Depression & Substance Abuse

Dual Diagnosis: Substance Abuse and Depression

Depression among teenagers is a serious health concern that is often seen in association with drug and alcohol abuse. In fact, between 24 and 50% of adolescents with a substance use disorder struggle with depression as well.¹
Substance abuse may co-occur with mental health issues for several reasons. For instance, abusing alcohol or drugs can lead to poor school performance, financial struggles, or legal problems which, in turn, can contribute to worsening moods. Likewise, feelings of depression caused by non-drug-related issues, in some instances, can lead teens to drugs as an attempt to cope—though substance abuse ultimately does not offer any lasting relief and can potentially further worsen depression.

What are the Common Symptoms of Depression?

Many people experience symptoms of depression at some point in their lives that can manifest in different ways, such as depressed mood, decreased interest in activities, sleep and appetite changes, and suicidal thoughts.² While depression affects people of all age groups, it is alarmingly prevalent during the teen years—12.5% of American adolescents between the ages of 12 and 17 have experienced at least 1 major depressive episode within a given year.³ Symptoms of major depression typically last around 2 weeks and impact everyday functioning, such as the ability to engage in school or work or to stay connected socially.²

In this article, we will look at the:

• Risk factors that contribute to drug abuse and depression.
• Assessments that further examine mental health and substance use concerns.
• Treatment options that are available for those who are struggling with a dual diagnosis of substance abuse and depression.

What Contributes to Teen Substance Use and Depression?

A wide variety of factors may contribute to both teen substance use and depression, including:^4-7

Because depression and substance use have a significant impact on one another, it can be difficult to separate these concerns into independent issues. Therefore, it is important to be properly assessed and treated for both depression and substance abuse issues.

What to Expect During a Mental Health Assessment (Evaluation)?

To find appropriate treatment, it is important to first be assessed by a therapist or psychiatrist for a mental health disorder or a substance use disorder. It is especially helpful if the clinician has experience working with teens who have dual diagnoses (e.g., a mental health issue in addition to a substance use disorder).¹

During a mental health assessment, the professional conducting it will ask a series of questions about your mental health history, such as whether or not you have been previously diagnosed with a mental health disorder or if you have ever been hospitalized for mental health issues. You will also be asked about your current mental health symptoms and evaluated for any safety concerns, such as the presence of suicidal thoughts.⁷

A thorough assessment also reviews:

• Any pertinent medical issues.
• Family history of mental health disorders.
• Substance use concerns.
• Social history.
• Current social activities.
• Education.
• Employment history.
• Any traumatic experiences you have had.

Mental health evaluations are conducted in order to make diagnoses such as major depressive disorder, which will then be used to help guide your treatment.

What Comes First, Depression or Substance Abuse?

Substance use and mental health disorders often co-occur.1 In the National Survey on Drug Use and Health, 9.5 million people in the United States had a co-occuring disorder in 2019.2 Individuals who have mental health problems are more susceptible to substance use disorders (SUDs).13 

Approximately half of the people who struggle with mental health issues also battle substance abuse, which requires a tailored dual diagnosis treatment model. Major depressive disorder is one of the problems most frequently experienced by individuals receiving medically assisted treatment for an SUD. A dual diagnosis makes treatment even more challenging.13

In one study that explored the causation between the two, the majority of teenagers with cannabis dependence experienced depression first. On the other hand, the same study showed that substance abuse typically followed alcohol and tobacco addiction.14  However, because of the complex factors that play a role in the development of major depression and SUDs, it’s difficult to definitively say which disorder precedes the other.14 

People with mental health problems sometimes start using drugs or alcohol as a form of self-medication. While their effects may make the person feel better for a while, drug and alcohol use only makes the symptoms of mental health disorders worse over time.14

Similarly, long-term use of commonly abused drugs has been known to cause depression. These include:15,16

• Cocaine.
• Ecstasy.
• Benzodiazepines.
• Opioids.

Therapies to Treat Depression and Substance Abuse

In cases of co-occurring depression and substance abuse, an integrated, simultaneous treatment approach is commonly used. The following evidence-based treatment options are effective for people struggling with a dual diagnosis:^1,8-10

Treatment Options for Depression and Substance Abuse

A combination of these therapies may be administered at various stages of recovery and in several different treatment settings, including:

Is Depression a Risk Factor for Substance Abuse?

