The Link Between Depression, Dependency, And Substance Use Disorders

According to studies, 25% of people living with major depressive disorder (MDD) also have a substance use disorder (SUD). For many people, substance use disorders and depression reinforce each other, which can cause a cycle of distressing symptoms. Knowing how to break out of this loop may involve learning more about how these conditions can develop and how to receive support.

How prevalent are comorbid depression and substance use disorders? 

Not everyone who experiences depression also lives with a substance use disorder, and vice versa. However, there is a connection between the two for many. Experts from the National Institute on Drug Abuse (NIDA) have noted that comorbidity (the occurrence of a substance use disorder alongside another mental illness) is common, with over 7.7 million adults experiencing it. In addition, they found that 37.9% of those with substance use disorders had another mental illness. Of those with comorbid conditions, 34.5% receive mental health support for their symptoms. 

Depression as a risk factor for substance use and dependency

In some cases, misuse of substances may be motivated by a desire to alleviate symptoms of a mental illness like depression. Because substances may lead to short-term improvements in mood, many people use them to self-medicate (use without a medical professional’s advice in significant amounts and for unhealthy reasons).  

Self-medicating may lead to an unhealthy sense of dependence on these substances. If an individual relies on alcohol to suppress symptoms of chronic depression, they might use it more frequently, as depression symptoms are often long-lasting and frequent. Studies indicate that managing depression through substance use can be a significant risk factor for a substance use disorder.

The term “self-medicating” may be partially misleading, as research indicates that using intoxicating substances does not lead to lower rates of depression. Often, they have the opposite impact. Depression can also involve low self-esteem and self-destructive impulses. If your depressive disorder makes you feel negatively toward yourself, you may be less inclined to avoid potentially dangerous behavior such as binge drinking or using illegal substances.

Substance use may cause or exacerbate depression

Although using substances might seem to offer a short-term reprieve from symptoms of depression, it is associated with long-term harm. Prolonged use of intoxicants can cause changes in your nervous system that may increase your susceptibility to mood disorders like depression. Below are a few other difficulties associated with substance use. 

Serotonin insensitivity 

Alcohol use can temporarily boost your brain’s serotonin levels, a neurotransmitter associated with positive mood. However, neurological research has found evidence that frequent overuse of alcohol can decrease the sensitivity of your serotonin system, so it may take more of this neurotransmitter to produce the same effects. Due to this impact, you might feel more depressed when you’re not drinking. 

Dopamine decrease 

Intoxicating substances often cause the activation of dopamine-based nerve pathways. This response incites the feeling of satisfaction that may result from achieving goals and fulfilling desires. However, prolonged, repeated substance use decreases the dopamine these nerves release. A lack of dopamine might lead to difficulty generating feelings of happiness and pleasure, which is a common symptom of depression.

Elevated cortisol 

Many psychological researchers believe that high levels of the stress hormone cortisol can sometimes cause depression. Prolonged excesses of this chemical in the bloodstream may damage parts of the brain that control mood. Some studies show that frequent use of drugs like MDMA can cause a lasting increase in cortisol levels. 

Disruptions in daily life

Substance dependency may also cause disruptions in your career, relationships, and health. The resulting feelings of shame and regret may also play a role in developing depression.

Shared coping mechanisms for suds and depression

If you’re living with a depressive disorder and a SUD, it may be challenging to separate your symptoms. Each condition may play a role in exacerbating the other. This connection can make both disorders more difficult to treat together than alone. However, many lifestyle changes, coping mechanisms, and treatments can treat depression and SUDs simultaneously, including the following. 

Regular exercise

Exercise has been found effective for both depression and substance use disorders. A 2014 paper reviewing 22 experimental studies reported evidence that physical activity increased abstinence patterns from substances while easing withdrawal symptoms. Other studies have shown that exercise is a natural mood booster and can increase positive neurotransmitters in your brain. 

Meditation

Mindfulness meditation has shown promise in treating various mental health difficulties. While it has been widely studied to treat depression and anxiety, some researchers have found that mindfulness may reduce cravings and dependence on intoxicating substances. Adopting this practice could include 15-20 minutes daily to relax, pay attention to your breath, and observe your thoughts and feelings without judgment. A guided mindfulness practice might also be helpful if you’re unsure where to begin. 

Creative expression

Adopting new hobbies might be beneficial in recovering from a substance use disorder. Dependence on substances is often linked to habit formation in the brain, and finding new ways to fill your time might be as beneficial as learning to resist cravings. Since creative activities like writing, painting, and dance reduce symptoms of  MDD, you might be able to target both conditions by adopting a new artistic pursuit. 

Social support

Positive relationships with friends and family may reduce the impact of depressive symptoms and substance use disorders. Reaching out to loved ones and spending time with people you love may make it easier to manage these intertwined challenges. Try to seek out the company of people who are not living with unhealthy patterns of substance use if that would be a factor that inhibits your own recovery. 

Psychotherapy

Support and guidance from a trained therapist can significantly improve depression and substance use disorders. Therapy may help many individuals identify the roots of unhealthy behavior patterns. It could also offer mental strategies to shift your emotional responses and reframe your thoughts. The positive effects of therapy on substance use and depressive disorders often last past the end of the course of treatment. 

Alternative counseling options

It may be challenging to find a therapist with experience treating combined substance use disorder and depression. The adverse effects of these conditions, like financial difficulties or challenges with motivation, can also make it difficult to keep up regular visits to an office. Working with a therapist online may relieve some of this difficulty. With internet-based therapy, you can attend sessions from home and connect with qualified mental health care professionals outside your immediate area. 

Cognitive-behavioral therapy (CBT), one of the most effective treatments for substance use disorder and major depressive disorder, appears beneficial online and in person. Studies on one of the longest-running online CBT programs have demonstrated substantial effects on various mental health conditions. The researchers concluded that “the accumulated evidence provides compelling support for the efficacy and effectiveness of online CBT.”

If you’re interested in trying online therapy, you can sign up with a platform like BetterHelp to get started. When you sign up, you may be able to get matched with a therapist within 48 hours, and many clients of online therapy find that they are able to choose between phone, video, or chat sessions with their therapist.