Depression and addiction often go hand in hand. The National Alliance on Mental Illness (NAMI) found that, in 2020, an estimated 17 million American adults experienced both substance use conditions and mental health concerns.¹ Having more than one diagnosis—commonly called co-occurring disorders—can make it difficult to know where to begin when you are seeking help.¹

Treatment is available for both depression and substance abuse, and NAMI and other addiction and mental health organizations and professionals recommend that they be treated together—commonly referred to as dual diagnosis treatment.¹ It’s important to understand how addiction and mental health issues might impact one another, what the symptoms may look like, and what treatment is available.

What Is Depression?

According to the World Health Organization (WHO), depression is one of the most commonly diagnosed mental health conditions globally, with around 280 million people affected.²Persistent themes of any kind of depression are the presence of a sad or empty feeling, irritability, changes in appetite and/or sleep, and symptoms that interfere with normal daily functioning.³ In severe cases of depression, thoughts of suicide can be present.³ It’s important to note that 90% of people who died by suicide had a history or showed symptoms of depression.⁴ Below are some common forms of depression and how they differ from one another:³

Major Depressive Disorder (MDD): Depression that lasts more than 2 weeks at a time. MDD is often cyclical, meaning that episodes will go through fluctuations in severity.
Persistent Depressive Disorder (Dysthymia): Dysthymia is depression that lasts longer than 2 years.
Substance/Medication-Induced Depressive Disorder: Taking certain substances or medications can induce symptoms of depression. Often, this can occur during the withdrawal period of substance addiction.
Seasonal Pattern, commonly called Seasonal Affective Disorder: This type of depression is categorized by an onset of depressive symptoms during certain seasons or months of the year.

The NAMI found that around 21 million U.S. adults had a diagnosed major depressive episode in 2020.⁴ Depression seen alongside substance abuse concerns can increase its severity.⁵ Additionally, research shows that having a substance use disorder (SUD) can increase a person’s likelihood of developing anxiety and/or depression, as well as that having an alcohol use disorder is linked with higher rates of death by suicide.^5,⁶

Major Causes of Depression

The reason why some people develop depression and others don’t is not known.² An individual’s probability of developing depression increases with certain risk factors, such as biological and genetic factors, environmental influences, and psychological causes.³Some statistics concerning the common causes of suicide and depression include:

Having first-degree family members—such as parents or siblings—with depression can double to quadruple your risk.³
Adverse life events—like unemployment and stressful or traumatic events—are shown to increase a person’s risk of developing depression.²
Women are diagnosed with depression approximately 3 times more than men.³
Lesbian, gay, and bisexual adolescents are 4 times more likely to die by suicide than their heterosexual peers.⁴
The transgender population is 12 times more likely to die by suicide.⁴
Nearly 78% of people who die by suicide are male.⁴

Signs and Symptoms of Depression

Some of the symptoms of depression are normal and commonly felt among people who don’t have depression.³ It can be difficult to tell what is a clinical presentation of depression and what is a stressful or difficult life circumstance.³ A few factors that differentiate types of depression are frequency, how long the symptoms have been present, when the onset began, and the severity of the symptoms.³Although presentation and symptoms can vary between people, here are some common signs and symptoms that might be indicative of depression:³

Feelings of sadness, hopelessness, or emptiness more days than not.
Feeling irritated or annoyed more easily.
Loss of interest or pleasure in things you used to enjoy.
Difficulty focusing or making decisions.
Feeling overly worthless or guilty.
Decreased energy and motivation to perform normal duties.
Changes to appetite, such as not feeling hungry, not eating enough, or eating too much.
Difficulty with sleep—trouble getting to sleep, difficulty staying asleep, or sleeping too much.
In severe cases, suicidal thoughts.

If you think you might be depressed, it’s important to speak with your doctor or mental health provider. There are various treatment options available for depression, including therapy, medication, and rehabilitation programs.² Depression can feel isolating and hopeless, but you and your health provider can discuss treatment options that will work best for you.

Which Comes First: Depression or Substance Abuse?

