of anxiety.” If anxiety is an emotional jog, then panic is a sprint.

How Addiction Plays In

So now we’re depressed, anxious, and at the point of panic. We feel terrible, and we’re desperate to feel good. And sometimes the bar isn’t even that high; we’re just desperate for a break from feeling so bad! We want to avoid our feelings of stress, anxiety, and panic, so we turn to substances. We use substances because we feel bad, not because we are bad.

Fortunately, there is another option. When you allow yourself to feel your feelings instead of stuffing them, you move toward healing.

The best way to sum up the core message of the Anger-Hurt-Loving Model is this: When you apply love to the parts of yourself that hurt, you heal.

You may be thinking, Wait a minute, what about my medications? Don’t they help me to heal too?

The Role of Medications in Healing

While self-medication with illegal substances is fraught with danger, taking legally prescribed medications such as SSRIs for depression and anxiety can do a world of good. Prescription medications can improve and stabilize people with mood disorders … up to a point.

In the short term, medication for depression may well be the perfect fit. But it’s important to address the root causes for the long term, not just alleviate symptoms.

Of course, we want to help people feel better. Of course, we want to provide crisis care. But we also want to give people the tools they need to recover from depression and anxiety.

We typically suggest that people maintain their current medications and dosages as they begin addressing the underlying core issues. Once they’ve had some time to work with a therapist, they can discern if a lower dose is warranted. We often find that chronic mental health issues diminish in intensity, or even disappear altogether, as people learn to apply love to the parts of themselves that hurt.

How to Treat Depression and Anxiety for Recovery

What’s really behind your mood swings, your depression, your anxiety? It’s time to find out. It’s time to treat your mental health conditions, rather than simply medicating them and hoping they’ll go away.

If you’re afraid to try and afraid to feel, don’t be. In offering yourself this compassion and care, you’ll find that you are much stronger than you know.

As author, speaker, and recovering everything Anne Lamott wrote:

“Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work: you don’t give up.”

As you now know, lasting recovery from substance misuse means addressing and healing the underlying core issues that caused depression and anxiety in the first place. So give yourself the tools and support you need to work with the anger and hurt you’ve held at bay. Maybe that means outpatient therapy. Maybe it means choosing inpatient treatment for depression. Everyone is different, but no one should have to go it alone.

American Addiction Centers (AAC) is a leading provider of mental health and substance use disorder treatment. AAC operates top treatment facilities across the U.S. and specializes in co-occurring disorder treatment for those struggling with both mental health conditions and an SUD. If you’re ready to take the next step and learn more about treatment, we’re ready. AAC admissions navigators are available 24/7 at to hear your story and provide resources as needed. Calling is confidential and free, and there is no obligation to enter treatment.