Alcoholism / Addiction and Depression

Alcoholism / addiction and depression make the perfect marriage. They are so alike we can barely tell them apart. And they love each other. But it is a mercurial marriage, a suffocating one. They are so woven together that one can kindle the fire of the other. In fact, their romantic dexterity is such that it can be very difficult – sometimes impossible – to figure out which came first and brought the other along. Or even to tell them apart. In this context, we are talking about “clinical depression,” not merely a feeling of sadness or having the blahs.

The medical term “depression” refers to a condition where a depressed mood on most days is accompanied by vegetative symptoms. These are symptoms which make the person “vegetate:” a loss of interest in doing anything (including things that we normally find fun), excessive sleep (although the sleep may be poor in quality or involve simply laying awake), poor or overactive appetite, feelings of guilt (usually excessive and unwarranted), low energy, poor concentration, inability to feel joy in anything.

There may be suicidal behavior (fantasizing about, planning, or committing suicide), and psychomotor agitation, which is physical jitteriness, fidgeting. As well, psychosomatic symptoms, also known as functional symptoms can appear. These are physical symptoms without a pathological cause. Commonly, these involve pain (particularly in the joints and muscles), headaches, stomach upset, diarrhea, dizziness. Depression can cause just about any physical symptoms or worsen pre-existing symptoms. For example, people with low back pain often find that depression worsened their pain perception.


Depression is known as a "mood disorder," and encompasses a variety of slightly different disorders. What I call "garden variety" depression is known as MDD (major depressive disorder). There is also dysthymia, bipolar depression, schizoaffective disorder, and so on.

Depression is commonly associated with addiction

The statistics for depression and substance use comorbidity are staggering. The lifetime risk of having a mental health disorder – of any kind, excluding alcoholism-addiction – is 22.5%. That of alcoholism is 13.5% and 6.1% for other drug addiction. The lifetime rate for any mood disorder (depression or anxiety disorder) is 19.3%. Compared with people with no mood disorder, those with depression were approximately twice as likely, and those with bipolar disorder approximately seven times as likely, to have a substance use disorder. Substance use disorders were shockingly common among people with bipolar disorder: 56%!

Mood disorders and substance use disorders mutually worsen the clinical course, treatment outcome, and prognosis for each other, so it follows that successful alleviation of one condition facilitates recovery from the other. Treating patients’ mood disorders will almost certainly reduce their substance craving and improve their overall chances at sobriety. Someone in active alcohol or drug use is unlikely to seek or respond to treatment for a mental illness.

Similarity of depression and addiction / alcoholism

Depression is very much a physical illness, caused by low levels of certain brain chemicals (neurotransmitters), or by a reduced ability of the brain to use these neurotransmitters. Anti-depressant medications bring these neurotransmitters back to healthy levels.

Most drugs of abuse, and especially alcohol, result in low levels of the same neurotransmitters that are low in depression. Therefore, they can cause depression or significantly worsen a pre-existing depression.

As well, drugs and alcohol work against anti-depressant medications by opposing their efforts to normalize the neurotransmitter levels. This is why these usually highly effective medications don't work well in someone who is drinking or using.

When we stop using drugs or alcohol, the low levels of neurotransmitters they caused start to normalize. However, it can take the brain a while to bring them back to normal levels. Because of this depression is common in early recovery and should be watched for because it's a major risk factor for relapse... and because it's an awful thing to live with.

Many people experience the "pink cloud effect" (Click Here) in early sobriety, which masks the depression-causing effects of the low neurotransmitter levels. Fortunately, for many people, the levels are back to normal when the pink cloud effect ends, and they are fine. However, if the brain hasn't yet corrected the levels, the person coming off the pink cloud can go from a high to a low very quickly, with devastating effects. This should also be watched for in early recovery.

Besides similar brain chemistry, addiction / alcoholism and depression share many of the same genes that play a part in bringing them on. As such, someone who is genetically more likely to become addicted is usually also genetically more likely to develop depression. (Click Here).

These similarities and overlap are not limited to depression. They are also seen in many other mental health disorders (Click Here).

Self-medicating with drugs or alcohol

Depression is an excruciating illness, truly a form of suffering. The depressed person is miserable, low-functioning, and feels guilty, hopeless and alone.  It’s easy to see how people feeling this way, suffering night and day, might easily turn to drink or drugs to try to alleviate the depressive symptoms, something we call “self-medicating.” Their desperation to have something – anything – make them feel good even if only for a little while is understandable. Naturally, alcohol and drugs provide only a brief and artificial escape from the suffering and, being a depressants themselves, will actually worsen the symptoms and lower the depressed person's already diminished level of function.

Treatment of depression

The good news is that depression is generally very easy to treat. We have treatments that address the neurotransmitter deficiencies effectively. Most cases are easily treated with a low-dose once a day medication that is well tolerated.

The effect of alleviating the suffering of depression is profound. Doctors like anti-depressant medications because they make us look like heroes when we achieve such a huge relief of suffering in a short period of time with an easy medication. Some cases are tougher to treat than others, and medication doses must be titrated, or other medications used. Psychotherapy, particularly Cognitive Behavioral Therapy (CBT), has a role in treating depression, although it is very time-consuming and expensive to properly pursue.

For alcoholics and addicts, it is crucial to recognize and treat depression. We know that treating depression can decrease substance use and craving. It will help us get sober and stay sober. Even in sobriety, the onset of depression is a major risk-factor for relapse. If you think you are depressed, seek medical help!



To learn more about the science and psychology of addiction and recovery, and to understand why alcoholics and addicts behave the way they do, see the author's book The Alcoholic / Addict Within.

Available for sample or purchase in paperback and ebook editions at amazon.com (Click Here).  

Statistics obtained from:
United States National Institute on Drug Abuse. Research report Series. Comorbidity: Addiction and Other Mental Illnesses. NIH Publication Number 10-5771 Printed December 2008, Revised September 2010 Comorbidity: Addiction and Other Mental Illnesses