Health Matters 7/22: Understanding the Link Between Depression and Substance Abuse


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By Sarah Carstens, LCSW, LCADC

When it comes to depression and addiction, it can be hard to know which came first.

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In fact, many patients report that they are not sure if they are using substances to cope with their depression or whether their substance use caused them to become depressed.

At Penn Medicine Princeton House Behavioral Health, patients have access to evidence-based treatment services that address both substance abuse and depression at the same time, formally known as a co-occurring disorder or dual diagnosis.

Dual Diagnosis

A dual diagnosis or co-occurring disorder refers to a specific combination of diagnoses that occur at the same time, such as depression and substance abuse, and is more common than you may think.

Consider that of the 21 million people in the United States who have a substance use disorder, eight million also live with a mental illness, according to the National Alliance on Mental Illness (NAMI).

Men are more likely than women to develop a co-occurring disorder. Other people who have a particularly high risk of dual diagnosis, according to NAMI, include individuals of lower socioeconomic status, military veterans and people with chronic medical conditions.

Warning Signs

Nearly everyone experiences challenging times, periods of sadness or significant life changes.

Moreover, many people will use substances every now and then to unwind or “take the edge off” — such as a glass of wine at the end of a hard day or a beer with friends to wrap up a difficult week.

But when these feelings and behaviors start to impact your daily life, relationships, work or school activities or when using substances becomes your primary means of coping with difficult emotions, it could be time to seek professional help.

Other warning signs include:

• Intense hopelessness.
• An overwhelming sense of worry or dread.
• Increased isolation or withdrawal from friends and family.
• Significant changes to sleep patterns.
• Significant changes to eating habits.
• Increased irritability or anger.
• Decreased energy or lethargy.
• Hiding your use of alcohol, medication or drugs from loved ones.
• Extreme mood changes.
• Confused thinking or problems concentrating.
• Suicidal thoughts.

It’s important to note that symptoms of a mental health condition can vary greatly. If you are concerned about your mental health or substance use talk with your doctor.


The first step in treatment for co-occurring disorders or dual diagnosis is to understand the interplay between depression and substance abuse and to begin the process of breaking the cycle.

Someone may deal with depression by drinking, for example, and that behavior may lead them to retreat further from family and friends, which then increases their isolation and can result in deeper depression.

Dual diagnosis treatment at Princeton House helps individuals work through the process of understanding this relationship and then helps them develop the skills needed to cope with their depression and substance abuse.

Dialectical behavior therapy (DBT) is a type of therapy offered at Princeton House that helps people learn to regulate their emotions, tolerate distress and uncomfortable feelings and interact effectively with others.

Inpatient and outpatient programs at Princeton House include learning and applying DBT skills in a combination of group and individual therapy, as well as family support sessions. Family and loved ones are important in the recovery process and play an integral role in a person’s success.

Inpatient treatment typically lasts five to seven days and is usually followed by outpatient treatment upon discharge. Outpatient treatment is generally six to eight weeks and therapists work with individuals to establish an aftercare plan prior to completing the program.

Healthy Habits

While life’s stressors can certainly bring you down, there are steps that you can take to boost your mental health and manage your emotions in a healthy way.

• Exercise regularly. Just 30 minutes of walking every day can help elevate your mood and improve your health, according to the National Institutes of Mental Health.

• Eat healthy. Eating a balanced diet that includes a variety of fruits, vegetables, grains, protein and dairy is good for your physical and mental health. Also, according to NAMI, research has shown that a diet high in refined sugar can worsen symptoms of mental health conditions, so it may be helpful to limit your sugar intake.

• Get a good night’s sleep. Sleep and mental health go together. Getting a good night’s sleep can help you better process your emotions and regulate your mood.

• Do something you enjoy. Whether it’s reading a book, gardening or taking a long bath, try doing an activity that can help you to unwind and destress.

• Talk to a friend. If you are feeling sad, angry or stressed, talking to a friend can often relieve those feelings and have you smiling by the end of the conversation.

Remember, if you or someone you love is experiencing mental health and substance abuse problems, help is available.

By working with trained professionals, you can receive an accurate diagnosis and treatment plan that helps you feel more capable of managing life’s stressors, gain more control over your mental health symptoms and substance use, and improve your quality of life.

For more information about Penn Medicine Princeton House Behavioral Health visit Princeton House admissions clinicians can be reached at 888-437-1610.

Sarah Carstens, LCSW, LCADC, is a licensed clinical social worker and licensed clinical alcohol and drug counselor. She is the clinical director of Addiction Services at Penn Medicine Princeton House Behavioral Health.

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