Most people who develop substance use disorders have some kind of dual diagnosis. They don’t just have an addiction; they have an addiction and something else. That ‘something else’ might be an anxiety disorder, a personality disorder, bipolar disorder, PTSD, OCD, ADHD, or schizophrenia. A very common dual diagnosis is addiction and depression. For most of these conditions, it’s pretty clear which comes first, but with depression, it’s not always so clear. First, depression often leads to substance use. Feelings of constant sadness or numbness, worthlessness, feeling overwhelmed, feeling constantly badgered by negative and self-critical thoughts often cause people suffering from depression to seek relief, even if it’s only temporary. This is especially true of men. Although women suffer from depression at about twice the rate of men, women are also much more likely to seek professional help or discuss their feelings with friends. Men, on the other hand, are more likely to self-medicate. It’s far more common for men to turn to alcohol or other substances as a way of coping with depression. Men are also more likely to engage in reckless and destructive behavior. If you combine this tendency men’s greater willingness to use illicit substances in general, you get a high risk of men with depression developing substance use issues. That’s not to say that women don’t develop substance use disorders because of depression. Although women are more likely to get help for depression, they are also much more likely than men to be the victims of domestic violence and sexual assault. Being stuck in an abusive relationship engenders feelings of helplessness and low self-worth, a perfect combination for depression. Being the victim of a sexual assault can lead to feelings of shame and PTSD, which is another major risk factor for addiction. Many women use drugs and alcohol to cope with these kinds of situations. Addiction can also cause depression. Perhaps the key feature of addiction is helplessness in the face of substance use. Most people with substance use disorders no longer enjoy using substances but they can’t stop. What’s more, addiction often leads to feelings of shame for having done things you hate in order to get drugs. Addictive behavior also leads to social isolation. Many people with substance use disorders like to carve out time when they can use. They become very rigid about protecting that time. They often spend less time with friends, unless those friends also use. They may alienate loved ones with their behavior. On top of all that, they may become financially constrained from using all their money to buy drugs, and perhaps even borrowing or stealing to buy drugs. They may have lost jobs. All of these are direct results of addiction and contributing factors to depression. Addiction might also change your brain in ways that make you more prone to depression. Addictive drugs increase the concentration of dopamine in the reward centers of your brain, which can contribute to depression after you quit. After a long time of using substances that flood your brain with dopamine, your brain starts becoming less sensitive to dopamine in various ways. As a result, when you quit, you have too little dopamine floating around in your brain for you to function normally. Many people experience protracted emotional numbness, lack of interest in things they used to enjoy, fatigue, sleep disturbances and low motivation. This is often called post-acute withdrawal syndrome, or PAWS, and it looks very much like depression. Addiction changes your brain in other ways too. Brain scans of people with long-time substance use disorders have found that the prefrontal cortex gets cut off from the brain’s reward centers. The prefrontal cortex is mainly responsible for executive functions, things like formulating plans and following through with them, working memory, attention, and self-control. When people with substance use disorders respond to addiction triggers as if they are on autopilot, it is because their prefrontal cortex has become disconnected from the reward centers. Essentially, there is no conscious decision about whether to engage in the addictive behavior. This part of the brain, the prefrontal cortex, also plays a role in depression. Studies have shown that the left prefrontal lobe is often underactive in people with depression. One way mindfulness meditation appears to improve the symptoms of depression is by strengthening the left prefrontal cortex. As little as eight weeks of mindfulness practice has been shown to thicken the cortex in this area. Another therapy that has proven effective in treating depression is transcranial magnetic stimulation, or TMS. This therapy uses a strong electromagnet to stimulate specific neurons in the brain. TMS for depression targets the left prefrontal cortex, an area called the dorsolateral prefrontal cortex. Daily treatments stimulate this area and help it form connections to other parts of the brain, including the reward centers. It should perhaps not be a surprise, then, to learn that some early studies have found that stimulating that same part of the brain has helped participants overcome cocaine addiction. Since this one part of the brain plays such a central role in both addiction and depression, it makes sense that the two conditions so often overlap. Whether the addiction or the depression came first, neither can be effectively treated without treating the other. A good therapist will be able to determine whether your depression led to addiction or vice versa. This is why finding a treatment program that can properly handle a dual diagnosis is so important. Dual diagnoses are never simple, but treating both conditions in an integrated way is essential for a successful recovery.
If you or someone you love is struggling with addiction or mental illness, we can help. Recovery Ways is a premier drug and alcohol addiction treatment facility located in Salt Lake City, Utah. We have the resources to effectively treat a dual diagnosis. Our mission is to provide the most cost-effective, accessible substance abuse treatment to as many people as possible. Request information online or call us today at 1-888-986-7848.
