Estimates indicate that close to a third of patients with major depressive disorder also have substance use disorders.1 Co-occurring disorders such as these can complicate the road to recovery, as some treatment facilities may treat the substance use but not the mental or mood disorder. Sometimes, mood disorders like depression go undiagnosed in those with substance use disorders, resulting in a missed opportunity for beneficial treatment intervention.
To provide comprehensive treatment for substance use disorders, treatment professionals also need to address a patient’s mental or mood disorder, should one be present. So, in this context, what’s the connection between depression and substance abuse? And what does treatment look like for co-occurring disorders that involve depression?
What is Major Depressive Disorder?
Major depressive disorder (MDD) is one of the most prevalent mood disorders in the U.S.—an estimated 17.3 million adults had at least one major depressive episode in 2017.2
MDD can have a pervasive negative impact on several areas of a person’s life, and has been associated with:
- General decline in quality of life.
- Interpersonal relationship issues.
- More prevalent substance use behavior.
- Other potentially harmful behaviors such as smoking or not taking prescribed medications.
- Increased risk of suicide.
- Greater likelihood of early mortality.
Risk factors for MDD
Those who suffer from MDD might wonder what in their genetics, family history, or life could have contributed to their mood disorder. Though the “cause” of many mental health conditions is often difficult to pinpoint, independent risk factors for major depressive disorder include:3
- Having a first-degree relative with a history of major depressive disorder. This is believed to be related to some unidentified genetic factor that contributes to the risk for depression.
- Gender. Females are diagnosed with major depressive disorder 1.5-3 times more often than males are.
- Adverse experiences in childhood. These experiences include abuse, loss of a parent, poor support from parents, etc. Such experiences increase the risk for depression in adolescence and adulthood.
- Major life changes, stress, and trauma. These are associated with an increased likelihood of major depressive disorder.
- A chronic or serious medical condition. There are many different medical conditions that are associated with an increased risk of developing major depressive disorder, including cancer, cardiovascular disease, stroke, Parkinson’s disease, diabetes, arthritis, and a host of others.
- A substance use disorder. Individuals with chronic substance abuse issues develop major depressive disorder at higher rates than people who have no substance abuse problems.
- Other psychological disorders. Major depressive disorder is comorbid with a number of other psychological disorders, including anxiety disorders, personality disorders, and eating disorders.
Symptoms of Major Depressive Disorder
In order to receive a diagnosis for major depressive disorder, an individual must present with five or more of potential symptoms during the same two-week period. The symptoms cannot be better explained by:4
- Some other mental health disorder (many psychological disorders have depressed mood as part of their presentation).
- A medical condition (e.g., hypothyroidism).
- The effects of medication or drugs.
The symptoms must significantly interfere with the person’s normal functioning and occur nearly every day.4
The symptoms of major depressive disorder include:4
- Feeling guilty or worthless.
- A depressed mood most of the day.
- Sleep difficulties (either insomnia or excessive sleeping).
- Demonstrating significantly diminished interests or an inability to experience pleasure.
- A significant loss of energy or feelings of fatigue.
- Recurrent thoughts of death or committing suicide.
- Significant physical slowing or irritability and restlessness.
- Significant weight loss not occurring as a result of dieting, weight gain, or changes in appetite.
Major depressive disorder can have potentially fatal outcomes such as an associated increased risk of suicidality and self-harm. The number of the above symptoms present in a given individual and their subsequent impact on daily functioning correlates with the severity of the disorder.4
Depression and Substance Use Disorders
In general, rates of substance use disorders are nearly twice as high in individuals diagnosed with a mood disorder such as MDD than in individuals without such a diagnosis.
Although any type of substance abuse or dependence may co-occur with mood disorders, several types of substance use may exemplify particularly prevalent comorbidities:
- Alcohol use disorders.5
- Cannabis use disorders.6
- Cocaine use disorders.6
Treatment for Depression and Substance Use Disorder
People with two mental health issues may benefit from the simultaneous treatment of both. For instance, someone with a dual diagnosis (a situation also described as co-occurring disorders) of major depressive disorder and a substance use disorder may experience more comprehensive recovery by having both of these issues addressed at the same time.7
Behavioral Therapy Options
A treatment team for someone with a dual diagnosis could consist of physicians (psychiatrists or other addiction treating doctors), psychologists, social workers, counselors, case managers, vocational rehabilitation counselors, and any other specialists that fit into the overall treatment plan for the individual.
Below is a breakdown of a few commonly used behavioral therapeutic techniques and treatment settings helpful for people with co-occurring disorders.
Cognitive Behavioral Therapy (CBT)
Although CBT is a general term classifying a few different types of therapy, it’s based on the idea that psychological problems come, in part, from unhelpful ways of thinking and learned patterns of unhelpful behavior. Professionals administering CBT endeavor to provide the patient with strategies and skills to help shift thinking patterns and cope with difficult situations.8
Contingency Management (CM)
CM may be integrated into a larger behavioral health treatment plan for people with co-occurring disorders. Such voucher or prize-based systems can be implemented to reward patients who practice healthy behaviors and reduce unhealthy behaviors.9
Therapeutic Communities (TCs)
For some suffering from major depressive disorder and substance use disorder, long-term residential treatment in therapeutic communities (TCs) might be a good choice for recovery. With a goal of focusing on the “resocialization” of the patient, many TCs integrate community programs and therapies with medical approaches.10
Some other, general rehabilitation settings and treatment features include:
- Residential/inpatient treatment programs to provide an immersive, supportive treatment environment in which to begin integrated treatment for substance use disorders and mental health issues.
- Medication management for both depression (e.g., using antidepressants) and—depending on the substance of abuse—the substance use disorder.
- Individual and group therapy to address the client’s specific issues that could otherwise complicate recovery from both the depression and the substance use disorder.
- Support group participation, such as getting involved in a 12-step group or some other specialty group, such as a depression support group.
- Medical treatment for any medical conditions that are present.
- Relapse prevention techniques to ensure that the person develops the skills necessary to avoid potential relapse in the future.
- Family counseling, if needed.
- Vocational counseling to help the individual maintain employment or feel more productive.
- Case management to assist the individual with housing or other needed supports
- Long-term aftercare support and case management to assist the individual down the road.
At Oxford Treatment Center, a patient dealing with depression and substance use disorders concurrently would have their treatment tailored to his or her specific situation. Many of the treatments, services, and therapies mentioned above are available at Oxford Treatment Center’s facilities.
- Davis, L., Uezato, A., Newell, J.M., & Frazier E. (2008). Major depression and comorbid substance use disorders. Current Opinion in Psychiatry, 21(1), 14-8.
- National Institute of Mental Health. (2019). Major Depression.
- Dobson, K.S. & Dozois, D.J. (2008). Risk Factors in Depression. San Diego, CA: Academic Press.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Arlington, VA: American Psychiatric Association.
- National Institute on Alcohol Abuse and Alcoholism. Other Psychiatric Disorders.
- National Institute on Drug Abuse. (2010). Comorbidity: Addiction and Other Mental Illnesses.
- National Alliance on Mental Illness. (2017). Dual Diagnosis.
- American Psychological Association. What Is Cognitive Behavioral Therapy?
- National Institute on Drug Abuse. (2018). What are the treatments for comorbid substance use disorder and mental health conditions?
- National Institute on Drug Abuse. (2015). What are therapeutic communities?