Have you ever tried cheering yourself up with comfort foods or a shopping spree when you’re feeling blue or having a bad day? Or, have you ever smoked a cigarette, or visited the bar for a drink or two with hopes of calming your nerves and lifting your mood?
Engaging in behaviors such as these from time to time can provide a much-needed escape and mood boost during unexpected moments of stress, sadness, or depression, even if just for a short time.
Yet, if you find yourself starting to practice these behaviors regularly and repeatedly, you might be using addiction to cope with the underlying depression. Or, perhaps you’ve already been suffering from drug or alcohol use disorders, and have noticed the onset of depression, or worsened depression symptoms. In any case, there’s a real link between depression and addiction, since each disorder has been found to increase the presence of the other.
Depression and addiction are two mental health disorders that can feed off one another due to the way each of these conditions affects the brain. Those who suffer from depression may frequently turn to drugs and alcohol to mask their symptoms and elevate their moods. At the same time, those who suffer from addiction are generally more predisposed to mood disorders like depression, due to the way alcohol and drugs alter brain chemistry.
So, which comes first, and which condition is more likely to trigger the other — depression or addiction? Does suffering from one condition mean that the onset of the other condition is inevitable?
Here’s a breakdown of the shocking link between drug addiction and depression.
Examining Mental Health in the United States
Depression and addiction affect a significant portion of Americans. Data shows that roughly 8.3% of Americans experience at least one major depressive episode per year. In addition, 21.5 million adults have a co-occurring substance use disorder (SUD) and mental health condition.
Gender has been shown to play a major role in co-occurring disorders involving mood disorders and addiction. Men are more likely to suffer from antisocial personality disorder, while women are more likely to suffer from both anxiety and mood disorders. Anxiety disorders are the most common mental health disorders in the U.S., and affect 19.1% of the population every year. Any mood or anxiety disorder, regardless of a person’s gender, is a known risk factor for substance abuse and drug use disorders.
Depression and the Opioid Crisis
Opioids, or painkillers, are often prescribed to treat moderate to severe pain. In the U.S., opioid abuse and addiction have become a serious public health crisis. In 2024, an estimated 54,743 people in the U.S. died from an opioid overdose.
Pain is a common symptom of depression and can cause discomfort in the form of chronic joint pain, back pain, limb pain, and related symptoms of fatigue, insomnia, and changes in appetite. Many researchers believe that the U.S. opioid epidemic is being driven in part by depression, since some with depression tend to feel more comfortable when admitting to suffering pain versus depression.
Though depression is widely recognized as a treatable mental health condition, some patients fear stigma surrounding their disorder and cite pain as their reason for needing pain treatment.
Opioids produce euphoric effects and offer sedative properties that can put those who suffer from depression at ease. However, given the highly addictive nature of opioids, people can quickly become dependent on these drugs within a short period. Also, opioids are not generally approved for use in treating depression. In some cases, they can even worsen symptoms of depression and increase certain health risks, including suicide.
How Depression and Addiction Affect the Brain
Depression and addiction are both shown to have an impact on the brain’s dopamine balance. Dopamine is a naturally occurring brain chemical involved in the brain’s reward system, and is essential to movement, motivation, and the way a person perceives reality.
Dopamine imbalance has been linked to drug use disorders and psychosis, which is characterized by hallucinations and delusional thoughts. For instance, some studies show that marijuana use increases the risk of psychosis in some individuals.
Alcohol, opioids, and all other drugs either interfere with or bind to receptors in the brain that increase dopamine production. This flood of dopamine is what makes people feel happy or “rewarded” when using drugs and alcohol. Those who get hooked on intense feelings of reward and euphoria will turn to drugs regularly to achieve these effects.
Over time and with regular use, a person can become tolerant to drugs and alcohol and require higher amounts to achieve the effects they’ve grown used to. Tolerance can lead to physical dependence, which is when a person experiences withdrawal symptoms upon ceasing or reducing drug use. When someone becomes physically dependent on drugs and alcohol, their brain stops producing dopamine on its own, and starts relying on substances for happiness and reward. Science shows that prolonged exposure to high dopamine levels can trigger depression.
Drugs most commonly linked to mental health disorders are:
People with depression are twice as likely to become addicted to drugs.
