Is your alcohol use making you depressed? Are you drinking more because you are struggling with depression?  Or are both things going on at the same time?

The National Center for Biotechnology Information reports that nearly almost 64% of people battling alcohol addiction also meet the criteria for a medical diagnosis of depression.

Why Do Alcoholism and Depression Co-Occur?

First, both illnesses – depression and Alcohol Use Disorder – are individually caused by similar environmental and genetic factors that increase the chances of developing both disorders. Some of those factors might include:

  • Heredity – Recent research suggests that a person’s genetic makeup may predispose them to both substance abuse and other mental illnesses.
  • Brain Development – Alcohol use while the brain is still maturing during the teenage and young adult years increases the chances of comorbid disorders.
  • Neurology – People with a deficiency in the neurotransmitters that regulate emotional stability, i=can cause both mood and addictive disorders.
  • Trauma – Surviving a severely traumatic event – serious injury or illness, death of a loved one, physical/sexual/emotional assault or abuse, can leave the victim vulnerable to addiction and mental disorders such as depression, anxiety, or PTSD.

Second, having either condition is a potential cause of the other.  In other words, depression can cause AUD, and AUD can cause depression.

How big is this risk?

Having either condition DOUBLES the likelihood of having the other.

AUD and Depression: The Cycle

Alcoholism and depression each contribute to the worsening of the other.

  • Alcoholics frequently experience unpleasant consequences directly related to their drinking – financial difficulty, relationship problems, issues at work, DUIs, injuries and illness. Each of these can have a negative impact upon a person’s self-esteem and peace of mind, resulting in depression.
  • Excessive drinking also causes changes within the brain, and this results in:
  • Poor decision-making
  • Memory loss
  • Confusion
  • Impaired impulse control
  • Mood swings
  • Cognitive decline

Each of these can make the person even more at risk for depression.

  • Alternately, many people with depression will try to relieve their symptoms by self-medicating with alcohol.

Depression, Alcoholism, and the Risk of Suicide

Depression and alcoholism also share a convoluted relationship with suicide.

  • Mental illnesses – such as depression – are the leading cause of suicide.
  • Approximately 90% of completed suicides are committed by someone with a mental illness.
  • Substance Use Disorders – such as alcoholism – are the second-leading cause.
  • Alcoholics and addicts have a suicide risk that is over six times greater than that of the general population and 60% of suicide completers were intoxicated at the time.

Dual Diagnosis Warning Signs

The symptoms of depression can so closely resemble those of AUD that sometimes, even a mental health professional can have trouble judging where one condition begins and the other ends.

Although AUD and depression are different disorders, they share many symptoms, and this can complicate an accurate diagnosis. Here, there are some signs of a dual diagnosis –

  • Feeling sad or hopeless for an extended period of time – more than two weeks – even when there has been no drinking
  • Using alcohol to deal with unpleasant feelings or painful memories
  • Becoming increasingly isolated because of alcohol
  • Relying on alcohol just to get through the day
  • Difficulties in personal and professional relationships because of alcohol abuse
  • Past treatment for depression, other mental disorders, or any Substance Use Disorder
  • A personal history of abuse or trauma that has not been treated by a professional

On their own, none of these signs are absolute indicators of co-occurring disorders. But because the two conditions are so intertwined, it is a good idea to routinely assume a dual diagnosis until it can be safely ruled out by a mental health professional.

The Partnership for Drug-Free Kids recommends that the treatment of co-occurring disorders should be approached as a separate medical discipline combining the best practices of both psychiatry and addiction treatment.

Concurrent Disorders

According to the National Institute on Drug Abuse, dual diagnosis treatment is one of the basic principles of substance abuse rehabilitation.

When treating  comorbid disorders, the most effective strategy is a “dual-treatment”  or “integrated” approach, where both illnesses are addressed as the primary disorder.  In other words, the treatment plan is designed to provide the patient with healing and relief from both conditions at the same time.

The opposite also true – when treatment for the multiple disorders ISN’T combined, successful recovery will be delayed, and possibly even rendered unsuccessful.

The Importance of Individual Treatment

Unfortunately, all treatment programs were not created equal.

Anyone checking into a rehab program should first investigate to see if that program provides specialized treatment specifically for dual diagnoses. Ideally, the staff should be fully-credentialed for co-occurring illnesses. Medical personnel, mental health professionals, and addictions specialists should all be involved.

By necessity, the treatment plan must be tailored to the individual patient. Cookie-cutter approaches will not work, because one person’s trauma, mental illness, and addictive disorder is not the same as another person’s.

Program requirements might include:

  • A detailed pre-treatment evaluation and case history of the patient’s psychiatric health and substance use
  • Medication-Assisted Treatment
  • Individual counseling that addresses the connection between the mental disorder and the addiction
  • Group therapy with other dual diagnosis patients
  • Trigger avoidance
  • Practical strategies for preventing and responding to relapse
  • Trauma processing
  • Healthy coping methods
  • Holistic therapies such as yoga, meditation, or exercise aimed at restoring the patient’s body/mind/spirit balance
  • Education for family member
  • Most importantly, long-term aftercare and support that continues past “graduation”.

What Does This Mean for San Diego Residents?

“Depression is more common than most people realize. As part of Live Well San Diego we are encouraging people to ‘check your mood’ and get routinely screened for depression just as they get screened for heart disease and high blood pressure.”

~ Alfredo Aguirre, Director, Behavioral Health Services, San Diego County Health and Human Services Agency