Depression as a Cause of Substance Abuse and Addiction: The Vicious Cycle

Depression as a Cause of Substance Abuse and Addiction:  The Vicious Cycle

Why does substance abuse become a cycle?

Is it weakness on the part of the drug user? Is the failure of the drug treatment system? The answer to these questions cannot be answered in a single sentence. Most people, who do not have a substance abuse disorder, blame the inpidual. It is an easy thing to do since the assumption is the inpidual must have control over his or her behavior. This is true to a certain extent.

Perhaps the best way for inpiduals without this issue to relate to substance abusers is to think about when he or she has had a depressed mood. Most people, at some point in their lives’ have been depressed. Depression can stem from a specific life event. Depression can also be a deficiency of chemicals in the brain. The effects of a depressed mood can take many different forms including drinking, substance abuse overeating, gambling among other destructive behaviors.

When an inpidual is depressed it may genuinely be difficult to function. Getting out of the bed in the morning can become a task. Personal hygiene, activities which were previously a source of joy the inpidual no longer reaps any benefit from. For anyone who has ever felt this way, it’s no mystery that whatever is necessary will occur in order to heal the pain. The following are the most common symptoms of clinical depression:

  • Decreased sleep or sleeping excessively
  • Lack of concentration, previously easy tasks are now difficult
  • Feelings of worthlessness and hopelessness
  • Can’t control negative thoughts, no matter how much one tries
  • Loss of appetite or can’t stop eating
  • Constantly irritated or become upset at small things, this is something that doesn’t usually happen.
  • Thoughts that life is not worth living, having a plan for how you would end life. Should this be the case, please seek help immediately.


How does substance abuse occur in these situations?

In all likelihood the inpidual experiencing such symptoms, has turned to drug use in order to feel ‘normal’. In many cases, alcohol use is the entry drug for depressed inpiduals. This can lead then to the use of drugs such as cannabis, as well as prescription drug use. Which drug is used depends not only on diagnosis of depression but also on socioeconomic status as well as the age of the abuser. For instance, cannabis is found to be more common among young males while prescription drug use is correlated with higher socioeconomic status.

The use of analgesics and sleeping aids is common and often abused. Since the depressed inpidual doesn’t feel like him or herself, they may be complaining of general malaise. If this is the case, then going to the primary care provider may entail complaints of various aches and pains which are manifestations of depression which then merit the writing of a pain medication prescription.

One of the main problems with treating the side effects of depression with substances is things like alcohol, cannabis and prescription medications can eventually lead to further depression. Though these drugs may relieve depressive symptoms for a short period, they can then in turn lead to a depressive state that is worse than what the inpidual had initially experienced.


The solution to issues such as this, often come back to the healthcare provider. Physicians and clinical staff are not often trained in mental health issues, so instead of treating the root of the problem, the physician may be treating the physical manifestations of depression. Though they are trying to help, by prescribing medications he or she may be spurring the start of a substance abuse problem which will only get worse. Most research shows that if healthcare providers are better informed on how to screen for these issues they may be able to better assist their patients.

What if a Substance Abuse Issue Has Already Occurred?

Once depression has manifested in a substance abuse disorder it is important to then treat both problems so that the solution as a whole is taken care of. Having said that, it is then important for substance abuse professionals to thoroughly assess the inpidual for multiple substance abuse disorders as he or she may need help with various issues.

Once the depressed inpidual is assessed a treatment plan can be developed. In all likelihood this will include a regime of anti-depressives or anti-anxiety medications which will have to be coordinated and managed. Prior to prescribing medications, it behooves the healthcare professional to assess whether the depressed inpidual succumbed to substance abuse as a result of situational depression (i.e. job loss, death, moving or other life stressors) or if the depression is a result of a biological component most likely such as a chemical imbalance.

What Can You Do For the Depressed Inpidual?

Get them help!! As the very nature of depression includes a lack of motivation to live or for life, it is important to push the depressed person to take care of him or herself. This can take the form of a support group, making an appointment with a psychiatrist, or in the case of substance abuse, making sure that the proper professional team is identified. Depression and the problems that come with it, including substance abuse, are treatable. The most important part is identifying and treating the issue.

Rachel Hayon, MPH, RN

Coulehan JL, Zettler-Segal M, Block M, McClelland M, Schulberg HC: Recognition of alcoholism and substance abuse in primary care patients. Arch Intern Med 1987; 147:349-352
Havassy BE, Schmidt CJ: Alcohol and other drug abuse disorders in primary care settings, in Current and Future Research in Mental Disorders in Primary Care. Edited by Miranda J, Hohmann AA, Atkisson CC, Larson DB. San Francisco, Jossey-Bass, 1997, pp 34-63
Roeloffs, C.A., Wells, K.B., Ziedonis, D., Tang, L., Unützer, J. (2002). Problem Substance Use Among Depressed Patients in Managed Primary Care. Psychosomatics 43:405-412
Warner LA, Kessler RC, Hughes M, Anthony JC, Nelson CB: Prevalence and correlates of drug use and dependence in the United States: results from the National Comorbidity Survey: Arch Gen Psychiatry 1995; 52:219-229
Wells KB, Golding JM, Burnam MA: Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders. Am J Psychiatry 1989; 146:1440-144

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