Is Depression Derailing Your Recovery Progress?

It is an accepted fact among mental health professionals that there is a link between substance use and depression. The Centers for Disease Control and Prevention, or CDC, estimates that 10 percent of Americans will suffer from depression at some point in their lifetime; and in any given year, about 7% will experience a major depressive episode.

According to research from the Genetic Science Learning Center at the University of Utah, 27 % of people with a major depressive disorder are also addicted to drugs.

The Link Between Substance Use and Depression

The link between substance use and depression follows a dual pathway. People who are depressed may drink or abuse drugs to lift their mood or escape from feelings of guilt or despair.

But some substances like alcohol, a depressant, can increase depressive symptoms such as sadness or fatigue. And once the effects of drugs or alcohol wear off, guilt or shame often increase feelings of depression even more.

Addiction and depression both originate in the brain, in areas that help regulate mood. Researchers believe that, along with alterations of levels of specific brain chemicals that regulate mood, certain nerve cell connections and circuits also have a major impact on depression. It is believed that people with depression may turn to drugs to stimulate their brain’s reward pathways in order to elevate levels of brain chemicals that foster positive moods.

Another factor in depression is the concept of negative urgency.  Negative urgency is a tendency to act rashly, without considering the consequences, when experiencing particularly strong negative emotional states. People with a greater tendency toward negative urgency tend to lose control over their behaviors when they are sad, angry, frustrated or fearful. Researchers believe that the behavioral impact of negative urgency may explain the connection between depression and the use of cigarettes, marijuana, alcohol, and prescription painkillers, especially in those who have other life circumstances that make them more vulnerable to mood inconsistencies. Substance use provides quick, ready relief from disturbing or uncomfortable feelings and may mitigate the tendency to act on these feelings.

Signs of Depression

Clinical depression, where the symptoms interfere with one’s ability to take part in everyday activities, is more severe than simply feeling sad or unhappy. Cues to recognizing depression that may need to be attended to by a therapist or doctor include:

• Feelings of helplessness and hopelessness
• Loss of interest in activities that were previously engaging
• Inability to experience pleasure
• Appetite or weight changes
• Sleep changes
• Loss of energy
• Strong feelings of worthlessness or guilt
• Concentration problems
• Anger and/or reckless behavior

How Depression can Adversely Affect Recovery Efforts

Being depressed in many ways can make it harder to sustain recovery goals. Depression can derail recovery by:

• Increasing feelings of anxiety and irritability.: When you are anxious or irritable, it is harder to refrain from giving in to the urge to use your drug of choice to calm your nerves.
• Interfering with sleep: Sleep problems are common during early recovery, and they are also often a symptom of depression. So the combined effects of both can exacerbate sleep problems even more. Without adequate quality sleep, it is difficult to stay committed and focused during recovery.
• Reducing motivation and energy: One of the hallmarks of depression is the loss of interest, motivation and the energy for pursuing life goals. Recovery requires tremendous commitment and effort, which can’t be sustained without significant motivation and engagement, and depression unfortunately undermines these.
• Limiting your ability to focus or concentrate: Depressed people often have difficulty staying focused and attentive for more than brief periods of time. Consciously distracting yourself is helpful if you are trying to avoid acting on cravings. But if you are too easily distractible, you can find yourself acting out of habit, without thinking, and potentially reinforcing using behaviors before you realize it.
• Increasing anger or reckless behavior: Just as substance use reduces inhibitions, so does depression sometimes elicit an “I don’t care” attitude that can override a person’s desire to monitor anger or recklessness.

Treatment and Self-Help Options

What can you do if you are in recovery and think you may have depression?

First, getting an accurate diagnosis is important, especially if your symptoms are severe. Talk to a therapist or doctor about your concerns and see if you may benefit from medication or other treatment. When depression or another mental condition are present along with substance use, the condition is called a dual diagnosis. Specific programs to address dual diagnosis are available and take into account not only the person’s recovery needs, but their mental health needs as well. So it is best to attend a program that specializes in dual diagnosis when that is called for.

Along with program options, there are a number of things you can do to facilitate your recovery from both depression and substance use:

• Educate yourself. Learn as much as you can about depression, why it occurs and how to manage it. Read up on medication and therapy options and explore the many self-help resources that are available online.
• Explore the role depression plays in your recovery process. Keep a journal, talk to peers or your support group and attempt to clearly define the specific triggers that cause your dips in mood. Then think of ways you can try to counteract these.
• Practice wellness. Physical health fosters emotional and mental health. Eat a healthy diet, get sufficient sleep, exercise and minimize stress by engaging in a mind-body practice such as meditation, mindfulness or yoga.
• Develop new emotional coping strategies. Cognitive behavioral therapy is one of the most commonly used therapies for treating depression because depression is in essence, a thinking problem. Learning to control negative mental ruminations, challenging negative thoughts and assumptions, and fostering a more self-empowered outlook are key elements that CBT addresses. You can learn more about CBT strategies by working with a therapist or counselor or by attending a CBT-based self-help group (in person or online). There are even phone apps to help you.

For a list of self-help apps, e-therapy and guided self-help options, go to this site. It’s maintained by the Mental Health Foundation of New Zealand, but its options are available to people everywhere. Many apps are also available from the iPhone store.

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