Co-Occurring Disorders: Addiction and Depression

One of the most common mental health conditions is depression, with estimates suggesting that nearly 5% of adults struggle with some kind of depressive disorder.² As a result of its high prevalence, it’s perhaps unsurprising that depression is a common co-occurring mental health disorder with substance use disorders, commonly known as drug or alcohol addiction.

According to the 2020 National Survey on Drug Use and Health, an estimated 17 million U.S. adults had both a mental health condition and a substance use disorder.¹ Having a mental health issue in addition to a substance use disorder is referred to as having co-occurring disorders, or dual diagnosis. Understanding the link between depression and substance abuse, and how to find a dual diagnosis rehab, can help you find recovery from both conditions.

What is Depression?

Major depressive disorder is not only the most prevalent depressive disorder, but it’s also the most common psychiatric disorder, affecting an estimated 10% to 15% of people at some point in their lifetime.⁵ According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), major depressive disorder is characterized by a depressed mood or a loss of interest in pleasurable activities as well as four or more of the following symptoms within a two-week period:¹¹

1. Weight loss or weight gain.
2. Insomnia.
3. A lack of energy or severe fatigue.
4. An inability to physically participate in daily life.
5. Constant, intense feelings of worthlessness or guilt.
6. Indecisiveness, loss in concentration, or general difficulty thinking and making decisions.
7. Thinking about death, suicidal ideation or suicide attempts.

There are other types of depression and depressive disorders, all of which share a common feature: having a sad, empty, or irritable mood accompanied by physical and mental changes that significantly affect a person’s ability to function.¹¹ Other types of depression include:³

• Persistent Depressive Disorder (Dysthymia) is characterized by the presence of a depressed mood more days than not for 2 years.
• Seasonal Affective Disorder is a type of depression that sees symptoms are attributed to seasonal changes. Generally, those struggling will see symptoms intensify and alleviate depending on the time of year.
• Postpartum Depression occurs shortly after a new mother gives birth, and can affect the mother’s ability to perform daily routines. While the condition is colloquially known as the “baby blues,” postpartum depression can be quite severe and should not go ignored.
• Psychotic Depression occurs when the symptoms of depression are present alongside the symptoms of some form of psychosis.
• Bipolar Disorders, though not technically a type of depression and classified as mood disorders, often encompass many of the symptoms of depression. Bipolar disorder is characterized by intense shifts in one’s mood, resulting in episodes of high-energy euphoria and low-energy depression. There are two main types of bipolar disorder:⁶
  • Bipolar I: Must have criteria met for at least one manic episode (criteria causes clinically significant impairment) and a major depressive episode. Hypomania might be present.⁶
  • Bipolar II: Must have criteria met for hypomania (criteria is not severe enough to cause clinically significant impairment) and a major depressive episode⁶
• Substance/medication-induced depressive or bipolar disorder is characterized by symptoms that appear consistent with a depressive or bipolar disorder, respectively, but symptoms appeared or developed during or after substance intoxication or withdrawal.⁶

How Depression and Substance Use Are Linked

While depression commonly appears alongside substance use disorders (SUDs), the exact reasons as to why these conditions occur and co-occur are not entirely understood. It’s clear, however, that a likely driver for the high prevalence of co-occurrence is due to depression and substance use disorders having a bi-directional relationship, which means that symptoms of one disorder increase and reinforce the risk of the other.¹² Research suggests that a combination of other common factors could influence or increase one’s vulnerability to developing a depressive disorder and/or an SUD:⁴

• Genetic Factors: Many believe that genetics is a common factor in determining one’s vulnerability to substance abuse and co-occurring disorders. Research suggests that genetic factors could account for between 40 to 60% of an individual’s vulnerability to substance abuse.
• Environmental Factors: There is evidence that environmental factors can contribute to the development of an SUD or mental health disorder. Factors like chronic stress, trauma, and negative experiences in childhood and adulthood can increase one’s vulnerability to behavioral health disorders.
• Pre-existing Mental Health Disorders: Some evidence suggests that having a mental health disorder, like depression, can lead to substance abuse. The symptoms of mental health disorders like depression can be difficult, and some may seek to alleviate symptoms of depression with substances like drugs or alcohol. This substance use as a coping mechanism could spiral into substance abuse and possibly addiction.
• Substance-Induced Mental Health Disorders: Conversely, it’s suggested that substance use can lead to physiological changes that can lead to the development of other mental health disorders or symptoms of mental illness.

