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Can Depression Impact Your Recovery?

If drug or alcohol dependency has touched your life, then you know well that addiction is a true thief of joy. What you may not realize, however, is that substance use disorders (SUD) often go hand-in-hand with clinical depression. In fact, people who are experiencing drug or alcohol addiction are significantly more likely to have or develop a major depressive disorder (1, 2, 3, 4, 5).

Unfortunately, however, co-occurring mood disorders often go unrecognized or insufficiently treated in patients in addiction recovery, and that can have devastating consequences for patients’ long-term sobriety. Research shows that those who have both depression and SUD generally experience poorer outcomes than those who are battling SUD only. This includes not only an increased risk of relapse in those with co-occurring disorders but also an amplified risk of suicide (6, 7).

As bleak as the picture may at first seem, there is hope. Co-occurring conditions do not have to doom you to a life of dependency and despair. It is possible to break the yoke of addiction and also to find your joy again. The answer lies in awareness and action.

The Serpent Is Subtle

One of the greatest obstacles to the effective treatment of clinical depression is simply the general lack of understanding of what depression actually is. Too often, we think of depression as an extreme despondency or black despair. While there’s no question that depression can manifest in these extreme emotions in some people and in certain circumstances, such as the sudden death of a loved one, the unexpected end of a relationship, or the unanticipated loss of a job, more often than not, depression is subtler and even more sinister than this.

For many people, in fact, depression shows up not with sobs, screams, or the rending of garments. Rather, it shows up in the gradual numbing of emotion, as if all the color has slowly leaked out of the world. You lose interest in the things that you once loved. You find that you really don’t care much about anything. You realize that there’s nothing that really gives you pleasure anymore and nothing much to look forward to. You’re just here, and maybe you’re starting to wonder if it matters whether you remain or not.

The gray barrenness of depression can make it difficult, if not impossible, to function in daily life. Simply trying to walk from one room to the next can feel like you’re dragging your body through wet cement. Your limbs can feel as if they weigh a hundred pounds each. You may have headaches, back and joint pain, and stomach distress. You may lose your appetite, or conversely, you may find yourself mindlessly devouring endless quantities of junk food, especially sugary treats, which the depressed brain often craves when it is running low on dopamine and other “feel-good” neurotransmitters.

You may be unable to concentrate or to sleep. Or, on the other hand, you may find yourself sleeping all the time. Sleep may, indeed, become a primary means of escaping the excruciating nothingness you feel.

And then there’s the addiction because food and sleep are by no means the only ways people try to escape the desolation of depression. When you are in the throes of depression, drugs and alcohol may become the crutch you use to feel better–to feel anything. They may feel, for a time, like the road out of the dark night of the soul you’re experiencing in your depression. Until, that is, they become yet another, and perhaps the greatest, cause of it.

Unfortunately, after the initial “euphoria” that may come with the first exposure to some drugs or alcohol, there frequently follows a crash. Many drugs of dependency, including both opiates and alcohol, literally alter the structures of the brain and impair its functioning, causing depressive disorders to emerge in persons with no previous history of the condition and the worsening of depression symptoms in those already affected. The brain’s “reward centers” appear to be particularly vulnerable to the effects of alcohol, opiates, and other drugs, making it increasingly difficult for you to experience joy, happiness, or calm without consuming ever-increasing amounts of drugs and alcohol (26, 27).

Knowing Your Risk

Because depression rarely looks like what we think it’s going to look like, it can often be very difficult to recognize the signs. You may not even realize you are depressed, let alone that you are turning to drugs or alcohol in a desperate and ultimately counterproductive attempt to self-medicate. Worst of all, because you are depressed, you may lack the interest, energy, or self-motivation to investigate the origins of your feelings, thoughts, and behaviors. Tragically, it is often the apathy that kills, as you find yourself caught up in the cascade of worsening addiction and deepening depression.

There is a way to stop the slide. It begins by recognizing that you are depressed and acknowledging the role that depression is likely playing in your addiction (and in your recovery). This often means understanding your unique risk factors and how to mitigate them.

Family history

Both depression and addiction have strong genetic and environmental features. We can inherit a predisposition for depression/addiction comorbidities and learn the behaviors from the home environment and family systems we grew up in (8, 9, 10). Genetics often play a key role in neurochemical processing and the development and functioning of deep brain structures associated with mood disorders, addiction, and depression/addiction comorbidities.

At the same time, the presence of addiction in a household contributes to the emergence of living environments, behavioral patterns, and relational/family dynamics that may trigger, exacerbate, and/or perpetuate depression and addiction alike, particularly for those who have also inherited the genetic predisposition.

What this means is that if you grew up in a home with a relative or caregiver who had depression, dependency, or both, then you may be genetically as well as environmentally conditioned for the same risks. This makes it all that much more important to be on the alert for signs that you may be struggling with your mental health as a key factor in your addiction and recovery.

