A Complex Combination
“If I am hurt in a car wreck, please don’t take me to a 12-Step meeting.”
This bit of wisdom is occasionally heard in the rooms of AA or NA, the point being there are human ills that recovery programs will not cure. Depression is one. But it doesn’t mean there is no hope for those suffering from the “double whammy” of depression and addiction. Quite the opposite: a key part of a program of recovery is learning effective coping skills for the all the difficulties of life.
The Chicken and the Egg
Psychological and psychiatric problems tangle with addiction in ways that are easy to misunderstand. Cause and effect get turned on their heads.
Does addiction and alcoholism cause depression or anxiety, or is it the other way around? The answer is not an either/or proposition. Since substances often bring a feeling of relief, sometimes anxiety and depression open the gate. In others, the substances themselves cause or contribute to mental disorders. Once addiction takes hold, they become so intertwined even mental health professionals have trouble declaring whether the chicken or the egg came first.
For people who self-medicate, anxiety and depression make fertile ground for drug and alcohol addiction to take root. In others, addiction itself acts as the fertilizer for mental health issues. According to the NIMH, “Substance use can lead to changes in some of the same brain areas that are disrupted in other mental disorders, such as schizophrenia, anxiety, mood, or impulse-control disorders. Drug use that precedes the first symptoms of a mental illness may produce changes in brain structure and function that kindle an underlying predisposition to develop that mental illness.”
Youth is a particularly vulnerable time for depression, anxiety, and addiction to mix. When they coexist, they are “comorbid disorders”, and studies clearly show a two-way street. Drugs and alcohol impair parts of the brain that control decision making and impulse control which do not fully develop until later in life. Experimentation with substances and alcohol has also been connected with later occurrence of mental illness.
There is an overwhelming amount of information on addiction and depression, enough for a lifetime of study. It doesn’t have to be your lifetime, though. We are going to try and give you some top line information to help you consider whether you or someone you love needs help today, and what kind of help to seek. Two things, here:
- Get diagnosis of depression or anxiety should from a mental health professional, just as for a physical illness.
- If diagnosed with depression, or anxiety, get help for those issues in addition to a program of sobriety
Depression is on the rise
A recent study by Blue Cross Blue Shield of America shows that the number of people diagnosed with major depression—one of the most common types—is on the rise, up 33% since 2013. Among those in their early 20s to mid-30s, that number jumps to 47%.
Meanwhile, the non-profit Anxiety and Depression Association of America reports the correlation between alcohol and substance abuse is something you could call “20/20”: twenty percent of Americans with mood and anxiety disorders have drug or alcohol abuse problems, and twenty percent of people with alcohol and substance abuse disorders also have an anxiety or mood disorder. The street runs both ways.
What are depression and anxiety?
First and foremost, depression is a brain disorder. Though its symptoms include certain behaviors and moods which healthy people also experience, it is not something a sufferer with sufficient willpower can simply “pull out of”. Just as you cannot “will away” flu, diabetes, or cancer, neither can you will away clinical depression.
Depression has different degrees of severity and shows up in different ways. Some are easily treatable, and all are best addressed with professional diagnosis and treatment from a doctor of psychiatry. Certain medications may be prescribed to address chemical imbalances in the brain. Also, treatment usually includes psychological therapy to help address behavioral issues and mental triggers which can cause a cascade of serious health issues.
With regard to alcoholism and addiction, however, it’s important to know that no treatment for depression will “cure” alcoholism or addiction. The opposite is also true: the depressed alcoholic or addict who does not address his substance problems will impair the treatment of his mental health issues.
Both require attention, or the chances of healthy and happy living are not great.
Symptoms of depression
- Overwhelming sadness
- Uncontrollable bouts of crying
- Lack of self-worth
- A sense of guilt
- Short temper
- Inability to focus
- Fatigue or listlessness
- Oversleeping or insomnia
- Disinterest in socialization
- General indifference
- Increase in food consumption
- Weight gain
- Lack of appetite
- Weight loss
- Physical pain or achiness
- Suicidal tendencies
In a person with depression, these symptoms do not come and go as they do with “normal” people. They linger, impairing a person’s judgement, often leading to harmful and self-destructive behaviors. Add drugs or alcohol, and it’s like adding gasoline on a fire.
