Depression and Co-Occurring Substance Abuse

Alcohol and drug abuse frequently co-occur with various psychiatric conditions, such as depressive disorders like major depressive disorder and persistent depressive disorder. In fact, about 50% of people with a substance addiction also experience a mental health disorder at some point in their lives—vice versa is true as well.1

This is of particular concern in Massachusetts, as nearly 19% of adults in this state were diagnosed with a depressive disorder in 2020.2 Individuals with depression may frequently turn to substance abuse to self-medicate, and although these substances may temporarily alleviate distressing depressive symptoms, they ultimately exacerbate the symptoms over time.1 If you struggle with depression and substance abuse, it’s important to seek out a dual diagnosis treatment program in Boston or another part of Massachusetts.

Types of Depressive Disorders

Depressive disorders frequently co-occur with substance use disorders. These depressive disorders vary from condition to condition, but a common feature of all of them is the persistent presence of irritable, empty, or sad mood, accompanied by cognitive and bodily changes that impair a person’s ability to function.3

Note: While bipolar disorders and depressive disorders used to fall under the same umbrella in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-4), they are now separated into two categories in the DSM-5: Depressive Disorders and Bipolar and Related Disorders.3 As such, we haven’t included bipolar disorders in this guide.

Major Depressive Disorder

Major depressive disorder, which is one of the most common types of mental illness, is characterized by the following:3

  • Depressed mood most of the day, every day
  • Inability to sleep or sleeping too much, every day
  • Lack of interest or pleasure in most activities
  • Profound restlessness or slowed thinking and movements, every day
  • Noticeable weight loss without dieting or significant weight gain
  • Severe fatigue
  • Inability to focus or concentrate or make decisions
  • Intense feelings of inappropriate guilt or worthlessness nearly every day
  • Repeating thoughts of death or recurrent suicidal thoughts, or suicide attempts

Persistent Depressive Disorder (Dysthymia)

Someone with persistent depressive disorder, or dysthymia, experiences a depressed mood for at least two years. They may have major depressive episodes periodically throughout this two-year period as well as periods of less severe depressive symptoms.3,4

Symptoms of persistent depressive disorder include:3

  • Overeating or poor appetite
  • Sleeping too much or too little
  • Fatigue or low energy
  • Low self-esteem
  • Difficulty making decisions and concentrating
  • Excessive feelings of hopelessness

Disruptive Mood Dysregulation Disorder

Individuals with disruptive mood dysregulation disorder frequently exhibit verbal rages and/or physically aggressive behaviors toward property or other people. These temper outbursts are significantly out of proportion in duration or intensity to the situation.3

These outbursts occur at least three or more times per week, and the individual’s mood between these outbursts is consistently angry or irritable most of the time. Disruptive mood dysregulation disorder is diagnosed in children and adolescents over age 6 and under age 18.

Postpartum Depression

People with postpartum depression experience clinically significant depression during pregnancy or after delivery. The symptoms of postpartum depression, such as severe anxiety and sadness, make it difficult for new parents to function and care for themselves and their babies.4

Seasonal Affective Disorder

Individuals with seasonal affective disorder experience depressive symptoms during the winter when there is less sunlight. Generally, their depression alleviates once spring hits. Symptoms of seasonal affective disorder include:4

  • Weight gain
  • Increased sleep
  • Social withdrawal

Why Depression and Substance Abuse Commonly Co-Occur

Individuals with a depressive disorder are at least twice as likely to have a drug or alcohol addiction than those without depression. Other studies of people in treatment have resulted in various rates, such as:5

  • Between 20% and 67% of people seeking alcohol addiction treatment had depression
  • Between 10% and 40% of people addicted to cocaine reported depression

Depression and addiction affect each other in such a complex and profound way that it can be difficult, if not impossible, to establish which condition developed first. And that’s okay, as long as both disorders are treated fully with an integrated treatment plan.

