Comorbidity

about depression and addiction

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Feeling depressed or low in mood is an everyday experience. What people mean when they say that they are “depressed” covers a lot of ground ranging from suicidal thoughts to distressing unhappiness to just being bored or fed up. The seriousness of the statement is often, but by no means always, reflected in an individual’s facial expression and general demeanour. So, getting an accurate understanding of the seriousness of the depression is all important.

"And sometimes it hits me out of nowhere - an overwhelming sadness rushes over me - I feel hopeless, sad, hurt and numb to the world."

A black and white drawing of a woman sitting with her knees up, her face covered by her hands, with colorful paint streaks running from her hands down her face and body, blending onto the floor.

How common is depression and addiction?

Depression is very commonly reported among people attending alcohol and drug services. The survey of UK Services may have overestimated the prevalence, nonetheless, there is a need for practitioners who are able to identify those individuals needing referral to specialist mental health services and those who can be helped by addiction practitioners. The second chart shows that there is a high risk of self harm persisting 24months after detoxification.

Weaver et al BJPsych 2003

Why do substance use and depression commonly co-occur?

Knowledge of a person’s circumstances is likely to set expectations: for example a recent loss, trauma, or poor quality of life will leave others unsurprised that somebody is depressed but may lead them to underestimate the severity of their low mood.

There are obvious reasons why people with an addiction problem experience low mood. Firstly, dependence is itself a stressful state to be in and commonly expressed as depression. Secondly, the consequences of addiction are mainly negative resulting in multiple losses. Thirdly, there may be a sense of being out of control and a pessimism about recapturing better times.

A particular risk occurs post detoxification and this may persist for months (see table). In the short term brain functioning is destabilised by withdrawal of alcohol or drugs and may be a factor in mood change but also realising the damage done socially from years of addiction may be a depressing experience longer term.

Dealing with Depression

Looking out for the risk of suicide…

Demographics

◼︎ Age – young adults (18-35) or older adults (>65)

◼︎ Gender – fatality more common in men; attempts more common in women; gender dysphoria

◼︎ Health – chronic pain, loss of mobility, terminal illness

Psychiatric conditions

◼︎ Substance use – dependence, intoxication, withdrawal

◼︎ Major depressive illness or bipolar disorder

◼︎ Post traumatic stress disorder

◼︎ Personality problems or alienation

Personal