Warm Horizon

Depression and Substance Abuse Not a Good Mix

There has and no doubt will continue to be much debate regarding the relationship between depression and substance abuse. And while specific precipitants of episodes/relapses of both of these problems may occur, the reasons why either are manifested in people are complex and often nebulous. It is more likely that individuals who exhibit substance-abuse tendencies are depressed than it is that depressives are substance abusers. Furthermore, it is more reasonable to view both of these problems as enhancing the other rather than to view either as actually being able to cause the other. Thus, there is little doubt that if both problems exist and one increases in intensity, the other will also increase as a result.

At any rate, substance abuse is extremely common for persons who must deal with depression. I have heard estimates as high as 85 percent for the number of individuals who deal repeatedly with depression who also get involved with some type of substance abuse.

Yes, definitely. But the key point to understand in these cases is that the depression is substance-induced and thus will likely be resolved with successful medical treatment. However, this fact does not mean that the same snowball effect I have described previously cannot still operate to intensify this kind of depression just as it does with psychogenic depression. Thus, we are still likely to be confronted with the same kinds of issues and associated tasks as with any form of this illness—the difference being that the subconscious thought process generates and drives psychogenic depression, whereas it is chemical ingestion primarily and thought process secondarily that drive substance-induced depression.

On the other hand, though, there are documented cases in which it appears that substance abuse has actually kept existing depression (psychogenic) at tolerable levels for long periods of time. Perhaps the best known of these cases is that of author William Styron, which he so eloquently depicts in his book Darkness Visible (1990). In Styron’s case, it was his consumption of alcohol that he was suddenly unable to tolerate. And from that point forward, his depression developed into the dark, abysmal experience with which so many of us are familiar. (In his case, I believe it was the loss—not the lack—of alcohol that symbolized the loss of his mother’s love, which triggered his plunge into depression.)

Again,

Thus far, my use of the term “substance abuse” has prompted many of you to think of the use of nonprescription drugs such as alcohol, cocaine, nicotine, and caffeine. But abuse of prescription drugs can be just as much a problem and one that most affected individuals likely never foresaw. Of course, the most understandable of these cases are chronic pain sufferers who become addicted to narcotic pain-killers. In fact, in the business of treating chronic pain sufferers it is more or less understood that should physical pain levels remain significantly high for significant lengths of time, then these individuals will become addicted (temporarily) to the very narcotics used to try to bring their pain levels down—a situation that the qualified physician will minimize. So be aware: self-medicating will not work.

But what about emotional pain? Does emotional pain compel people to seek whatever substances they might find that will, at least to some extent, successfully relieve their pain? Of course it does. But once that happens, no matter how helpful that substance seems to be or how well the individual handles it, the user must with rare exception stop the use of that substance before he/she can successfully deal with the issue underlying its use. Until that happens, it will usually be impossible even to address the underlying problem. The only notable exception to this unlikelihood is that sometimes physician-prescribed pharmacological treatment will significantly decrease the unpleasant symptoms of the underlying depression, anxiety, and/or pain even while substance abuse is ongoing. The most common example of such situations is found with chronic-pain patients who are experiencing related depression. Often in those cases treatment with an antidepressant results in a decrease in pain levels, whereas pain-killers alone have minimal effect. Thus, it is then much easier for physicians to taper such individuals off of their addictive pain-killers as the newfound benefits of the antidepressant remain in effect, especially since long-term narcotic addiction can actually contribute to pain levels.

Categories most commonly associated with the generation of depression are depressants, opoids, and stimulants—including both prescription and nonprescription drugs.

There are three categories of depression-related problems for which affected individuals most commonly seek the help of substances:

The following table indicates the types of substance—prescription and nonprescription—commonly used for these problems:

In that many prescription substances—perhaps most notably antihypertensives—have been shown to induce depression in some individuals, it is wise to notify your physician if a new medication seems to have resulted in symptoms of depression. But do not assume a medication is making you depressed if you experience some lethargy or uneasiness when first taking it. It commonly takes your system a few days to adapt to a medication before you will feel comfortable.

Normally, self-medicating to relieve symptoms of depression ultimately will cause you much greater difficulty with your depression than it will help (temporarily) in decreasing your symptoms.