A history of trauma

There’s no question about it. Life is tough sometimes. But when you have a history of trauma, the effects can linger far longer and in far more varied ways than you might imagine. This is particularly true for those who have suffered trauma during childhood. There’s mounting evidence that even one adverse childhood event (ACE) can significantly increase your chances of experiencing depression, addiction, or both (11, 12, 13).

It’s important to note that traumatic ACEs aren’t limited only to the experience of neglect or abuse during childhood. An early life stressor can leave an indelible mark if it is severe or long-lasting enough (13). This means that if you experienced parental divorce, if you faced financial hardship or food insecurity, or if you or another member of your household experienced significant or chronic illness, then you may still be dealing with the aftermath of those experiences, even if you thought you had long since forgotten about or gotten over them.

As significant as childhood traumas may be, however, they’re not the only experiences that can reverberate across the years. Traumas experienced in adulthood can also dramatically increase your risk for depression, SUD, and co-occurring depression and addiction. From homelessness and hunger to the loss of a loved one or the experience of military combat, when you face profound fear, uncertainty, shock, or sadness, it can be impossible to overcome without help (14, 15, 16). Trying to move past those life-changing events without striving to process them in healthy and productive ways may well lead to a long hard battle for your mental health and your sobriety.

Prolonged, negative stress

We often minimize the physical, mental, and behavioral impacts of chronic stress, but the reality is that prolonged, negative stress can contribute to both depression and addiction. There is vast and growing evidence that people who work in highly stressful and emotionally-depleting professions, such as first responders and healthcare providers, are particularly vulnerable to depression and dependency (17, 18, 19).

In addition to the deleterious effects of chronic workplace stress, there’s substantial evidence that other stressors, such as chronic illness, can give rise to comorbid depression and SUD (20, 21, 22). This means that if you are facing a health crisis or some other source of prolonged, negative stress, then it’s imperative to recognize the increased risk of depression and dependency and to take action to integrate mental and behavioral healthcare into your treatment protocols and/or stress management strategies.

Mitigating Risks, Managing Triggers

Once you’ve learned to identify the often subtle signs of depression and you’ve assessed your risk factors for co-occurring depression and dependency, it’s time to go on the offensive both for the sake of your sobriety and for the restoration of your joy.

One of the first and most important things you can do is find a recovery program that specializes in dual diagnostic care (23, 24, 25). After all, co-occurring depression and SUD feed off of and exacerbate one another. Thus, you cannot effectively treat the one without also simultaneously addressing its dark corollary. Dual diagnostic care encompasses both evidence-based addiction recovery protocols and psychiatric care, including pharmacotherapy, as appropriate and when used in conjunction with other psychotherapeutic approaches, such as cognitive behavioral therapy (CBT) and meditation and mindfulness training.

When you’re managing depression and dependency, it’s also critical that you learn to recognize and mitigate your triggers. The holidays, for example, are often a particularly stressful time, and if you have a history of addiction and/or mental illness in your family, then the behavioral and environmental triggers may be intense. That’s why, for the sake of your sobriety and your mental well-being, you should formulate a plan now to insulate yourself from the environments that incite your cravings or your depression. You may, for instance, choose to visit with family in a neutral setting, such as a hotel or restaurant, rather than at home, where painful memories may arise and dysfunctional family dynamics may be highlighted.

Similarly, if your depression is principally physiological in nature, you may find that your mental health worsens (and, consequently, so too do your drug or alcohol cravings) during the fall and winter seasons. Seasonal affective disorder (SAD) is estimated to affect up to 20% of the adult population and can increase the risk of worsening depression and relapse in those affected by it. If you suspect that you are experiencing SAD, then speaking with your healthcare provider or recovery team is a must. They can help you address the exacerbation of your symptoms before it even occurs, such as through the use of ultraviolet light therapy or short-term psychotropic treatments (i.e. selective serotonin reuptake inhibitors (SSRI)).

How Bayshore Can Help

At Bayshore, our multidisciplinary team of physicians, mental health experts, and addiction recovery specialists is uniquely qualified to provide personalized, evidence-based dual diagnostic care. We are fully accredited and certified by LegitScript and the Joint Commission to provide pharmacological therapies for the treatment of depression and other mental health disorders where appropriate. Our mission and our expertise lie in helping our clients return to the healthy, happy, dependency-free life they want and deserve.

Contact the caring team at Bayshore today to discuss how our dual diagnostic treatment program can help you or someone you love.

At Bayshore Retreat we have extensive knowledge in treating substance abuse and co-occurring mental health issues. We understand that Mental Health Disorders can be the root cause of substance abuse. We use the latest scientific research and holistic approach for drug and alcohol addiction treatment.

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