Mental health and addiction are so intertwined that many question: what comes first, depression or substance abuse? The criteria utilized for an official diagnosis are quite similar for both. In order to unravel the mental health and addiction issues, it’s important to understand what co-occurring disorders are and how they can impact an individual’s road to recovery. In short,, dual diagnosis can be challenging to assess and even more difficult to treat.
An article by American Journal of Psychiatry suggests that people suffering from mental health conditions may use prescription and illicit drugs as a form of medication. According to the Epidemiologic Catchment Area study, an estimated 45% of individuals with alcohol use disorders and 72% of individuals with drug use disorders had at least one co-occurring psychiatric disorder. The staggering numbers suggest that while co-occurring mental health and substance abuse is prevalent, it’s still next to impossible to determine which comes first.
Depression as a Co-Occurring Mental Disorder
Major depressive disorder affects approximately 17.3 million American adults, or about 7.1% of the U.S. population. In addition, over twenty percent of American with an anxiety or mood disorder such as depression are also experiencing co-occurring alcohol or other substance use disorders. But, what comes first: depression or substance abuse? Substance abuse and mental health disorders such as depression are closely linked, and while some substance abuse can cause prolonged psychotic reactions, one does not directly cause the other.
Co-occurring mental disorders can increase the risks, as well as, short and long-term effects of substance dependence. Research indicates that certain drugs can create problems that trigger mental health symptoms. In other cases, substances can create mental health symptoms like paranoia, delusions, and depression. Some examples of these triggers include:
- Chronic drug and alcohol abuse increases risky behavior. Some users may fall victim to assault or rape. These traumatic events can create serious mental health issues like PTSD and depression.
- Depression, especially when the person is under the influence of a drug, is also a common effect experienced by drug users when they’re withdrawing from drugs like methamphetamine and alcohol. When the euphoric feelings wear off, users can be left feeling isolated, guilty, and these feelings can initiate triggers to continue use.
Defining Depression and Substance Abuse
According to the Diagnostic Statistical Manual for Mental Disorders, the criteria for depression and substance dependence are difficult to diagnose without proper testing skills and assessment tools. However, understanding the criteria for both depression and substance abuse is an important step in seeking proper mental health and rehabilitative services. Below are the official criteria for both depression and substance dependence as recognized by the American Psychology Association.
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Substance Dependence Criteria:
- Hazardous use: You’ve used the substance in ways that are dangerous to yourself and/or others, i.e., overdosed, driven while under the influence, or blacked out.
- Social or interpersonal problems related to use: Your substance use has caused relationship problems or conflicts with others.
- Neglected major roles to use: You’ve failed to meet your responsibilities at work, school, or home because of your substance use.
- Withdrawal: When you’ve stopped using the substance, you’ve experienced withdrawal symptoms.
- Tolerance: You’ve built up a tolerance to the substance so that you have to use more to get the same effect.
- Used larger amounts/longer: You’ve started to use larger amounts or use the substance for longer amounts of time.
- Repeated attempts to control use or quit: You’ve tried to cut back or quit entirely, but haven’t been successful.
- Time spent using: You spend a lot of your time using the substance.
- Physical or psychological problems related to use: Your substance use has led to physical health problems like liver damage or lung cancer, or psychological issues, such as depression or anxiety.
- Activities given up to use: You’ve skipped activities or stopped doing activities you once enjoyed in order to use the substance.
- Craving: You’ve experienced cravings for the substance.
How Can I Tell What Diagnosis is Impacting the Most?
Answering “what comes first depression or substance abuse” is not easy. Substance use may be a coping strategy used to ease the distress that major depression disorder may cause.
