What Comes First: Depression or Substance Abuse?

What Comes First: Depression or Substance Abuse?

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It’s the age-old question about mental health and addiction—does poor mental health cause addiction, or does addiction cause depression and other mental health issues? The truth is that there’s often not a surefire way to know the answer to whether depression or substance abuse comes first. The facts suggest that many people who have mental health issues also have comorbid addictions. This is why making sure you find treatment for both is so vital.

Dual Diagnosis Statistics

A 1990 report in the Journal of the American Medical Association found that over half the people suffering from mental health disorders also face problems with drugs or alcohol. Additionally, nearly a third of people with mental health disorders have addiction disorders at some point in their lives. 1

Those statistics often lead people to ask which comes first? Mental health issues like depression or substance abuse? The answer is not definitive and differs for different people.

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In some, the effects of addiction on relationships and life structures may lead to depression and anxiety. In others, the need to deal with depression and anxiety may lead to substance misuse and abuse as a coping strategy. Essentially, there’s no set formula for whether depression or substance abuse comes first because it’s unique to each individual.

Depression and Substance Abuse Comorbidity: Why So Many Dual Diagnoses?

When you’re wondering about what comes first – depression or substance abuse – a research report from The National Institute of Drug Abuse found a few different points to consider. 2

The most important thing to think about is not necessarily whether depression or substance abuse comes first, or even that one caused the other. It isn’t easy to define what comes first and what may have caused the other. Sometimes symptoms of one don’t reach a diagnostic level (per DSM, the Diagnostic and Statistical Manual of Mental Health Disorders) but may prompt some drug use to treat lesser symptoms. That drug use may not necessarily be defined as addictive yet, either. The lines of whether the depression or substance abuse came first depend on when there were enough criteria for diagnoses.

The Dangerous Connection Between Depression and Substance Abuse

Most important, we know that mental illnesses can lead to drug and alcohol addiction, often starting as self-medication for mental health conditions. If you’re suffering from mental health symptoms that cause you depression, anxiety, or other pain, you may be inclined to use and abuse drugs or alcohol to numb or eliminate the symptoms. You may not even know that you’re suffering from mental health issues; you’re just looking to make things better.

For instance, dopamine is known as the “feel-good” neurotransmitter, and there’s a link between depression and low dopamine levels. 3 High dopamine levels are linked to feelings of euphoria and extreme happiness, which both heroin and prescription painkillers give the user. Taking something to feel euphoric is tempting when you’re depressed, but it requires more and more as tolerance develops. Too often, you’re already addicted at that point and now suffering from depressive disorder and addiction.

While it’s understandable to seek a way to feel better and curb pain, drugs and alcohol will only cause worse problems over time. If you’re struggling with a dual diagnosis of addiction and a mental health condition, the best approach is to treat both. 

Ocean Hills Recovery: Dual-Diagnosis Treatment You Can Count On

It doesn’t matter whether depression or substance abuse came first. Either way, the outcome is that you’re not living your most free life, especially when both issues are present. 

At Ocean Hills Recovery, we understand that co-occurring disorders are common when you’re going through recovery. Our staff walks you through the nuances of mental health and addiction recovery, allowing you to rehabilitate your whole self. We offer dual diagnosis treatment that combines medical, spiritual, social, and psychological interventions to address the whole you.

Our “Collaborative Recovery” approach involves your family, therapists, physicians, and your community to provide safety and security as you recover. We excel at assisting you with mental and emotional health while supporting your first steps into sobriety.

Let us help you live the life you were meant to live. If you’re ready to take the first steps, contact us today.


[1] https://jamanetwork.com/journals/jama/article-abstract/383975?redirect=true
[2] https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf
[3] https://www.sciencedirect.com/science/article/abs/pii/0010440X9290007D?via%3Dihub

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