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Behavioral Health & Substance Abuse

DUAL DIAGNOSIS: Addiction and Depression

There is a strong relationship between substance abuse and mental illness. In addiction treatment, this is called having a dual-diagnosis or co-occurring disorders. The connection between depression and addiction is clear, but it’s hard to know whether the mental illness precedes the addiction or vice versa.
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The Connection Between Addiction and Depression

Depression and addiction seem to be inextricably tied together.  Substance abuse can cause a person to feel depressed or exacerbate existing feelings of sadness, hopelessness, and worthlessness. 

Similarly, feeling consistently depressed for weeks on end can lead a person to escape through unprescribed mood-altering drugs.  Self-medication can bring temporary relief to those in the throes of depression.  It may make the depressed person feel temporary joy or at least numb their emotional pain.  However, it will inevitably make the situation worse.

As a person becomes addicted to a substance, they will need more of it to achieve the desired effect.  If they do not reach this threshold they will experience the symptoms of withdrawal.   These physical and psychological symptoms mirror the symptoms of depression and can lead to a cycle of depression that many people cannot climb out of without help. 

Understanding Depression

Depression is a mental illness categorized by a long-lasting low mood, despondency, and thoughts of self-harm. All of those factors don’t have to be present for a person to be clinically depressed, although they are common to people experiencing the illness.

Depression can come from many sources. Some people may become depressed based on their own biology or genetic makeup. A lack of serotonin produced naturally in the brain might lead a person to be clinically depressed.  A person might also have a set of difficult life experiences that create a negative internal environment.  In some cases, a person’s diet can be inadequate and lack the nutrients needed to maintain a healthy brain.

The introduction of drugs and alcohol may bring upon depression as well. If the person is already depressed or prone to depression, an addiction could amplify the symptoms and make it a lot harder to break out of the cycle.

Common Symptoms of Depression

The symptoms of depression are far-reaching and varied.  Everyone experiences depression in their own way, but here are some of the more common symptoms of depression:


Sadness and low mood are common characters of this disorder. Although a person might not always display these emotions on the outside. 


A depressed person may also lose the desire to participate in things they used to enjoy.  Time spent with friends, pursuing hobbies, or leisure activities can all decrease or diminish completely.


 As a result of this sedentary lifestyle and appetite, a person could lose or gain weight.  They may also have trouble getting to sleeping or waking up leading to insomnia or hypersomnia. 


Low mood and lack of activity can lead to general feelings of fatigue. Low energy and lack of motivation can make it difficult for a person to even get out of bed.


There may be a distinct change in the ability to think or concentrate. Racing thoughts or intrusive negative thoughts can occupy the mind.  This can make it harder to focus on other things.


A depressed person may be burdened by feelings of low self-esteem, worthlessness, or excessive guilt.  These feelings can compound making a depressive person feel guilty about their own symptoms of depression.


Thoughts of death or suicide can become regular. The trouble of managing the illness often becomes too much to bear, and thoughts of escaping find their way into the mind of someone with major depression.

How Depression Can Lead to Addiction

When a person is going through a complete change of motivation and personality, it seems natural that they would seek out ways of alleviating those feelings.  Drugs and alcohol might seem like a simple way to get out of the depressive state and into one that’s more enjoyable. Different drugs can alleviate those pains in different ways.

For example, stimulants or amphetamines might help to lift the person’s mood for a time. Other drugs like opiates or alcohol could help the individual remove some internal pain and feel comfortable. When your mind is actively suffering throughout the day, the idea of a quick release is difficult to refuse.

Over time, using those drugs might become the person’s way of self-medicating. The trouble is that many drugs that help a person to relieve mental pain are addictive.  Both physical and mental addictions can form in response to certain drugs, especially when the drug combats something as intense as serious depression.

Low Tolerances to Dopamine and Serotonin

Another theory on why individuals with mental illness often develop addictions relates to the natural production of certain neurotransmitters.

A lot of mental illnesses have to do with a lack of dopamine and serotonin production. Some people just don’t produce enough of these chemicals naturally.  That leads to imbalances in mood, clear thinking, stress responses, and more.  A healthy brain needs those chemicals to function. When they’re diminished or absent, a person will adapt to the low levels,  but their brain will still crave those chemicals.

When we introduce a drug that satisfies those needs and desires, the drug might strike us as more enjoyable if we don’t already have the dopamine or serotonin present in the body.  Imagine someone who has snacked on sugary foods their whole life. Next to that person stands someone who has never had sugary food.  If you placed a delicious cake in front of both people, how do you think they would respond? The first person might take a bite, enjoy it, and set the fork down.

The second person would be overwhelmed with how the cake made them feel. It would activate an enjoyable experience that they weren’t used to, and they might want to eat the rest of the cake to reproduce the experience.  The relationship between drugs and different individuals with mental illness is similar to this scenario.

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Understanding Addiction

Addiction is a disorder that can befall any kind of person. It’s not an issue that reflects a lack of discipline or weakness. Instead, it’s something that occurs for a number of reasons, typically having to do with past experiences.

Take someone who gets addicted to pain pills after surgery. They had an accident, needed surgery, and took the prescribed pills to treat their pain after the procedure. The powerful opioids prescribed to them left them with physical addiction and intense symptoms of withdrawal.  Instead of suffering through the agony of opioid withdrawal, they self-medicate and sustain the addiction. Other individuals, like those suffering from depression, might be dealing with intense mental pain.

