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Depression And Substance Abuse: Which Comes First?

According to popular belief, depression is one of the main causes of substance abuse and addiction in teenagers.  It is thought that depressed youth tend to self-medicate with things such as drugs and alcohol, which, over time, leads them to become addicted.  Yet, as studies continue to emerge around depression and substance abuse, it seems more and more unclear as to whether or not depression does actually leads to substance abuse.  Some research now suggests that depression is, in many cases, actually caused by an already existing drug or alcohol problem.  So, much like the chicken or the egg debate, many want to know, which comes first – depression or substance abuse?  And the truth is, there is no definitive answer.  It can go either way and truly depends on individual circumstances.


When Depression Comes First


Adolescents and teenagers who suffer from depressive disorders experience uncomfortable feelings and emotions (sadness, hopelessness, loneliness, etc.).  Depressed individuals often isolate themselves, have trouble sleeping, and experience a lack of motivation or interest in daily activities.  Thus, teens with depression often want to feel better and/or seek to “numb out” (dull) the difficult emotions associated with depression.  Many do this by self-medicating with drugs and/or alcohol.  While drugs and alcohol can provide relief in the short term, these substances are highly addictive and can actually intensify depressive symptoms in the long term.


Addiction and depression both originate in the brain, which automatically makes teens with mental health issues more apt to developing addictive behavior(s).  And because teenagers’ brains are still developing, they are particularly vulnerable to the damage that is caused by drug and alcohol use.  Drugs and alcohol can greatly reduce the production of dopamine in the brain.  Dopamine (a neurotransmitter) plays a central part in regulating emotions and sending reward/pleasure signals to the brain, so the less dopamine one produces, the more prone they become to the symptoms of depression.


Another factor to consider when examining the presence of depression before substance abuse is the concept of negative urgency.  Negative urgency occurs in people who have a tendency to act impulsively during times of heightened emotion.  When teens experience negative urgency and act impulsively, they are not thinking about potential consequences, which is when many turn to drugs and/or alcohol.


When Substance Abuse Comes First


Some teenagers develop symptoms of mental illness, such as depression, only after engaging in drug and/or alcohol use for a period of time.  Drugs and alcohol are chemicals and have a significant effect on the chemistry and cell composition of the brain.  Over time, the effects of substance use can change the way the brain operates and regulates emotional and mental functioning, leading to a chemical imbalance that contributes to the development of depression in many teens.


Symptoms of Depression and Substance Abuse in Teenagers


Every teen is different, and depending on the length of time he or she has had depression and substance abuse, symptoms can look different.  Nonetheless, there are some general signs to look out for that could indicate your teen is struggling:


  • Sadness or hopelessness

  • Changes in sleeping pattern

  • Changes in eating habits (including weight gain or weight loss)

  • Isolation or withdrawal from friends and family

  • Loss of interest in previously enjoyed activities

  • Frequent crying episodes


Statistics: Depression and Substance Abuse in Teenagers


  • Teens who experience symptoms of depression are two times more likely to abuse drugs and alcohol than other youth who are not depressed.

  • A study conducted in 2016 indicated approximately 50% of high school seniors had used illicit drugs at some point in their lifetime.

  • Approximately 25% of teenagers in America consume alcohol in an average month and 17% of teenagers in American use one or more illicit drugs in an average month (with marijuana accounting for a wide majority of this drug use).

  • Symptoms of sadness and depression are found in 75% of substance-abusing adolescents and teenagers.


Dual Diagnosis


Whether depression leads to substance abuse, or the other way around, the correlation between depression and drug/alcohol use is so common it has it’s own term – dual diagnosis.  Dual diagnosis, also referred to as co-occurring disorders, is common in teens, and can be difficult to treat when compared to teens that have only been diagnosed with a single disorder.


Treatment Options for Teens


Dual diagnosis treatment is needed when a teen is suffering from both a mental illness and a substance abuse problem.  Whether addiction came first, or depression was the first to arrive, treatment can make a significant difference for your teenager.  There is some debate regarding the most effective approach to treating those with dual diagnosis.  Some believe the substance abuse should be seen as the primary disorder, and always treated first, while others view both disorders as equally important and opt for an integrated approach to treatment.  Regardless, treatment of depression and substance abuse in teenagers often involves various steps, or levels of care, to effectively treat both disorders and prevent relapse.


  • Detoxification – often occurring in an inpatient, medical setting, those struggling with substance abuse are monitored on a 24/7 basis where medical staff can administer tapering amounts of the substance (or the medical equivalent) in an effort to wean a person off the drug in a safe and effective way.


  • Inpatient rehabilitation – inpatient treatment provides teenagers with 24/7 medical and mental health support. Inpatient treatment centers frequently include a combination of individual and group therapy, medication management, experiential activities, and other health services.


  • Step down programs – various options are available for “stepping down” from an inpatient or residential setting including sober living homes or “halfway houses”, partial-hospitalization programs, and intensive outpatient programs. These programs assist individuals who are newly sober maintain that sobriety and avoid relapse through promoting a healthy, balanced lifestyle including being surrounded by supportive individuals who are also sober.


  • Individual psychotherapy – almost always a crucial element to any phase of dual diagnosis treatment in teens, individual psychotherapy can be very effective. There are various approaches a counselor or therapist may use when it comes to individual psychotherapy, but cognitive-behavioral therapy (CBT) is amongst the most commonly used for teens with depression and substance abuse issues.  CBT assists individuals in challenging and changing negative and ineffective thought patterns, which can contribute to depression and drug or alcohol use.


  • Medication – medication is often used in conjunction with psychotherapy in treating depression in teenagers. Medication can also be helpful in easing the symptoms associated with detoxing from certain substances.


  • Support groups – 12-step groups (such as Alcoholics Anonymous or Narcotics Anonymous) can be helpful to a teen’s efforts in maintaining sobriety and avoiding relapse. Such groups also provide a safe environment and a healthy support network.


Of course, the elements of treatment may vary depending on the individual prevalence and severity of symptoms.  Nonetheless, if your teenager is struggling with depression and a substance abuse problem, it is essential they be assessed and provided treatment recommendations.


Courtesy of Polaris Teen Center



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