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What is Depression?
Depression is a severe mood disorder, characterized by negative emotions, low energy, and difficulty anticipating pleasure or happiness. Many depressed people feel sad, but for some, the dominant feelings are anxiety, irritability, emptiness, or guilt. Some depressed people sleep far too much, while some are restless and have persistent insomnia. Depression can manifest in many different ways in different people, but it always impacts the quality of life and interferes with daily functioning.
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Depression is also very common among individuals who suffer from substance abuse disorder, and experiencing both is known as a co-occurring disorder, or dual diagnosis. For some people, depression is the reason they began using drugs or alcohol in the first place, but chronic drug or alcohol use can also cause depression. No matter which problem came first, what’s important is that an individual struggling with both depression and substance use disorder receives dual diagnosis treatment to address both issues.
What are the Signs and Symptoms of Depression?
If you or someone you love is depressed, then at least some of the following signs will have been present nearly every day for most of the day for at least two weeks:
- Persistent “empty,” sad, or anxious mood
- Feelings of worthlessness, guilt, or helplessness
- Feelings of pessimism or hopelessness
- Restlessness or trouble keeping still
- Low energy or fatigue
- Difficulty with concentration, memory, and decision-making
- Feeling “slowed-down.”
- Sleep difficulties such as insomnia, waking up too often or too early, or sleeping too late
- Lack of pleasure or loss of interest in activities, hobbies, or social events
- Changes in appetite or weight
- Unexplained aches and pains, cramps, headaches, or digestive problems
- Thoughts of death or suicide
You don’t have to experience every symptom on the list to be considered depressed. Whether you are suffering from just a few or almost all of these signs, you are experiencing some form of depression and could benefit from treatment.
Types of Depression
- Major Depression: Severe depression that impacts an individual’s ability to eat, sleep, work, study, socialize, take care of themselves, and enjoy life. Major depression severely impairs functioning for months or years at a time, and tends to be chronic, and recur in multiple episodes.
- Persistent Depressive Disorder: Depression that persists for at least two years, often featuring ups and downs, i.e., some episodes of severe depression alternating with episodes with milder symptoms.
- Postpartum depression: Severe depression induced by hormonal changes combined with the physical and emotional challenges of giving birth and caring for a newborn.
- Seasonal affective disorder: Depression that occurs in the winter months and can sometimes be improved with light therapy.
- Psychotic depression: When depression is accompanied by psychotic symptoms such as delusions or hallucinations.
Depression can also include high levels of anxiety and even panic attacks.
While episodes of major depression can make someone temporarily unable to function in daily life, some people suffer from what’s known as “subsyndromal” depression, meaning they experience just a few depressive symptoms that negatively impact their quality of life, but still allow them to continue functioning somewhat normally.
Risks of Depression
Approximately 16.2 million Americans age 18 and up experienced an episode of major depression in the past year, and 10.3 million of these episodes resulted in significant functional impairments. Some of these Americans will only ever experience a single depressive episode in a lifetime, but for many, depression is a chronic, recurring disorder, with episodes lasting months, or even years.
Untreated depression not only takes a toll on quality of life for both the individual and everyone who cares about them, but it is also associated with many serious risks.
Risks associated with depression include:
- Pain or physical illness
- Unhealthy weight gain or loss
- Drug and alcohol misuse
- Family and relationship problems
- Social phobias
- Anxiety and panic disorder
- Social isolation
- Difficulties at work or school
Depression can also lead to premature death or suicide.
Premature Death: Depression impacts physical health in a number of ways. Stress has many proven adverse health effects, and these will naturally be exacerbated by the poor self-care found in most depressed individuals. The fatigue and hopelessness of depression will also keep many individuals from seeking needed medical care or fully following through on treatment regimens or lifestyle changes required to cure or manage any other disease they may have. The misuse of alcohol and drugs associated with depression can contribute to premature death as well, as can obesity, which is another common risk of depression.
Suicide: Severe depression often leads to suicidal thoughts and suicide attempts. Sometimes these attempts are successful. People who misuse drugs or alcohol are six times more likely to be suicidal, putting anyone with a dual diagnosis of depression and substance use disorder at a greatly magnified risk of suicide.
How Does Depression Interact with Addiction?
In 2016, approximately 19 million American adults had a substance use disorder, and 43.3% of those individuals experienced a co-occurring mental illness that same year. Misuse of addictive substances makes people far more vulnerable to mental health problems. Thirteen-point-eight percent of American adults with a substance use disorder also had a severe mental illness in 2016, compared to only 3.4% of adults without a substance use disorder.
