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Major Depression + Substance Abuse = Dual Diagnosis

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Major Depression + Substance Abuse = Dual Diagnosis
By Matthew Peters

(Disclaimer: I’m not a medical doctor. The information provided here is a result of my research and/or personal experiences.)


“Welcome this pain; for you shall learn from it.” Ovid’s words from The Metamorphoses are a trenchant observation on the benefits that might be culled from life’s tribulations.

But when we speak of major depression, we speak of more than the feelings of sadness and emotional pain that are inevitable parts of being human. We speak of the frequent occurrence of depressive episodes, which are marked by five or more of the following symptoms that persist for at least two weeks:

–A sad, anxious or “empty” mood
–Sleeping too much or too little, middle of the night or early morning waking
–Reduced appetite and weight loss, or increased appetite and weight gain
–Loss of pleasure and interest in activities once enjoyed, including sex
–Restlessness, irritability
–Persistent physical symptoms that do not respond to treatment (such as chronic pain or digestive disorders)
–Difficulty concentrating, remembering or making decisions
–Fatigue or loss of energy
–Feeling guilty, hopeless or worthless
–Thoughts of suicide or death

Major depression is widespread. In the United States, an estimated 15.7 million adults aged 18 or older had at least one major depressive episode in the past year. This represented 6.7 percent of all adults. Frighteningly, 3.4% of people with major depression commit suicide, and up to 60% of people who commit suicide had depression or another mood disorder.


Living with Major Depression


I’ve lost track of the number of depressive periods I have had in my life. Sometimes, when looking back, it seems that major portions of my life were nothing but long, drawn-out depressive episodes. Problems are compounded when people ask things like, “Why can’t you just snap out of it?” I answer, “Why can’t you simply will yourself to stop an explosive case of diarrhea?”

Numerous times in my life, I’ve been depressed to the point where I can’t function. Getting out of bed is a major accomplishment and showering is worthy of a gold medal. Self-care is accompanied by a constant refrain of, “Why bother?” Feelings of low self-esteem run to the point of questioning why existence should be wasted on the likes of me.

Carrying on and assuming a “normal” life during such periods is unimaginable. I feel as vulnerable as if I’m made of glass while my emotional resiliency is as strong as wet tissue paper. The world goes on, but I stop. I watch life unfold from backstage. It is enervating and frightening. The smallest thing becomes a herculean task. The last thing I want to do in such a state is to draw attention to myself, but somewhere deep inside I know I desperately need help. But I can’t express the pain I’m in and can’t ask for help because I don’t know what in the world would make the situation any better.

Now, you might be asking yourself why all this talk about major depression on a site devoted to substance abuse? The fact of the matter is that substance abuse and mental disorders are sometimes comorbid (meaning they occur at the same time). It is estimated that 29% of those who suffer emotional/mental disorders have abused substances and that 53% of substance abusers have had a psychiatric problem. Since depression is the most common form of mental illness, it makes sense to talk about depression (and other mood disorders) here.

In addition, just like substance abuse, depression and other forms of mood disorders come with their own sets of triggers. Here are some common ones:

–the anniversary dates of losses or trauma
–frightening news events
–too much to do, feeling overwhelmed
–family friction
–the end of a relationship
–spending too much time alone
–being judged, criticized, teased, or put down
–financial problems, getting a big bill
–physical illness
–sexual harassment
–being yelled at
–aggressive-sounding noises or exposure to anything that makes you feel uncomfortable
–being around someone who has treated you badly
–certain smells, tastes, or noises


Dual diagnosis

Courtesy of

A person who has a mental illness (e.g., depression, anxiety, bipolar disorder, schizophrenia) and chemical dependency is considered dual diagnosed. Six out of one hundred Americans have a dual diagnosis. Famous individuals among the dual diagnosed include Elvis Presley, Marilyn Monroe, Ernest Hemingway, Sigmund Freud, and Robin Williams.

Treating dual diagnosis is very difficult. Part of the reason is that the use of certain drugs can mimic psychological symptoms associated with some mental disorders. Alternately, people who suffer from psychiatric conditions often self-medicate to feel better. A professional treating someone with both disorders may tell a patient that he/she must first address one issue (e.g., stop drinking) before the other (e.g., depression) can be treated. Unfortunately, this leaves open the possibility that the underlying depression will never get treated because a person may be unable to stop drinking without dealing with the depression.