Some reasons that depression and substance addiction may commonly co-occur include:1,5

  • Shared risk factors: Substance addiction and depression are both heritable and share some environmental influencers like childhood abuse.
  • Addiction can cause depression: Substance abuse changes brain chemistry, structure, and functioning, which can result in depressive symptoms.
  • Depression can lead to substance addiction: Those with depression may self-medicate distressing symptoms with alcohol or drugs. Once they are sober, they may feel worse than they did prior to self-medicating, which may make them return to substance use once more.
  • Kindling: Certain substances like cocaine and alcohol make brain cells more sensitive, a process called kindling, which can contribute to the progression of addiction. Likewise, depression can increase sensitivity of neurons and make periods of remission shorter and shorter. Because of these shared pathways in the brain, these two conditions are likely to overlap.

Risk Factors for Depression and Substance Abuse

While researchers are continually exploring the many risk factors for depressive disorders, they have established several causes that may predispose someone to the development of one or more depressive disorder, such as:3,4

  • Substance abuse
  • Temperament, such as neuroticism
  • Certain chronic or disabling physical conditions
  • Adverse childhood experiences, such as abuse and neglect
  • Stressful life events
  • Genetics/Family history
  • Other mental illnesses, such as borderline personality disorder
  • Parental loss or separation

Many causes of depressive disorders overlap with risk factors for substance use disorders, such as genetics, life stressors, trauma, other mental health disorders, and childhood abuse.3

Dual Diagnosis Treatment for Substance Abuse and Co-Occurring Depression

Both depressive disorders and substance use disorders impact treatment progress and outcome for the other condition. For example, if you only receive treatment for your drug or alcohol addiction, you are at risk of relapsing once you complete treatment—this is because you won’t be equipped with the coping skills you need to deal with your depressive symptoms. Likewise, if you receive treatment solely for your depression, then you may continue to use substances, which may worsen your depression.

Because these conditions affect treatment outcomes, it’s important to seek a dual diagnosis treatment program in Boston or another part of Massachusetts. Dual diagnosis treatment programs specialize in providing comprehensive services for both depression and addiction.

Dual diagnosis treatment programs in Boston begin treatment with an intake evaluation, which assesses:

  • Previous treatment programs or dropouts
  • Previous withdrawal episodes
  • Family history of mental health disorders and substance abuse
  • The presence of other mental health conditions
  • Depressive disorder history
  • Substance abuse history
  • Medical history

The treatment team at the Boston dual diagnosis treatment program will use this information to create a treatment plan that’s tailored to your individual needs. Your dual diagnosis treatment plan may include:5

  • Medications for depression: Selective serotonin reuptake inhibitors, such as Prozac, Zoloft, Paxil, Lexapro, and Celexa. Others include Wellbutrin and Effexor.
  • Medications for substance use disorder: They may prescribe medication for addiction, such as buprenorphine, methadone, or naltrexone, as long as it doesn’t have any dangerous interactions with your antidepressant.
  • Cognitive-Behavioral Therapy (CBT): This type of therapy has proven effective for both depressive disorders and substance addictions. A therapist helps you understand how you thoughts, feelings, and behaviors affect one another so you can recognize and rectify negative feelings and behaviors.
  • Contingency Management: Incentives and rewards are used to reinforce positive and abstinent behaviors, such as negative drug tests.
  • Group Counseling: A therapist facilitates a group counseling session in which patients learn from the experiences of others while also learning and practicing new strategies, such as drug refusal, impulse control, emotional regulation, and sober social skills.c
If you are struggling with depression and substance abuse, help is just a call away. Call us at (857) 577-8193 to find a Boston dual diagnosis treatment program. Most types of insurance, including MassHealth, cover rehab.


  1. National Institute of Mental Health. (2021). Substance Use and Co-Occurring Mental Disorders.
  2. United Health Foundation. (n.d.). Depression in Massachusetts.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.).
  4. National Institute of Mental Health. (2018).
  5. Quello, S. B., Brady, K. T., & Sonne, S. C. (2005). Mood disorders and substance use disorder: a complex comorbidityScience & practice perspectives3(1), 13–21.

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