Depression, substance use and abuse

Many studies show a strong association between substance use and mental health conditions. Although the reasons for this connection are still are being researched, there is recognition that these conditions share risk factors such as genetic vulnerability and environmental triggers like stress or trauma*. Several people in our study talked about current or past use of alcohol, alcohol in combination with over-the-counter or prescription medication, marijuana, or opioids.

Using substances to cope with the experience or symptoms of depression

Some people we talked to struggled to describe specifically how substance use and their depression were connected. Others, though, stated it was used to self-medicate, in order to “avoid feelings” or to “feel normal”. Whitney said, “it just made me happy for that little bit and, um, I kind of clung to that. Like I felt normal.” Sierra Rose noted she never learned to properly cope, and turned to substances to help herself. Others said it served to “numb myself” or made it easier to fall asleep. Elizabeth said, “I was interested in taking anything that would make me fall asleep, because it was the only relief that I really got.”

Marty describes how drugs and alcohol helped him express his true self.
Interview Transcript

I would say, alcohol was a big part of it, too – I forgot to mention that – alcohol was a great deal. It, it takes me out of my body. Oh, well, I can’t say that – it takes me out of the mindset, alcohol especially. It’s liquid courage for me to be who I want to be and for me to be who I believe I am inside. I believed that it just brought out who I am deep down inside. Aside, you know, the anxiety, let’s say the anxiety, the depression, was all up here, and when I drink, it just gets pushed down and my true self comes out and I’m able to talk to women or, or, or go and, you know, jump off the cliff into the water because it, that’s who I am inside, deep down inside. Or, you know, if I’m laying in bed not doing anything – no drugs, no anything, and just looking out my window and looking at the birds or people walking by and wondering how they’re even functioning in life. Taking a shot or two, or, or doing a bag of heroin would make me go enjoy, go enjoy life. It would help me to enjoy my life, that I believe God wanted me to enjoy. And, yeah, heroin is bad, so is cigarettes, you know? I’m not defending heroin at all. It ruined my life, actually, but, it, I, I just, and, and, and I know, it stuffed everything down and there was an extreme explosion of what was stuffed down throughout the years, of me self-prescribing, -medicating, and drinking. It exploded and, you know, I ended up in jail for that. But, it shoved everything away that I was ever scared of or depressed about. It gave me motivation to get up in the morning knowing I had a bag of dope or I had a pint of E and J in my closet.

DEP Marty
Profile Info
Age at interview: 28
Sex: M
Age at diagnosis: 11

Background: Marty lives with his girlfriend in temporary housing. He is currently looking for work and a good place to live in preparation for the birth of his first child. He is Caucasian.

Click here to view Marty's profile page

About 5% of the U.S. population experiences seasonal affective disorder, a type of depression that is triggered by seasonal changes, often in late fall and winter*1. Jeremy, who has seasonal depression, described how during winter he is less physically active and more prone to use drugs and alcohol.

Jeremy turns to substances in winter when his depression gets worse.
Interview Transcript

Well, it usually, you know, it usually go through a cycle, like I get, pretty bad seasonal depression, like, as winter kicks in and … usually once it starts to – ’cause I become sedentary, because I do a lot of exercise and working out in the summer, so – but, once winter comes along I just get real sedentary, very quickly and, just, usually … it’s, it depends, it depends on the year, it’s different, but like, it’ll start, it’ll in the winter and, I would like, drink, drink more heavily in the winter, do more drugs, and just really be down on myself wouldn’t really, wouldn’t really want to do anything.

DEP Jeremy
Profile Info
Age at interview: 22
Sex: M
Age at diagnosis: N/A

Background: Jeremy is a psychology student and lives in an apartment with a roommate. He is mixed, Black and White.

Click here to view Jeremy's profile page

Starting to use substances

People first became involved with substances in a few different ways. Many reported turning to them when life was particularly difficult. For some, this occurred in the context of a major change such as when a family member died. Leanna started self-medicating by using marijuana when her father won custody over her. She “went from foster care to living with a complete stranger.” She continues to think that marijuana keeps her “happy and calm and I can’t be angry.” She also uses aromatherapy, such as lavender, for the same effect.

One man we interviewed said he turned to heroin when he could not afford medication for his depression. Tia started taking prescription Tylenol with hydrocodone for menstrual cramps, and realized how mellow it made her feel. Many who used substances said they were first introduced to them by new friends. Using substances helped them to bond with the group and served a social need.

Tia describes how she became addicted to prescription medication that made her feel balanced.
Interview Transcript

I don’t remember exactly what but it started off, I think, like a Tylenol 3? Had hydrocodone, codeine, vicodin .. it kind of just like went from Tylenol 3 and then after a while, it’s like, this isn’t working and I don’t have that feeling, that like comfort, like mellow like, balanced feeling that I’m used to having. And it just went from taking them, like, for menstrual cramps and just like, “Oh, I want to feel like this all the time.” And then just keep taking them and then keep upping the dosage and I didn’t feel like I needed … like, what were they gonna prescribe to me that was, I think it would make me feel like a zombie or it would make me tired or, it would just have a negative effect? So, I just felt like what I was taking was fine.

It was fine because it, it made you feel better?

Yeah.

Not like a zombie?

Yeah.

So it was sort of a, gave you a sense of comfort?

Yeah, yeah.

