Depression and Substance Use Disorders
Depression is the most common behavioral health diagnosis among adults. An estimated 300 million people around the world suffer from depression according to the World Health Organization. In the United States, the National Institute of Mental Health estimates that nearly one in five U.S. adults live with a mental illness, roughly 46.6 million adults in 2017.
Depression is a significant complicating factor in recovery from substance use disorders. Nearly all persons in substance abuse treatment show significant depression in the first several weeks of recovery. In most cases, the depression quickly subsides. Others, however, suffer from serious bouts of depression throughout their recovery.
Depression is a state of central nervous system inhibition that operates on a continuum between severe depression (i.e. severe central nervous system inhibition) and severe mania (i.e. severe central nervous system stimulation). When a depressed mood becomes so severe that it interferes with normal daily routines necessary to maintain interpersonal relationships, work activities, or the maintenance tasks of life, it is identified as a mental disorder called depression.
Need for Recognizing Patterns of Depression and Substance Use Disorders
For those addicted, depression often presents itself in one of four common patterns:
1) Substance Induced Depression
2) Depression Induced Substance Abuse
3) Situational Depression in Sobriety
4) Co-occurring Addiction and Depression
To avoid relapse it is critical to recognize these four types of depression and to match patients to appropriate treatment strategies that properly address their depression into the treatment plan.
- Substance-Induced Depressions are caused by the use, abuse and addiction to alcohol and other drugs. The depression quickly remits in early recovery without special treatment.
- Depression Induced Substance Abuse occurs when patients suffering from depressive illness start using alcohol or other drugs to medicate or manage the symptoms of depression (commonly referred to as self-medicating) and then becomes dependent upon those substances.
- Situational Depression in Sobriety occurs in some chemically dependent patients who experience extreme stressors in recovery. The depression is clearly linked to the mismanagement of specific problems in sobriety. The depression is relieved when these problems are identified and effectively managed.
- Co-occurring Depressive Illness occurs when patients are suffering from both substance use disorder and an independent depressive illness. These patients typically have a family history of substance abuse and addiction, as well as a family history of depression or other mood disorders. History reveals that the symptoms of the depression predated the chemical abuse, and that as the addiction progressed, so did the severity of the depression. There is often a fluctuating symptom pattern. The depression temporarily goes into remission when the patient is drinking or drugging, only to return in a severe form when the patient attempts abstinence. With co-occurring depressive illness, both the chemical dependence and the depression need to be treated simultaneously.
Treatment and Recovery
Whenever depression becomes severe enough to interfere with ongoing addiction recovery, it is serious enough to seek specific help for managing the symptoms.
Although it is possible to recover from depression, there is no one correct way to do it. Different people use different recovery tools. What works well for one person may not work very well for another. Yet, there are general principles and basic tools that are effective for a large number of people.
This means that putting together a recovery program from substance use and depression (mental health) will require learning about the choices that are available. It means being willing to put together an initial recovery plan and being open to adjust the details of that plan in order to make it work more effectively. In recovery we seek progress not perfection. We take small steps that make us feel a little bit better. We learn from those steps, and then take other small steps.
Depression can be debilitating. Many in recovery may seek relief through using alcohol and drugs, but we all know that relapse will only add to our problems. Reach out and seek help if your depressive symptoms are interfering with your life and responsibilities. There is no need to suffer when help is available.
Depression and Relapse – A Guide to Recovery
I have authored the book Depression & Relapse – A Guide To Recovery to help recognize that depression is a significant, complicating factor in recovery from substance-use disorders. Fortunately, the recovery plans for addiction and depression are closely related. Many of the things that help people stay comfortably sober and in recovery also help them manage their depression. People suffering from addiction and depression can develop a recovery plan that addresses both the addiction and the depression.
I am excited to announce, Gorski-CENAPS is in a time of transition, like many other organizations. In recent years, addiction and mental health disorders have not been reduced and have in fact, increased significantly. The basic principles that govern effective treatment have not changed. My goal has always been to create and maintain a higher order model for the treatment of substance use and mental health disorders that recognizes the contribution of all clinical disciplines.
You can also find home study courses, upcoming trainings, and access to ebooks at www.cenaps.com
I have spent many years developing mechanisms to change behavior patterns of those who suffer from mental illness and substance abuse disorders, as well as helping people abstain from drugs and alcohol, and assist with their mental health conditions. My mission remains to bring hope, healing and support to those and their families struggling with behavioral health disorders everywhere.
Terence T. Gorski is an internationally recognized expert on relapse prevention, substance abuse, mental health, violence, and crime. He is a prolific author and has published numerous books and articles.