Dual Demons – Depression and Addiction

Although experts are not entirely sure whether depression more often precedes addiction, or addiction precedes depression, clinical depression frequently accompanies addictive behaviors. The truth, many believe, may lie somewhere in between.

These twin tendencies may lead to tandem and symbiotic conditions. Some experts believe that women are more likely to develop depression first and self-medicate with alcohol, whereas men are more likely to develop the addiction first and experience depression as a result. In either case, each problem feeds off the other; for this reason, both conditions must be sufficiently treated in order for the individual to truly recover and find mental and physical health. When an individual is diagnosed as having both a clinical mental health problem and a substance abuse problem, this person is said to have a “dual diagnosis.”

From 1980 to 1985, the United States Department of Health and Human Services National Institute of Mental Health (NIMH) conducted an in-depth Epidemiologic Catchment Area Study. The purpose of the NIMH study was to collect data on the prevalence of mental disorders and on the use of and need for services by the mentally ill. Research teams at five prestigious universities collaborated with the NIMH to collect data in designated sample or “catchment” areas.

The NIMH study found that almost one-third of individuals with depression also had a co-existing substance use disorder at some point in their lifetime. Another study conducted by the NIMH from 1990 to 1992, the National Comorbidity Study (NCS), found that women who were dependent on alcohol were four times more likely than the general population to experience depression, and alcohol dependent men were three times more likely (Kessler et al, 1997).

In addition to the dual demons of addiction and depression, individuals dealing with substance abuse issues often present with other clinical mental health diagnoses, including bipolar disorder, anxiety, personality disorder, and post traumatic stress disorder. In a recent small study conducted by Dr. Dennis C. Daley, Ph.D., Chief of Addiction Medicine Services and Professor of Psychiatry at Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, 153 new clients at six different substance abuse treatment clinics scored on average in the moderate range for depression and the moderate-to-severe range for anxiety, based on two commonly used tests – the Beck Depression Inventory and the Beck Anxiety Inventory. Of these clients, 34.1 percent were already taking antidepressants, 10.5 percent were taking mood stabilizers, 8.5 percent were taking anti-anxiety medications, and 7.8 percent were taking anti-psychotics.

These data indicate not only the prevalence of mental health problems among substance users, but the fact that many users are aware of their co-existing mental health problems. Other work by Dr. Daley and colleagues has shown that individuals with addiction and depression are also more likely to exhibit suicidal and homicidal behaviors, poorer treatment adherence, higher relapse rates in either disorder, and higher re-hospitalization rates (Cornelius et al, 1997; Salloum et al, 1996; Daley & Zuckoff, 1998 & 1999). As such, finding a substance abuse treatment center that specializes in treating dual diagnosis is essential to lasting recovery.