What can be done? In the presence of one of these conditions, an aggressive effort should be made to determine if the other is present. Both alcoholism and mental disorders are genetically-based. So if a person presents symptoms for one, a professional should ascertain whether the other condition is exhibited in the patient’s family history. If both conditions are identified, an effort should be made to address them concurrently. In cases in which there is no family history of either mental illness or addiction, it should be ascertained whether the mental disorder preceded the addiction problem or whether both developed at the same time. If the former, then both conditions should be treated simultaneously. If the latter, then the addiction problem should be the initial focus of treatment to see if the mental symptoms subside with the cessation of the use of addictive substances. Of course, it is imperative that the patient be completely honest in reporting the use of addictive substances.


Is There Hope?

Yes. For me, successful treatment of my Major Depressive Disorder has consisted of a combination of finding the right medication, therapy, education, and self-awareness. On a daily basis, I use a variety of coping mechanisms. Here are some suggestions that have worked for me in the past.

1. Nip it in the bud as early as possible
If you feel yourself getting depressed, try one of the things mentioned here, or something else you know will provide some immediate relief, yet is good for your overall sense of well-being.

2. Listen to music
I can’t begin to stress the importance of music and how it can elevate your mood. Whatever your taste, put on some music and play it loud, sing along if it has lyrics, or just close your eyes and let it take you away.

3. Watch a movie
I, myself, can’t be depressed AND watch a good movie, especially a musical. The two are mutually exclusive for me. In fact, musicals are my secret weapon and often the first defense against bouts of depression. I highly recommend upbeat ones, like The Sound of Music or Singin’ in the Rain. Anything with Fred Astaire is also a safe bet. In addition, I sometimes use Christmas specials and/or children’s movies to combat depression.

4. Talk to someone
Be it a friend, therapist, doctor, significant other, or a person on a helpline let someone know how you feel. Depression and isolation seem to go hand in hand. Letting others in often lessens the pain, however, difficult it might be. If you can’t find someone to talk to, try writing about how you feel. Putting your feelings into words is an important step. Naming your emotions often takes the power out of them. Once you are able to express how you feel, you have unburdened yourself of some of the pain. Pain shared is pain lessened.

5. Move about
Moving about helps fight depression. This doesn’t mean you have to start training for the Olympics or a marathon or scaling Mount Everest. Sometimes it can just be getting out of your chair, or your bed, going up or down the stairs, taking a walk, visiting a place or even a part of your living space you haven’t been in a while. As one of my dear friends says, “It’s hard to hit a moving target.” So start moving.

6. Eat regularly and eat right
As simple as it sounds eating three meals a day is crucial to maintaining a sound emotional state. Altered eating habits (AEHs), though sometimes tempting when in the midst of a serious bout of depression, wreak additional havoc on mental fitness. Whether it involves skipping meals, eating at irregular times, or overeating, AEHs exacerbate the problem. Try as best you can to stick to a regular eating schedule, choosing foods that are both good for you and tasty.

7. Sleep regularly
Just as important as eating, maintaining a regular sleep cycle is crucial for mental wellness. Sometimes depression makes you want to sleep more than usual; sometimes it keeps you up at night. Neither one is good. Sleep is a way to rejuvenate mind, body, and spirit. Try to stick to as regular a sleep pattern as you can.

8. Set achievable goals
I’m a writer. When I get depressed it often interferes with my productivity. As hard as it may be, I try to meet a daily word count. While the act of doing this may not exactly cheer me up, I feel much better knowing that I have accomplished something. I find that not accomplishing an achievable goal exacerbates my depression, while meeting it usually ameliorates it. You may be in a state where getting out of bed is your goal. That is great. Whatever you can do, do it.

9. Maintain good hygiene
This is important and more important than it might seem at first. I don’t claim to know how any of this works psychologically, but I do know that brushing my teeth, taking a shower, and shaving often makes me feel loads better. Being clean in clean clothes is often an anodyne to depression.

10. Maintain an open mind when it comes to treatment options
Various treatment options for depression include medication, in- and out-patient services, spiritual approaches, etc. I am not advocating any of these options, but I am saying that keeping an open mind with regard to them is crucial for getting help.


Here are some links to learn more about Major Depressive Disorder and dual diagnosis:
Click here for the Wikipedia overview of Dual Diagnosis.
For more information see Mental Health America’s website.
See also National Alliance on Mental Illness’s website.
American Foundation for the Prevention of Suicide
American Psychiatric Association
American Psychological Association
Substance Abuse and Mental Health Services Administration
National Suicide Prevention Lifeline

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