Regardless of the exact links between depression and SUDs, people with these disorders may face significant challenges, such as severe mood symptoms, worse functioning, a higher risk of suicidal ideation, and a high risk for developing more co-occurring disorders.⁸

How to Treat Co-Occurring Alcohol or Drug Addiction and Depression

When a depressive disorder and a substance use disorder co-occur, integrated treatment that addresses both conditions at the same time is typically the recommended approach.⁸ Because of the bidirectional relationship of depression and substance use disorder, treating symptoms of one will likely influence symptoms of the other disorder.¹² Depressive symptoms can also interfere with recovery from SUD and may also hinder a person’s ability to participate in treatment.¹³

Standard substance abuse treatment supported by behavioral therapies like cognitive behavioral therapy (CBT) and motivational interviewing (MI) targeting symptoms of both disorders can effectively reduce the frequency of substance use and depressive symptoms and improve functioning.⁸ In some cases, treatment may include antidepressants, which often alleviate symptoms of depressions and can even some alleviate certain symptoms of SUD.⁸

Co-occurring Disorders Treatment Settings and Program Types

What types of services you receive while in treatment as well as the treatment setting will vary depending on your needs.¹ Some common treatment settings and types of treatment services you may encounter include:^{1, 9, 10, 11}

• Detox: Detoxification, also known as medical detox or simply detox, is a set of interventions that manage acute intoxication and withdrawal symptoms. Detox is often considered a precursor to ready a person for formal treatment of a substance use disorder. Supervised detox can help to prevent complications that may arise from withdrawal symptoms, which can range from mild to severe to possibly fatal. Medical staff may also prescribe medications to eliminate or ease certain withdrawal symptoms.
• Inpatient Treatment (Residential Treatment): Inpatient and residential treatment programs often take place at a hospital or rehab facility. These rehab programs offer 24/7 medical supervision and a range of treatments and therapies, ranging from counseling to behavioral therapy to medication-assisted treatment (MAT). Inpatient or residential treatment tends to last for a few weeks to a few months.
• Medications: An emerging field of treatment, medication-assisted treatment (MAT) combines medications approved by the FDA for certain substance use disorders (alcohol use disorder, opioid use disorder) alongside counseling and behavioral therapies. Medications like antidepressants may be used the alleviate symptoms of depression.⁹ Not everybody will be prescribed medication, so it’s important to discuss the option with your treatment providers.
• Outpatient Treatment: Outpatient treatment is generally less intensive than inpatient or residential treatment, and allows patients to participate in daily life (eg. going to work, attending school, participating in family events) while still receiving SUD and depression treatment at a facility. Outpatient treatments can vary in the number of hours or days spent in treatment and are sometimes used in a step-down approach from a more intensive inpatient or residential program.

Overall, each person’s time in rehab will be different depending on their needs. It’s important to discuss your treatment options with a doctor or rehab staff to determine which will work best for you.

Does Insurance Cover Treatment for Addiction and Depression?

The Affordable Care Act (ACA) requires most health insurances to cover treatment for mental health disorders in some capacity.⁷ This means that your private or public insurance plans may be able to cover some or all of the cost of substance abuse and depression treatment. However, your coverage may vary depending on your location, your insurance type and plan, and the intensity and length of treatment. It’s important to reach out to your insurance provider to determine the extent of your coverage before going to treatment. Additionally, treatment centers like us, American Addiction Centers (AAC) make it possible for you to check your coverage online.

American Addiction Centers (AAC) is a leading provider of detox and rehab, with facilities throughout the nation. If you still have questions about depression, addiction, or the treatment process, American Addiction Centers operates a 24/7 detox hotline that can walk you through the treatment process. Alternatively, if you would like to get started online, start the process by checking your insurance coverage instantly or texting our team.

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