Over two and a half million adults in the U.S. have a dual diagnosis of substance use disorder and a co-occurring mental illness. Over 30% of adults who struggle with substance abuse also struggle with depression. The considerable overlap between these problems indicates a massive need for coordinated treatment plans that target both issues at the same time.
Consider the example of someone who struggles with both alcohol and depression. If they are treated for alcohol use disorder but not depression, their depressive disorder will make them likely to start drinking again. Conversely, if they are treated for depression but not alcohol use disorder, any improvements in mood and functioning will be short-lived, as excessive drinking will cause their depression to return.
What Causes Depression?
Depression is most often caused by a combination of different factors that can be biological, genetic, psychological, or environmental.
People facing serious illnesses such as cancer, diabetes, or Parkinson’s disease often deal with depression. Sometimes this is psychological, due to the severity of the disease, but sometimes depression is a side effect of medications or treatments prescribed to treat the disease. As was stated earlier, misuse of drugs or alcohol also often leads to depression.
Other risk factors for depression include:
- A family history of depression
- Sleep deprivation
- Major life changes
- Chronic stress
It should be noted that all the factors with the potential to cause depression also have the potential to lead to substance use disorder. This is because difficulties in life can lead some individuals to self-medicate, trying to soothe negative mental and physical states with addictive substances. These common factors are also why a dual diagnosis of depression and addiction must be treated comprehensively, with careful attention paid to all aspects of each problem.
How are Depression and Addiction Treated?
There is a significant treatment gap in the United States today, with far too many people struggling from substance use disorders not getting treatment. In 2016, some of the most significant treatment gaps were seen for individuals suffering from both addiction and mental illness. Of the approximately 8.2 million Americans in need of dual diagnosis treatment, 51.9% did not receive any form of treatment, 38.2% received only mental health treatment, and 2.9% received only substance use treatment. Only 6.9% of these 8.2 million received the dual diagnosis treatment that they needed.
The combination of alcohol and depression is a significant problem in the United States, especially when it comes to treatment, or the lack thereof. 56.3% of people with depression go untreated, 78.1% of people with alcohol use disorder go untreated—and the overlap between these two groups is considerable.
The good news is that both depression and substance use disorder can be effectively treated if an individual allows themselves to receive professional help. Furthermore, many of the same treatments that work for depression also work for substance use disorder, as long as the counselors, therapists, and patients tailor the approach to address the various issues unique to both sides of the dual diagnosis.
People suffering depression and addiction will get the necessary comprehensive treatment at a rehabilitation facility that specializes in dual diagnosis. This may be an inpatient program, where the patient lives full-time at the treatment facility, or an outpatient program that allows the patient to continue living at home while receiving treatment. The ideal recovery plan should take a “step-down” approach to dual diagnosis recovery that starts with inpatient care, then moves to outpatient care, and then to aftercare. Medications, such as Zoloft, can be prescribed to help treat depression also.
Aftercare helps people in recovery stay healthy by having them attend alumni events at their treatment centers, check in periodically with counselors, or attend peer support group meetings. Services that help patients find stable housing, vocational training, or employment are also a big help, allowing people in recovery to become more independent. A successful long-term recovery is only possible with self-awareness, self-reliance, and self-care.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy, or CBT, is one of the most effective treatments for both depression and addiction. CBT for depression usually starts by helping the patient identify negative thought patterns and false beliefs that are prolonging depressive symptoms. Then therapists work with the patient on replacing the negativity and falsehoods with healthier, more realistic ideas. Over time, switching from a negative thought to a positive one turns from a deliberate effort into a habit, and depressive symptoms gradually improve. CBT helps patients learn healthy coping mechanisms that will allow them to effectively deal with life stressors and conflicts so that depressive episodes do not recur. It also guides patients towards a shift in perception that allows them to interpret life events and environments more positively.
CBT for addiction usually begins with helping the patient to identify thoughts, situations, emotions, and environments that trigger substance use. Then the patient learns how to avoid the triggers that can be avoided and healthier responses for those triggers that cannot be avoided. Much like CBT for depression, CBT for addiction also teaches everyday coping techniques to help patients effectively deal with the ups and downs of life without turning to substances, as well as shifts in perception so that things that would once be labeled as negative can be reinterpreted in a more positive light.