Depression is one of the most common health issues Americans face, and the number of people that go through it at some point in their life seems to be growing. According to the National Institute of Mental Health, more than 17 million adults in the U.S. experienced a major depressive episode in 2017. That’s more than seven percent of all adults in the country. Depression has also been linked to substance use disorders, and people seeking treatment for one often struggle with the other.
Someone who comes to treatment for a substance use disorder should be assessed for other underlying issues like mental health disorders. The existence of comorbid issues like depression needs to be addressed for addiction treatment to be effective.
According to the National Institute on Drug Abuse (NIDA), effective addiction treatment will address biological, psychological, social, legal, and financial issues that may be related to addiction. Otherwise, untreated problems are likely to lead to relapse. Depression has a unique relationship to addiction because of the way both disorders feed into each other.
Learn more about depression and how it’s treated alongside substance use disorders.
Mental health problems are extremely complicated, and finding their root cause can be difficult. Like addiction, depression can be caused by a variety of factors that work together to create a problem.
Depression is sometimes assumed to be caused by a chemical imbalance in the brain. Others may assume that depression is just an emotion that’s caused by a tangible factor like a breakup or a stressful job. Both of these factors are valid and may be a potential cause of a depressive disorder.
However, depression is often more complicated than that. Sometimes someone can feel depressed even after they take medication to correct a chemical imbalance. Your depression might also predate your rough breakup. When treating depression, many psychologists take an approach called the biopsychosocial model.
The biopsychosocial (BPS) model was developed as an approach to treating all kinds of medical issues from diseases to mental health disorders. The model emphasizes a holistic method of treating all types of issues.
The aim of this approach is to develop effective treatment options by understanding how a wide range of factors can interact to influence health, illness, and treatment. The BPS model is important in treating both depression and addiction because of the way multiple factors can work to create these complex mental health issues.
Depression can be caused by a combination of factors that need to be addressed to facilitate a lasting change.
Here’s how the three components in the biopsychosocial model can impact depression:
Important chemicals like dopamine and serotonin help to motivate you and leave you feeling satisfied and happy. In some cases, biological factors can cause a chemical imbalance that leads to depression. In other cases, outside issues can cause a chemical imbalance. For instance, methamphetamines can damage dopamine receptors, which leads to the inability to feel pleasure, causing severe depression.
Of course, psychological factors can play a significant role in depression. For instance, you may become stressed and depressed on the way to work when you go through a mental process called catastrophizing. If you are stuck in traffic, you may think you will be late, which may lead to you getting fired, which may lead to you falling behind on your bills, which may lead to you getting evicted. Poor coping responses can lead to damaging mental exercises that lead to depression and anxiety.
Social factors can play a significant role in causing and treating depression. Mental health issues are often linked to loneliness and isolation, which can trigger or worsen depression. In many cases, interventions that seek to treat depression should emphasize increasing social connections and building healthy relationships.
Studies have shown that depression and addiction are closely related. A 2008 study found that nearly one-third of patients with a major depressive disorder also met the qualifications for a substance use disorder.
It can be difficult to say which disorder is likely to come first or if one causes the other at all. It’s possible that the two disorders share some of the same genetic, environmental, and developmental factors that cause them to develop simultaneously.
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However, depression may cause addiction through a phenomenon called self-medication, which is when you use a psychoactive substance to treat negative symptoms without consulting a doctor. It’s common for people with depression to self-medicate with alcohol or other drugs, which can lead to a substance use disorder.
Also, addiction can lead to depressive issues. Substance use disorders can start to affect multiple parts of your life, including your relationships, finances, health, and legal standing. As your life seems to spiral downward, many people start to experience anxiety and depression.
In either case, it’s important to address substance use disorders and depression in treatment. If one is ignored, it can worsen the other one while making treatment less effective.
Since depression is such a concern for many people who are seeking addiction treatment, clinicians routinely check for it when building treatment plans for clients.
When you are first going through the intake process at an addiction treatment facility, you will undergo a thorough assessment process that’s designed to determine the right level of care for your needs.
Clinicians may use the ASAM criteria, a set of six factors to consider in addiction treatment that was outlined by the American Society of Addiction Medicine.
After immediate medical concerns, like your withdrawal potential and any biomedical conditions, the criteria looks at psychological factors. Serious emotional, behavioral, and cognitive conditions may require higher levels of care and specific treatment types to address.
After entering an addiction treatment program, you will sit down with your therapist and go through what is called a biopsychosocial assessment.
This assessment is designed to determine the biological, psychological, and social needs that should be addressed in your treatment plan.
Through this assessment, you can talk to your therapist about your history with mental health and depression. If you have a depressive disorder, your therapist may recommend specific therapies like group therapy and cognitive behavioral therapy, where depression can be addressed.
Davis, L., Uezato, A., Newell, J. M., & Frazier, E. (2008, January). Major depression and comorbid substance use disorders. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18281835
Matthews, T., Danese, A., Wertz, J., Odgers, C. L., Ambler, A., Moffitt, T. E., & Arseneault, L. (2016). Social isolation, loneliness and depression in young adulthood: A behavioural genetic analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819590/
National Institute of Mental Health. (2019, February). Major Depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml
University of Rochester Medical Center. (n.d.). The Biopsychosocial Approach – Rochester, NY. Retrieved from https://www.urmc.rochester.edu/medialibraries/urmcmedia/education/md/documents/biopsychosocial-model-approach.pdf
Volkow, N. D. (2004). The Reality of Comorbidity: Depression and Drug Abuse. Retrieved from https://psycnet.apa.org/record/2004-21590-002