Does Addiction or Depression Come First?

At least half of people with substance use disorders have a co-occurring mental health issue and some estimates put that figure much higher–as high as 80 percent or more. These disorders include depression, anxiety disorders, OCD, ADHD, PTSD, personality disorders, autism spectrum disorders, and schizophrenia. Of these, depression and anxiety are the most common. A common question is whether the depression or the addiction comes first. In practice, it can go either way.

For many people, the depression comes first. There are many paths to depression, including childhood abuse or neglect, traumatic experiences, such as a sexual assault or the unexpected death of a loved one, inflammatory diseases, or neurotransmitter imbalances in the brain. Whatever the cause, people with depression are often in a lot of pain and they find drugs or alcohol relieve that pain, if only temporarily. Drugs and alcohol provide relief from intrusive memories, self-critical thoughts, and feelings of hopelessness. If a substance makes you feel normal for even a little while, it’s tempting to take it as much as possible, which can lead to physical dependence and addiction.

Men are especially prone to self-medicating with drugs or alcohol in this way. Men often don’t recognize their own symptoms of depression and if they do, they are less likely than women to seek help. They may just start using drugs or alcohol to self-medicate without even being aware of what they are doing.

However, women are more likely in general to develop depression for a number of reasons. For example, women are more likely to be victims of domestic abuse or sexual assault. There is also evidence suggesting that hormonal changes, especially around pregnancy and childbirth can lead to depression. Many women do use drugs and alcohol to deal with depression symptoms too, and since women have roughly twice the depression risk of men, they may actually be more women who develop substance use disorders because of depression.

On the other hand, substance use can also lead to depression. There are several ways this can happen. One is simply a rebound effect. When you drink, for example, it raises your GABA levels and decreases your glutamate levels, which relaxes you. However, your brain compensates and as the alcohol leaves your system, you become more anxious. Alcohol is also inflammatory and it suppresses your blood sugar for hours at a time. Both of these effects can cause feelings of sadness, irritability, poor concentration, poor sleep, and other symptoms depression. Cocaine is another example. It winds up your dopamine to ridiculous levels and eventually your brain compensates by making less dopamine. As a result, you feel depressed, unmotivated, and unable to concentrate without cocaine.

Finally, substance use disorders can lead to depression by making you feel helpless. Helplessness is one of the most common characteristics of depression. It’s the feeling that nothing you do will make any difference, so there’s no point trying. Wanting to quit but being unable to is one of the primary characteristics of substance use disorders. However, it is possible to quit with the right help. That help should address the depression and the addiction in an integrated way. Addressing one but not the other is not a sustainable path to recovery.

Arbor Behavioral Healthcare offers an integrative and holistic approach to treat substance abuse and a wide variety of addictions, as well as underlying mental health and psychological issues. All of the addiction recovery programs offered by The Arbor are designed to heal the mind, body, and spirit leading to a lifetime of sobriety, health and wellness. If you’re ready to find healing and restoration in a peaceful, loving environment, please call us today at 844-560-7269.