Depression and drug abuse are commonly seen together, but it can be nearly impossible to determine whether one was caused by the other. Each person and their experiences are unique. A 2020 study found that the risk factors for SUD and depression were similar.⁵ The same study showed that 93% of people with SUDs also had symptoms of depression and 97% expressed feelings of severe anxiety.⁵ Depression was identified in 24% of men and 48% of women with alcohol use disorders.⁷ Listed below are several reasons why depression and addiction may trigger one another:³

Self-medication: Suffering with depression increases a person’s likelihood of having a substance use disorder.³ Individuals may attempt to alleviate symptoms of depression by using drugs or alcohol, which can temporarily relieve the depression.⁸
Biochemical factors: Drugs and alcohol temporarily increase the activity of certain neurotransmitters, leaving you feeling high or intoxicated.⁸The flooding of these transmitters disrupts them, making it difficult to produce important chemicals naturally.⁸
Genetic predisposition: Having a family history of both depression and substance misuse puts you at increased risk.^3,9
Effects of withdrawal: Depressive symptoms may be seen after the effects of intoxication or drug or alcohol withdrawal. Sedatives, hypnotics, anxiolytics, and alcohol are typically associated with depressive symptoms not present before use.⁹
Past trauma: Adverse childhood experiences such as abuse, neglect, and other traumatic experiences may cause a person to be at increased risk.³

Does a Co-Occurring Disorder Affect Treatment?

The National Alliance on Mental Illness recommends an integrated approach when treating co-occurring disorders.¹ An integrated therapy approach pulls techniques from both alcohol and substance use rehabilitation and mental health therapies.¹You and your addiction specialist/healthcare provider will identify how to address both concerns through a drug or alcohol and depression treatment plan.¹

Since the prevalence of co-occurring disorders is so high, treatment should be considered with all factors taken into consideration.¹ By screening and assessing for co-occurring disorders, the outcome of treatment has been shown to improve.¹⁰ The Substance Abuse and Mental Health Services Administration (SAMSHA) promotes a “no wrong door” philosophy with both substance abuse and mental health treatment.¹⁰ This encourages substance use facilities to assess for mental health concerns and for mental health facilities to assess for substance use concerns.¹⁰ Being aware of the overlap can help improve the quality of life and quality of care of the individual.¹⁰

Depression and Addiction Treatment Types

Each person’s treatment process will look different. An integrated therapy approach can involve a combination of detoxification, inpatient rehabilitation, outpatient therapy, medication management, supported housing, and support groups.¹

Detoxification: This process tapers or weans an individual off a substance under the supervision of trained medical staff.¹
Inpatient rehabilitation: Facilities that offer extended-stay resources, like hospitals.¹
Outpatient therapy: Usually offered through community mental health centers, hospitals, or other psychotherapists.¹
Therapy: The most common therapy modalities used in the treatment of co-occurring disorders include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and motivational interviewing (MI).¹¹
Supported housing: Housing facilities—sometimes referred to as sober living—offer temporary and permanent living arrangements with others who are in recovery from addiction.²
Support groups: Alcoholics Anonymous, SMART Recovery, and Narcotics Anonymous are common support groups.²
Medication management: Working with your medical and/or mental health provider to find the best medication(s) to treat all your symptoms.²

Medications known as antidepressants have been shown to be effective in treating depression, anxiety, and other mental health conditions.¹² These medications promote an increase in serotonin, norepinephrine, or both.¹³ Selective serotonin re-uptake inhibitors (SSRIs) work solely on encouraging serotonin production.¹³Common SSRIs include fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft). Typically, SSRIs are the first medication used to treat depression.¹³

Serotonin-norepinephrine re-uptake inhibitors, or SNRIs, work on both serotonin and a different neurotransmitter called norepinephrine.¹³ Better known SNRIs include venlafaxine (Effexor XR) and duloxetine (Cymbalta).¹³

The only way to determine which addiction treatment options are best for you is to talk with your medical and/or mental health provider. You can talk with them about which program—like inpatient or outpatient therapy—will be best considering your priorities and goals. Under the Affordable Care Act (ACA), mental health and substance use disorders are covered with insurance.¹⁴ The best way to know if you are covered for treatment is to verify your health insurance coverage.

Dual Diagnosis Rehabs Near Me

Rehab programs are located throughout the U.S., and a variety of treatment types is available. American Addiction Centers (AAC) is a leading treatment provider and has trusted rehab facilities across the country. When you come to AAC for substance treatment services, we see you as more than your addiction. You have unique strengths, potential, and challenges; we believe that your drug or alcohol abuse treatment should be personalized, too.

If you or a loved one is in need of help, our helpline is open 24/7. Please call us free at . You can also contact free drug and alcohol hotline numbers.

Depression and Substance Abuse: Symptoms, Statistics, and Treatment Programs