Common types of depression
This is the most common, also called major depressive disorder. Symptoms include extreme sadness, lack of energy, irritability and disruptions in sleeping patterns that last for more than two weeks.
Dysthymia is a “milder” form of depression, but a person can experience a continuous “gloomy mood” lasting a year or more. Since it is chronic, it can lead to major depression.
Seasonal Affective Disorder
A person with anxiety, mood changes, overeating and sleep problems linked to variations of light may have seasonal affective disorder. To properly diagnose SAD, a person must exhibit these symptoms over three consecutive winters.
This depression includes major ups and downs beyond normal variations of mood. A person has symptoms of major depression, but their mood is briefly uplifted with good news. During “low” periods, depression can be so severe it feels as though life is not worth living.
Other types of depression
Other well known types of depression include bipolar (I and II), psychotic (hallucinations, delusions, paranoia), postpartum, premenstrual, and situational depression.
Again: depression should be diagnosed by a healthcare professional. While there is a wealth of information online, self-diagnosis is dangerous. Most addicts and alcoholics with depression have already been the route of self-diagnosis and self-medication with unfortunate results.
Anxiety and depression often co-exist, with the symptoms of generalized anxiety disorder overlapping those of depression:
- Excessive worry
- Being easily fatigued
- Trouble concentrating
- Sleep disturbance
- Muscle tension
What’s the difference between anxiety and depression?
Loosely speaking, depression is “down” while anxiety is “up”. Depression flattens a person’s moods and reactions. Those with anxiety tend to be more “wired” and subject to racing thoughts, fears, paranoia, control issues, or panic.
Depressed people often believe things are bad, will continue to be bad, and resign themselves to feelings of hopelessness.
Anxious people are often fearful and tense. They, too, may be pessimistic, so self-medication with drugs or booze relieves this double-whammy (at least at first). While “normal” people can drink socially or take a prescribed anti-depressant in stressful situations, the addict and alcoholic often has little control over his consumption after the first drink or dose.
Common types of anxiety
Phobias are marked by strong aversion and intense fear out of proportion to the actual danger from a situation or object. The term is often misused to describe simple dislike of certain things or situations. Actual phobia is more serious.
Social Anxiety Disorder
A person with social anxiety disorder is said to have social phobia, with strong feelings of anxiety or fear in social situations. Meeting new people, dating, job interviews, answering a question in class, or even having to talk to a cashier in a store results in physical symptoms such as sweating, trembling, rapid heart rate, or nausea.
Post-Traumatic Stress Disorder (PTSD)
The National Institutes of Mental Health defines PTSD as a disorder which occurs “in some people who have experienced a shocking, scary, or dangerous event.” The normal “fight or flight” reaction persists and reoccurs, even when a person is no longer in danger.
Panic disorder manifests in sudden and repeated attacks of fear that last for several minutes or longer, characterized by a fear of disaster or loss of control even when there is no real danger. Sometimes a person has symptoms similar to those of a heart attack.
The Role of Self-Medication in Depression and Addiction
For both a depressive and one with an anxiety disorder, self-medication can bring relief—at least at first. That’s why so many addicts and alcoholics describe their early experiences with substances in miraculous terms. For the first time, I didn’t feel anxious, like I could finally fit in. It was like a weight lifting. Unfortunately, a familiar cycle followed. Relief led to repeated use, tolerance, dependence, and finally, addiction. This pattern played out for both the depressive and the anxious. For the depressive, the stimulant effect of booze and some drugs brought a welcome sense of euphoria, while the anxious felt his burden of constant fear and worry lift.
So, What Difference Does It Make?
Since each condition makes the other worse, this is a great question, since once these conditions co-exist, they will never separate. They just are. Any mental health professional will tell an addict or alcoholic with mood disorders or depression that treatments or therapies will be ineffective as long as they continue to drink or use. On the other hand, we have seen over and over again that recovery amplifies the effectiveness of treatments for existing health conditions in miraculous ways.
A big part of this “booster” effect is meeting life on life’s terms—definitive actions to take during unpleasant feelings and situations. This doubly applies to those with depression and anxiety: one of the most important tools of recovery is learning how and when to ask for help without shame, and accepting it.