One way to explore which diagnosis is more prominent is to examine the history of substance use. As you may have noticed, the criteria for both depression and substance dependence are quite similar and appear to be quite vague. However, these criteria are used widely by primary care physicians, psychiatrists, counselors, and nurses to aid in discovering the primary cause for one’s emotional and behavioral struggles. Understanding the personal background of an individual seeking support in their mental health is critical to understanding the needs one may have for treatment. For example, a 55-year old gentleman who has a history of military service and has seen active combat may exhibit substance use disorder and depression because of post-traumatic stress disorder. A 21-year old college student may meet the criteria for substance dependence and continue to excel in all academic requirements and responsibilities. Because of the variety in patient’s lives and experiences, considering family history and predisposition to alcohol abuse, dependence and depression is critical to proper treatment. These difficult diagnoses are referred to as co-morbid disorders or dual-diagnosis.
Likewise, understanding maladaptive coping strategies is also critical to understanding substance use. There are several ways to self-assess for severity of dependence. Assessing one’s self for unhealthy coping skills is important and examining the situations where alcohol and other substances are used is helpful in providing clarity into the impact substances may have. A list of questions to ask yourself are listed below:
- How often do I seek out substances?
- How many consequences have occurred due to the use of substances?
- Have relationships been impacted negatively because of substance use?
- What are the financial costs of my substance use?
- What are the impacts on physical and emotional health?
The questions above are a short guide to help discover how severe one’s substance dependence may be. The number of questions a person can answer positively is correlated to more significant concern. For further self-assessment on substance dependence, please visit a commonly used website: WebMD. They offer more in-depth questions that can help in assessing the level of substance use dependence.
Dual Diagnosis Treatment Centers are in Demand
Given the rate of co-occurring mental health and substance abuse, treatment programs nationwide are beginning to recognize the importance of offering integrated programs.
Depression is the second leading cause of disability nationwide. According to Colorado.gov, Colorado consistently faces of the highest suicide rates in the country and nearly two-thirds of Coloradans who die by suicide were suffering from depression at the time of death. Still, among the Colorado youth population, aged twelve to seventeen, of those that suffered from depression, only 41.3% received treatment. Nearly one in seven Coloradans said they did not get needed mental health services. According to the same data taken in 2017, nearly 95,000 residents said they didn’t get needed substance abuse treatment, either.
The national average of total clients in treatment centers with co-occurring disorders is 47.8%, meaning that nearly half of those facing substance abuse and seeking treatment also had a mental disorder. Unfortunately, only 37.13 %of treatment facilities nationwide had programs to help those with co-occurring disorders.
How Do I Find Treatment for Both Mental Health and Substance Abuse?
AspenRidge Recovery is a leading and certified dual diagnosis treatment center in Colorado. Our trained and licensed therapists recognize the high rate of individuals suffering from both mental and substance abuse disorders. The prevalence of co-occurring depression and substance abuse has allowed us to successfully integrate our mental health treatment and substance abuse programs.
Depression and substance abuse are linked either by correlation or causation. An individual may be self-medicating with drugs to alleviate symptoms of depression, or the substance abuse could exacerbate an existing mental disorder and/or produce ongoing struggle with new ones.
AspenRidge has combined efforts to recognize substance abuse and addiction as a disease and seeks to identify underlying causes. Our licensed staff members are trained in offering treatment modalities that are evidence-based while still taking a holistic and tailored approach to help more individuals discover sobriety and long-term recovery. Our integrated approach offering ongoing counseling, group therapy and activities, sober living skills and opportunity, and 12-Step treatment.
Can AspenRidge Help Me Find Answers?
Yes! AspenRidge is the leader in Colorado for mental health and drug rehabilitative services. We will work with all patients and their families to help find the correct path for treatment. Each person is unique, and their treatment plan will differ upon personal experiences, family history, past medical history, and several other factors.
Because of the difficulty in understanding depression and substance use, AspenRidge is able to provide a clear understanding for the recovery process as well as helping to maintain an improved and sustainable quality of life both during and after treatment. AspenRidge has a proven evidence-based treatment process that has led to the recovery of thousands of clients. You can explore personal testimonies on AspenRidge’s website, and please call us at 855-281-5588 for more information.