It might surprise you to learn that people living with depression are more likely to develop substance use disorders than people who don’t have depression.
Substance use disorders are involve a pattern of drug or alcohol use that can begin to interfere with your day-to-day function, health, and quality of life. In short, substance use disorders go beyond occasional drug or alcohol use.
Substance use disorders and mental health conditions so often occur together that experts have given the combination a specific name: dual diagnosis. Major depression is the most commonly diagnosed mental health condition among people with a dual diagnosis.
Below, you’ll find an in-depth explanation of the connection between depression and substance use, along with unique risks associated with a dual diagnosis. You’ll also find guidance on getting support for depression and substance use, whether you meet criteria for dual diagnosis or not.
Recent research on dual diagnosis
One 2020 review of research considered both community and clinical data from 1990 to 2019. According to the results:
- 25% of people with major depressive disorder (MDD) also have a substance use disorder
- 20.8% of people with MDD also have alcohol use disorder
- 11.8% of people with MDD also have illicit drug use disorder
- 11.7% of people with MDD also have cannabis use disorder
The researchers didn’t offer a definition of “illicit drugs” in the article, but “illicit” typically refers to illegal substances.
If you live with depression, you might find yourself using alcohol and other substances to help ease or better manage symptoms of depression. This is often called self-medicating.
Some common reasons people might be motivated to self-medicate include:
- Soothing unwanted emotions: It can be exhausting to feel sad, lonely, or angry a lot of the time. For some, drinking alcohol may relax them, give them a break from the distress, or “numb” their pain.
- Lifting moods: Depression can make it tough to feel happiness or joy, even when good things happen in your life. Some people might feel as if they can only feel good — or feel anything at all — while under the influences of alcohol or other substances.
- Getting some sleep: Depression and insomnia often go hand in hand. Some people turn to sedatives to knock out.
- Boosting energy levels: Depression often saps energy, in part due to lack of sleep. Some people may use stimulants to feel more alert.
Alcohol and drugs may temporarily mask or ease your symptoms, it’s true. But they can’t completely get rid of those symptoms or treat the underlying condition. When you stop using them, in other words, your depression symptoms will typically come back.
You might eventually find yourself developing a tolerance, which means you need to use more of the substance to get a similar effect.
In time, you might also become dependent on the substance, which means you need the substance for your body to function as it typically would. Dependence may increase your chances of addiction.
Self-medication tends to be more common among people who lack access to mental health care. If you’re living with untreated depression, you might find yourself doing anything you can to get relief from your symptoms.
Research from 2018 also suggests youth are more likely to develop conditions like depression and anxiety first. An earlier diagnosis of these conditions could help lower their chances of also developing a substance use disorder.
Just as depression can factor into substance use, substance use disorders can also play a part in depression. More severe substance use disorders are more likely to contribute to depression.
What counts as a ‘severe’ substance use disorder?
The most recent edition of the “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)” defines substance use disorder severity according to the number of symptoms.
- Mild: 2–3 symptoms
- Moderate: 4–5 symptoms
- Severe: more than 6 symptoms
Learn more about the signs and symptoms of substance use disorders.
Substance use can contribute to depression in four main ways:
Inflammation
Many substances, particularly alcohol, can prompt the short-term release of dopamine in your brain, which can produce feelings of pleasure.
But they can also increase inflammation in the brain. Inflammation, in turn, makes it harder for your brain to produce mood-boosting chemicals like serotonin and dopamine on its own.
Cortisol
Alcohol and drugs don’t just reduce levels of mood-boosting chemicals in your brain. They can also greatly increase levels of chemicals related to stress.
According to a 2014 research review, people who use MDMA regularly have up to 4 times the level of the stress hormone cortisol in their bodies than people who don’t use MDMA.
Withdrawal
When you use alcohol or drugs regularly, your brain may grow to depend on those substances to function.
If you suddenly stop using those substances, it may take a while for your brain to adjust and produce the levels of serotonin, dopamine, and other important chemicals it typically would. In the meantime, you might feel low, numb, or have trouble finding pleasure or interest in your regular routine and daily activities — all of which can also happen with depression.
As a result, you might wind up using substances again, simply to feel like your usual self.
Isolation
Spending a lot of time drinking alcohol and using drugs can eventually sabotage your career or schoolwork, not to mention affect relationships.
Isolation can make it more difficult to get encouragement, sympathy, and affection — emotional support can go a long way toward helping you manage and cope with mental health symptoms. This may, in part, help explain why loneliness can increase your chances of developing depression.
There’s another potential explanation for dual diagnosis. In some cases, substance use disorders and depression may stem from a shared root cause.
Depression and SUD can both be caused by dysfunction in certain parts of the brain, such as the:
- circadian clock, which controls your sleep-wake cycle
- hypothalamic-pituitary-adrenal axis, which controls your stress response
- reward circuits, which control motivation and satisfaction
Trauma and abuse can also contribute to a dual diagnosis, especially if the abuse happened in childhood.
If you experienced abuse, neglect, or other maltreatment in childhood, you’re up to 3 times as likely to develop depression as peers who didn’t experience childhood abuse. You’re also more likely to develop a substance use disorder.