Yes, depression can be a contributing factor to the development of substance use disorders. When a person is experiencing the symptoms of depression, such as the feelings of hopelessness, sadness, emptiness, and low energy, they may be tempted to use alcohol or drugs as a coping mechanism.17 Around one third of individuals who suffer from clinical depression has a co-occurring SUD and require dual diagnosis treatment.18 

Depression and substance use disorders share many of the same root causes. These factors include chemical processes in the brain, family history, and traumatic life experiences. For example, dopamine levels are similarly reduced in people who use certain drugs and those with depression. Also, serotonin disturbances are seen in both depression and alcohol abuse. The brain reward system is affected in a similar way in individuals with mood disorders and cocaine addiction.18 

Sustaining psychological trauma early in life also contributed to both depression and substance abuse. Traumatic life events during childhood may include abuse, neglect, abandonment, or parental death. These painful experiences may lower a person’s oxytocin levels, which can ultimately lead to mental health disorders and increase the risk of addiction. Finally, both substance abuse and depression may be linked to genetic factors, too.18

How to find Rehab for Depression and Substance Abuse near me?

Different therapeutic combinations may be used to best treat those with a dual diagnosis. For example, CBT and mindfulness-based techniques may be used in individual or family therapy while you attend an outpatient treatment program. The important thing is to get the help you need for your depression and substance abuse as soon as possible so you can begin a healthy life in recovery.

1. Kaminer, Y., Connor, D.F., & Curry, J.F. (2007). Comorbid Adolescent Substance Use and Major Depressive Disorders: A Review. Psychiatry (Edgmont), 4(12), 32–43.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition. Arlington, VA: American Psychiatric Association Publishing.
3. National Institute of Mental Health. (n.d.). Major Depression Among Adolescents.
4. Griffin, K.W., Botvin, G.J., Scheier, L.M., Diaz, T., & Miller, N.L. (2000). Parenting Practices as Predictors of Substance Use, Delinquency, and Aggression Among Urban Minority Youth: Moderating Effects of Family Structure and Gender. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 14(2), 174–184.
5. Khoury, L., Tang, Y.L., Bradley, B., Cubells, J.F., & Ressler, K.J. (2010). Substance Use, Childhood Traumatic Experience, and Posttraumatic Stress Disorder in an Urban Civilian Population. Depression and Anxiety, 27(12), 1077–1086.
6. Neher, L.S. & Short, J.L. (1998). Risk and Protective Factors for Children’s Substance Use and Antisocial Behavior Following Parental Divorce. American Journal of Orthopsychiatry, 68(1), 154–161.
7. Cook, M.N., Peterson, J., & Sheldon, C. (2009). Adolescent Depression: An Update and Guide to Clinical Decision Making. Psychiatry, 6(9), 17–31.
8. Chapman, A.L. (2006). Dialectical Behavior Therapy: Current Indications and Unique Elements. Psychiatry, 3(9), 62–68.
9. Quello, S.B., Brady, K.T., & Sonne, S.C. (2005). Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Science & Practice Perspectives, 3(1), 13–21.
10. Witkiewitz, K. & Bowen, S. (2012). Depression, Craving and Substance Use Following a Randomized Trial of Mindfulness-Based Prevention. Journal of Consulting and Clinical Psychology, 78(3), 362–374.
11. National Institute on Drug Abuse. (2020). The Connection Between Substance Use Disorders and Mental Illness.
12. Substance Abuse and Mental Health Service Administration. (2020). National Survey on Drug Use and Health.Substance Abuse and Mental Health Service Administration. (2021). Co-Occurring Disorders and Other Health Conditions.
13. Libby, A. M., Orton, H.D., Stover S.K., Riggs P.D. (2005). What Came First, Major Depression or Substance Use Disorder? Clinical Characteristics and Substance Use Comparing Teens in a Treatment Cohort. 
14. Drake, R. E., Mueser, K. T., & Brunette, M. F. (2007). Management of persons with co-occurring severe mental illness and substance use disorder: program implications. World psychiatry : official journal of the World Psychiatric Association (WPA), 6(3), 131–136.
15. Rethink Mental Illness. Drugs, Alcohol & Mental Health.
16. WebMD. (2021). Drugs That Cause Depression.
17. National Institute of Mental Health. (2018). Depression.
18. DualDiagnosis.org. (2021). Depression and Addiction: Symptoms, Causes, Treatment.