Whether the person has had trauma in their life or they’re burdened with a mental illness, a recreational experience with drugs might impact them differently than it would others. The release from that pain might be a favorable alternative to the pain they were feeling.  Without insight into the nature of addiction or resources to try and treat their pain in other ways, using drugs or alcohol to keep themselves afloat can turn into an addiction.

Some people have a predisposition toward addiction. There are genetic factors that might contribute to an addictive personality. In this way, we can see that addiction isn’t always a “choice” or a personal characteristic.  There are legitimate reasons that a person gets addicted to different substances, and the unfolding of that addiction doesn’t reflect their personal characteristics or worth.

But do you know if someone’s dealing with an addiction?

Common Symptoms of Addiction

A person who’s addicted to a substance will display a number of things. They’re not all present in every case, but there are some general effects that addiction tends to have on people.


Their priorities shift a little bit. If you didn’t know they were using, it might just look like they’re starting to slack on the things that they were once responsible for.


They might call in sick to work more often than before. Maybe they’re late to various things that they weren’t late for in the past. There also might be some confusion or secrecy as to why they were late or absent.


You might get the idea that they were lying about where they were or why they weren’t at the obligation. Additionally, the person might start to show changes to their personality even when they aren’t using.


Withdrawals are common in most addictions, and the experience of withdrawal can make a person very irritable, aggressive, and distinct from who they were before.

After some time, the addiction might become evident through behavior or the physical toll that it takes on a person’s body. Addiction, whether it’s to alcohol or Adderall, will start to wear down on a person’s physical health.

How Addiction Can Lead to Depression

Addiction, especially to opiates and alcohol, can lead to, or worsen the symptoms of depression.

Alcohol and opiates depress the nervous system and amplify feelings of low mood and energy that mirror the symptoms of depression.  The excessive use of psychoactive substances then alters that person’s production of dopamine and serotonin.  Using a lot of drugs will momentarily boost those neurochemicals, but those stores will be depleted in the following days. This is very dangerous, especially for people who already have limited levels of serotonin.

Those lows could lead the person to use their drug of choice again, building a habit that’s difficult to break. Many drugs also reduce inhibitions, making it easier for the individual to follow through on thoughts of suicide or self-harm.  It’s also worth noting that drugs and alcohol may interfere with the medications that a person is using to try and treat their mental illness. At the very least, the medications will be less effective and prolong the illness.

Another thing to consider is the stripping of the person’s personality and lifestyle in exchange for something that tends to cause shame and guilt. An addict might do or say things that harm others and change their life to accommodate their addiction.  Significant changes to a person’s life or personality can lead to an imbalance that produces some of the effects of mental illness. Anxiety, intense stress, and more can all contribute to depression.

Treating Co-Occurring Addiction & Depression

A co-occurring disorder or dual-diagnosis happens when a person experiences two disorders at the same time, often with overlapping symptoms and causes.

These comorbid disorders can be difficult to treat, but it’s important that both issues are addressed at the same time. This is because resurgences of one disorder can bring on symptoms of the other, and vice versa.  When we fail to address both disorders at once, there’s a high chance of relapse or the continuation of the mental illness. The treatment should be tailored to the individual’s particular situation as well.

Specialized treatment tends to include counseling, rehabilitation, and a professional plan for recovery. This often means that the person should enter into a treatment facility to receive the care that they need to move forward.  Treating both ailments at the same also allows professionals to account for symptoms that overlap between the mental illness and the addiction. In a lot of instances, the person will show behaviors that could be ascribed to either condition.

Changes to personality, paranoia, erratic moods, and more can all be symptoms of both addiction and depression. It’s important to note, though, that depression and addiction are both treatable, even when they occur at the same time.

Recovery works for many individuals, and it could work for you or the loved one in your life who needs help.

Dual Diagnosis Treatment at New Method Wellness

Handpicked by Dr. Phil, New Method Wellness is a premier dual diagnosis treatment center that is accredited by The Joint Commission. It has been singled out as one of the best drug and alcohol rehab centers in America, offering a unique 3:1 staff-to-client ratio that pairs every client with two therapists instead of one.

At New Method Wellness, we add another dimension to dual diagnosis treatment, and that is the integration of holistic therapy, such as massage/acupuncture therapy, equine therapy, and art therapy. As addiction therapists and substance abuse counselors work with clients to treat the substance use disorder and the co-occurring illness associated with it, holistic therapy adds meaning to life after treatment and sustains long-term recovery. Our 3:1 staff-to-client ratio ensures client success after treatment, as evidenced by our Extended Aftercare program.

For more information about New Method Wellness’s treatment programs, call (866) 951-1824

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Clinically Reviewed By:

Deanna J. Crosby, M.A., LMFT, LAADC, Psy.D. (C)

Deanna Crosby is a Licensed Marriage and Family Therapist (LMFT) with over 20 years of experience working with clients in recovery. Her expertise has catapulted her into the spotlight. Featured on several episodes of the Dr. Phil Show as a behavioral health expert, DeAnna is a routine contributor for NBC News, The Huffington Post, Elle Magazine, MSN, Fox News, Yahoo, Glamour, Today, and several other prominent media outlets. 

After receiving her bachelor’s degree from the University of California in Irvine, Crosby did postgraduate work at Centaur University where she graduated at the top of her class with a CAADAC certification in Centaur’s chemical dependency program. Following her time at Centaur, Crosby received her Master of Counseling Psychology degree from Pacifica Graduate Institute, where she also attained a Doctoral Degree in Depth Psychology.

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From all of us at New Method Wellness co-occurring treatment center, we wish you peace and serenity in knowing that you or your loved one will get the necessary help.


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