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Co-Occurring Depression and Substance Use Disorder

Depression is a common but serious mood disorder that can cause debilitating symptoms that affect a person’s emotions, thoughts, and daily functioning.1 People with depression are more likely to have a substance use disorder (SUD), and vice versa.2 This is often due to using drugs and alcohol as ways to self-medicate symptoms of depression. When a person experiences at least one mental health disorder and at least one SUD simultaneously, it is known as a comorbidity or co-occurring disorder.2

Managing depression or SUD separately is challenging, but when they co-occur, it can complicate both diagnosis and treatment as many symptoms are masked by either disorder. Furthermore, both depression and SUD have similar underlying triggers that should be addressed.3 Fortunately, integrated treatment that addresses both conditions at the same time is available and can lead to better outcomes and improve a patient’s quality of life.3

What Is Depression?

Depression is a common but serious mood disorder that affects millions of people each year.4 Depression goes beyond feeling sad and can have a profound impact on a person’s emotions, thoughts, and ability to carry out daily activities, such as eating, sleeping, and working.1 Changes in appetite, difficulty concentrating, and sleep disturbances are among the symptoms commonly associated with depression.1 While depression is often self-diagnosed, only a qualified mental health professional can determine whether a person has a depressive disorder.5

Types of Depressive Disorders

There are different types of depressive disorders, but they all share a common feature: a persistent feeling of sadness, emptiness, or irritability.6 These feelings are often accompanied by cognitive and somatic changes that significantly disrupt a person’s ability to function in their personal and professional life.6 What distinguishes one disorder from another is the cause, duration, and timing.6

Some different types of depressive disorders include:1, 6, 7

  • Major depressive disorder (MDD): MDD is characterized by either a depressed mood or a loss of interest in nearly all activities a person previously enjoyed. At least one of those symptoms must persist most of the day, almost every day over two weeks.
  • Persistent depressive disorder (PPD): Also known as dysthymia or dysthymic disorder, PPD is characterized by a depressed mood or excessive sadness that lasts most of the day or more days than not, for at least two years.
  • Premenstrual dysphoric disorder (PMDD): PMDD is characterized by intense emotional and physical symptoms that occur during the premenstrual phase of a person’s cycle and go away around the onset of menses or shortly after.
  • Substance/medication-induced mood disorder: Intoxication and withdrawal from certain substances or medications can also lead to depressive symptoms. In certain cases, depressive symptoms may be characterized as a substance/medication-induced mood disorder.
  • Perinatal depression: This type of depression occurs during (prenatal) or after pregnancy (postpartum).
  • Seasonal affective disorder: This type of depression comes and goes seasonally, typically beginning in the fall or winter and going away in the spring or summer.

People with bipolar disorder also experience depressive episodes, however, bipolar disorder is different from depression as it is preceded by or followed by hypomanic or manic episodes.1 As with depression, addiction and bipolar disorder commonly co-occur.8

The Connection Between Depression and Addiction

People with a substance use disorder (SUD) are at an increased risk of developing a mental health disorder, including depression. Similarly, individuals with a mental health disorder have a higher likelihood of developing a SUD compared to those without.8 Studies suggest that up to 40% of people with depression will experience SUD or alcohol dependence at some point in their lives.9

Despite the high level of co-occurring depression and SUD, one does not necessarily cause the other.10 The relationship between co-occurring disorders is bidirectional and complex and it is not always apparent which disorder came first. However, the two disorders are likely to affect and potentially exacerbate one another.7

Mental health disorders and SUD share common risk factors, including:10, 11

  • Genetic vulnerabilities, which are said to account for 40-60% of a person’s vulnerability to SUD. Links are found between genetic factors and a person’s predisposition for certain substances. Genes can also act indirectly by influencing how a person responds to stress.
  • Environmental influences, such as exposure to stress. Higher levels of stress have been shown to increase impulsivity, which can lead to risk-taking behaviors such as using substances.
  • Childhood adversity or trauma, which can increase a person’s risk of substance use by attempting to reduce symptoms associated with mental health disorders.

Substance use can both contribute to and result from the presence of a mental health disorder. People may be motivated to use substances to self-medicate unwanted mental health disorder symptoms. But while substances may alleviate symptoms in the short term, chronic use and withdrawal can exacerbate symptoms in the long term, contributing to increasing substance use.10, 11

Substance use can also cause changes in specific brain regions that are affected by various mental health disorders. When substance use occurs before the initial symptoms of a mental health disorder, it can induce changes in the function and structure of the brain, which can potentially trigger or “unmask” a mental health disorder.10, 11

How to Treat Co-Occurring Depression and Substance Use Disorder

Treatment that addresses both a mental health disorder and substance use disorder (SUD) is increasingly becoming the standard of care. Studies show that integrating treatment for both disorders can help address a patient’s full range of symptoms, leading to better outcomes compared to treating each disorder separately.12, 13

While there is no single treatment that is right for every patient, treatment for co-occurring disorders often includes a combination of psychotherapy and medication.12, 13 Medication is often a core part of co-occurring disorder treatment, especially for people with depression.13 Patients may be prescribed antidepressants, which can alleviate depressive symptoms and potentially reduce substance use.14 While not all SUD can be treated with medication, certain medications are effective for alcohol use disorder (AUD) and opioid use disorder (OUD).12 Because co-occurring disorders are also associated with health and socioeconomic factors that can make recovery more complex, (e.g., homelessness, legal trouble, unemployment), treatment should be comprehensive and individualized to address a patient’s additional needs outside of substance use.13

Treatment for co-occurring depression and SUD may take place in a range of settings. Patients may begin recovery with a period of medical detox to help them more comfortably and safely withdraw from certain substances before transitioning to an inpatient rehab or outpatient rehab.15

Therapies Used in Treatment for Depression and Substance Use Disorder

Therapies that may be used to treat co-occurring mental health disorders and substance use disorders (SUD) include:7, 12

  • Cognitive-behavioral therapy (CBT): This therapy focuses on the thought processes of a person and how their thoughts contribute to their feelings and behaviors.
  • Dialectical behavioral therapy (DBT): DBT is effective at reducing self-harm behaviors, including substance use.
  • Motivational interviewing (MI): This behavioral therapy focuses on the patient’s perspective and strengthens their motivation for change by addressing and resolving feelings of ambivalence.

How to Find Treatment for Depression and Substance Use Disorder

If you or a loved one need help, treatment is available. You can start the process by talking to your doctor or a qualified mental health practitioner to discuss your situation and ask for referrals to treatment. You can also use online tools like our rehab directory to search for a treatment center based on specific criteria.

American Addiction Centers (AAC) is a leading provider of evidence-based addiction treatment with AAC rehabs nationwide. We specialize in co-occurring disorder treatment, including addiction and anxiety, addiction and ADHD, addiction and PTSD, and beyond. To learn more about your treatment options, contact one of our caring admissions navigators today at .

Does Insurance Cover Rehab for Depression and Substance Use Disorder?

Yes, all insurance providers available in the Marketplace are required to provide substance use disorder (SUD) and behavioral health treatment and cannot deny coverage for a pre-existing condition, according to the Affordable Care Act (ACA).16 Coverage varies based on your specific plan; you can call your provider to inquire about your specific coverage. Using health insurance to pay for rehab is just one way to get help. Additional financial assistance can be found in alternative ways to pay for treatment, which includes sliding scales, loans, and grants specifically designated for people seeking treatment for mental health and addiction.

Take the first step towards a brighter future. Call to connect with a compassionate admissions navigator today. You can also check your insurance benefits at American Addiction Centers facilities in just a few minutes when you fill out the short form below.

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