Even if you have depression, it’s possible to have a healthy relationship with alcohol and other substances. That said, since depression and substance use disorders can feed into each other, it never hurts to practice some caution.
A few signs of potentially concerning substance use:
- You spend a lot of time thinking about your next chance to drink alcohol or use substances.
- You know your substance use has had a negative impact on your career and relationships, but you can’t bring yourself to care — or stop using the substance.
- Once the effects of the drugs or alcohol wear off, you feel even more exhausted and bitter about life.
- You need more and more of the substance to keep your mood and energy stable.
- You feel guilty or ashamed about your substance use but you can’t stop even when you try.
- You feel so hopeless about your future that the potential long-term effects of substance use don’t seem to matter much in comparison.
If you’ve noticed any of the above signs, a mental health professional can offer more support and guidance with next steps.
Which came first?
Not sure whether your depression happened on its own (primary depression) or in relation to substance use (substance-induced depression)?
It can often help to consider how and when your depression symptoms appeared.
| Primary depression is more likely to: | Substance-induced depression is more likely to: |
| involve a history of depression before the substance use | first appear after you start using a new substance |
| appear during a period of stable substance use, or no substance use | appear after you use a lot more of the substance, or during a period of withdrawal |
| persist even after you stop using the substance | improve when you lower the amount of substance you use, or stop using it entirely |
If you have a dual diagnosis, you might find your symptoms harder to manage than if you had either depression or a substance use disorder alone.
Compared to people with a single diagnosis at one time, those with a dual diagnosis are more likely to:
- have more severe depression symptoms
- relapse when trying to quit substances
- have a lower quality of life
- attempt suicide
According to a
Most people who had both conditions at different times developed depression first. Over a third of this group reported at least one suicide attempt.
The attempted suicide rates among this group were:
- twice as high as they were for people who developed alcohol use disorder before depression
- 3 times as high as they were for people who only developed depression
- 9 times as high as they were for people who only developed alcohol use disorder
Study authors theorize the people in this group may have had more severe and chronic forms of depression than the other participants, but they couldn’t draw any conclusions about why people in the depression-first group had higher rates of attempted suicide.
Are you having thoughts of suicide?
If you’re thinking about hurting yourself or ending your life, you can get support right away by connecting with a crisis helpline.
Trained crisis counselors can offer calm, compassionate guidance and support managing overwhelming feelings and emotional distress.
Get free, confidential support 24/7, 365 days a year, by:
- Calling 800-273-8255 to reach the National Suicide Prevention Lifeline.
- Texting “HOME” to 741741 to reach the Crisis Text Line.
Get more tips on helping a loved one who’s thinking about suicide.
Treatment for a dual diagnosis typically addresses both mental health conditions at the same time.
To put it another way, you don’t need to quit using substances before seeking help for depression. Likewise, you don’t need to wait until your depression improves before getting support for substance use.
A therapist or other trained specialist may recommend a treatment approach that includes medication, therapy, and support groups.
Medication
Medication can help address the physiological causes of depression and substance use disorders.
Antidepressants can help level out the neurotransmitters involved in depression. While they don’t directly improve symptoms of a substance use disorder, they may
If you have alcohol use disorder or opioid use disorder, medications can help reduce your cravings and withdrawal symptoms.
Medications for alcohol use disorder include:
- naltrexone
- acamprosate
- disulfiram
Medications for opioid use disorder include:
- buprenorphine
- methadone
- naltrexone
While it’s possible to take antidepressants at the same time as these medications, keep in mind that some medicines are not recommended together. For instance, both methadone and the antidepressant sertraline can raise your serotonin levels. If you take them together, your serotonin levels may become dangerously high and lead to serotonin syndrome.
A doctor or psychiatrist can offer more information about your options for medication treatment.
Psychotherapy
Therapy helps address the social and emotional roots of your mental health issues.
Some approaches used for dual diagnosis include:
- Cognitive behavioral therapy (CBT): This approach can help you address distorted thought patterns and unhelpful behaviors that factor into both depression and substance use.
- Motivational interviewing: This approach can help you resolve conflicted feelings around substance use or self-sabotaging habits.
- Dialectical behavioral therapy (DBT): This approach can help you learn and practice new ways to regulate emotional distress and better manage low moods, cravings, and withdrawal symptoms.
Support groups
If your budget right now doesn’t stretch to therapy, or you simply don’t feel ready to work with a professional yet, you might consider a support group instead. You can also join a support group in combination with individual therapy.
Support groups create space for people with similar concerns and mental health symptoms to get together and help each other as equals. Members can share advice, offer comfort, and celebrate successes.
If you have a dual diagnosis, you may want to check out:
- Double Trouble in Recovery, a support group specifically for people with dual diagnosis
- SMART Recovery
- Alcoholics Anonymous
Even if you don’t have access to professional treatment, you don’t have to navigate your symptoms alone.
Depression and substance use often go hand-in-hand. Sometimes depression can lead to substance use, but substance use can also contribute to depression.
No matter which condition came first, the gold standard for dual diagnosis treatment addresses all of your symptoms and concerns at the same time. Your recovery journey may involve medication, therapy, support groups, or a combination of all.
The most important thing to remember is this: Both depression and substance use disorders can improve with treatment. Professional support can make a big difference in your symptoms, once you feel ready to seek it out.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.