- Marijuana
- Cocaine
- Methamphetamine
- Prescription stimulants (e.g., Adderall, Ritalin)
- MDMA, or ecstasy
- LSD, or acid
- Inhalants
- PCP
- Kratom
- Ketamine
- Steroids
Evidence shows that the existence of drug use disorders and mental illnesses at the same time is generally caused by overlapping factors, including genetic background, underlying brain deficits, and early exposure to trauma or stress. For example, a person with both depression and addiction in their family history may be more predisposed to these mental health conditions than their counterparts. Research shows that between 40 and 60% of a person’s vulnerability to addiction can be attributed to their genetic background.
In cases where drug abuse exists before mental illness, evidence shows that drugs can alter brain chemistry in a way that makes the brain more prone to developing that particular mental illness.
When mental illness exists before drug abuse, the changes in brain chemistry brought on by the mental illness can enhance the positive effects of drugs, while reducing that person’s awareness of the negative effects of drug use. Additionally, some drugs can reduce many unpleasant symptoms associated with depression and other mental health disorders.
Which Comes First: Depression or Addiction?
Considering how drug addiction and depression both affect the brain in similar ways, there is no causal relationship between the two mental health conditions, especially when depression and addiction affect people in different ways, for different reasons. Depression does not always come before addiction, or vice versa.
Certain drug use disorders are known to trigger symptoms of depression in some users. For instance, alcohol use disorder can cause feelings of sadness, hopelessness, and lethargy. On the other hand, depression can also lead to drug abuse, since individuals who suffer from depression frequently turn to drugs and alcohol to self-medicate and reduce their symptoms.
When depression comes first, some drug users tend to choose substances that specifically treat their most problematic symptoms. For instance, a depressed individual struggling with severe fatigue and lack of concentration may abuse prescription stimulants to boost their energy and focus. On the other hand, a depressed individual suffering restlessness and anxiety may turn to opioids or benzodiazepines to help them relax.
When addiction comes first, a person’s drug use can awaken or trigger the onset of depression, especially in instances where mental illness is part of family history. Some drugs even disrupt brain chemistry gradually over time to increase the risk for depression later on.
Data shows that a person who suffers from only depression or addiction is often more susceptible to the other condition by default. Depression increases the risk for addiction, and addiction increases the risk for depression.
Fortunately, drug addiction and depression can be effectively managed and treated using a combination of detox, behavioral therapy, counseling, and other therapies that treat the underlying causes of both disorders.
Treatment for Co-Occurring Disorders
There are several different kinds of treatment that can be used to treat co-occurring disorders. Your physician may recommend one or a combination of these to support your recovery journey.
Medical Detox
Those who suffer co-occurring disorders often go through drug detox first before starting psychological therapy for depression and addiction. Drug detox helps patients overcome physical dependency on drugs and alcohol, and allows them to withdraw from these substances safely with a lowered risk for relapse, overdose, and other health complications. Detox improves one’s physical and mental health so the person can move on to being treated for depression and the root causes of addiction.
Cognitive Behavioral Therapy
Addiction is commonly treated using cognitive-behavioral therapy or CBT, which helps patients identify triggers and negative thoughts and behaviors driving their drug use. CBT teaches patients healthier ways to deal with stressors and other situations without relying on drugs and alcohol. For instance, someone with depression who uses drugs as a way to overcome a loss of interest can learn to modify their thinking and discover new, healthier interests to replace drug use.
12-Step Programs
Other therapies commonly used to treat addiction include 12-step support groups like Alcoholics Anonymous and Narcotics Anonymous, and individual and group counseling. Depression is treated using similar therapies as addiction, since both disorders are mental illnesses. Depression may be treated using CBT, behavioral therapy, and psychotherapy, and may also involve the use of antidepressants and other medications that treat depression.
Aftercare
Long-term therapy and aftercare programs are essential to helping patients stay healthy and drug-free following treatment. Aftercare allows patients to receive ongoing support-group therapy, counseling, and relapse prevention training in the months and years after overcoming drug dependence. Many addiction treatment centers also recommend that those who suffer co-occurring disorders opt for inpatient care, which offers intensive therapy in a safe, controlled environment for those who need help fighting addiction and depression at the same time.
Find Help for Addiction and Depression
It’s never too late to get help for depression and addiction — no matter your age, gender, socioeconomic status, or the severity level of one or both disorders.
Since some signs of depression and addiction overlap, it’s important to seek help immediately. Getting treatment for co-occurring disorders can help you take back control of your life and learn necessary skills for managing depression and staying addiction-free.