And so then what happened? At some point?

I just, sat back, and kind of reflected. I mean, I was drinking a lot and that wasn’t doing much. And I started mixing them, and that worked, for a while. And then after that, I just said, “What’s the next highest drug?” You know, like, what’s the strongest, which one has the most alcohol content? And I just thought, like, “I kinda know what’s next and I know where this can go. And, it’s not safe, and I don’t wanna go down this road.” So I even, for a period of time, I stopped taking it even for, for my menstrual cramps and I just endured the pain, I just dealt with it just because I wanted to kinda clear my system out of being immune to, you know, such high-dosage medications.

DEP Tia
Profile Info
Age at interview: 25
Sex: F
Age at diagnosis: N/A

Background: Tia works as a patient advocate. She is single and lives alone in an apartment. She is African American.

Click here to view Tia's profile page
Julia describes how the group of friends she gravitated to when depressed reinforced her substance abuse.
Interview Transcript

But I think maybe a part of me did it to, kind of like, self-medicate? The only way that I knew how to and the only way I, like, had access to something. So, I did that for a few years and then I just started hanging out with a really bad crowd and I kind of started ditching all of my friends that I had been friends with for a really long time because they weren’t filling those needs of partying and stuff like that. So, so I lost a lot of really good friends and … yeah, and the friends that I hung out with, they were meeting my social needs and they were meeting like a lot of superficial needs, but, I mean, I couldn’t count on them for anything, which made me even more depressed. [laughs] So, I felt, kind of, trapped in this cycle of just like, partying and being stupid, doing stupid shit with these people, who I knew, like, didn’t care about me. But I was so used to people not caring about me – or feeling like people didn’t care about me – those are the people that I associated myself with because it was just like a weird comfortable feeling.

DEP Julia
Profile Info
Age at interview: 22
Sex: F
Age at diagnosis: 16

Background: Julia is a family therapist. She is single and lives alone in an apartment with a cat and a dog. She takes medication and sees a therapist. She is Caucasian.

Click here to view Julia's profile page

The unintended consequences of substance use

People we talked with described that when they first started using substances, they were not thinking about the potential impact this use would have on their thinking, relationships and functioning. Elizabeth says the alcohol, sedatives, and cigarettes she used “really impacts your capacity to think properly, accurately, clearly.” Some people spoke about how their substance use threatened to end or actually did end relationships with friends and family. Drugs and alcohol also impacted some people’s ability to hold a job. Ben describes how his drinking “before the clock” led him to arguing with a customer and getting suspended from work. Some people were incarcerated because of their substance abuse. Others named their “constant struggle” with substance abuse as the reason they have trouble keeping a job. Ryan describes how his substance use prevented him from getting a medication that he found helpful for his panic attacks.

Ryan describes how his use of other drugs led him to not be prescribed a medication that would have been useful for panic attacks.
Interview Transcript

But I am only using it for panic attacks so, it’s, I’m not addicted to it or anything.

Yeah.

Yeah.

So it’s the occasional thing?

Yeah, it’s the occasional thing, I think they were seeing the other drugs I was doing as, you know, “Oh you’re addicted to those. You’re dependent on those, so you’re gonna be dependent on anything the doctor prescribes you, basically.” So, it, that’s not how it is, but, that’s how they saw it, unfortunately.

DEP Ryan
Profile Info
Age at interview: 19
Sex: M
Age at diagnosis: 13

Background: Ryan lives with his girlfriend and her family in a suburb but is looking to move. He works as a janitor. He is White.

Click here to view Ryan's profile page

Relapsing with drugs/alcohol

A few people we interviewed discussed starting up again with drugs and alcohol after stopping. Emerging research indicates complex changes in brain circuitry and chemistry are related to substance use cravings and relapse*2. For people we interviewed, sometimes, this relapse was due to being around others that also took part in substance use. Others wanted again to feel the happiness that they initially felt from using drugs and alcohol. Whitney says, “And I was having issues with my boyfriend at the time so, it, he kind of played on that. And that’s how I got my happiness there for a little bit but I started feeling the effects from the drugs again and I’m like oh not this again. I went right back to where I was. I noticed it.”

Others experienced stressors that again triggered their substance use. These could be everyday life stressors or one time stressful experiences. James says the stresses of everyday life and depression lead him to continuously turn to marijuana. He describes, “every day I get up and smoke because I think it make[s] me happy because I know I get, I messed up in… life.” In contrast, Julia started using alcohol again after a particular school assignment that triggered her depression.

Julia experienced a relapse with drinking during a difficult class that required writing about her family history.
Interview Transcript

There’s a lot of stuff that I didn’t want to, you know, bring up again. You know, things that I specifically put in the back of my mind. I had to write it all down and read it and edit it and then have a professor read it … and I lost it. You know, I couldn’t even get through a page without drinking wine. And I hadn’t drank, you know, since high school. And then I started drinking because I felt like I had to. You know, I couldn’t write this paper sober. And then, it, it was just like constant [dog barking] like, I, I was so depressed, I talked to my supervisors and they asked me if I wanted to, pause the program and then come back the following year. And I said no, because then I would feel like a failure. But, you know, like my partner would come over and I would have drank like half a bottle of wine and then taken Tylenol, you know, and I know Tylenol is like, the one over the counter thing that you’re really not supposed to take because that can really fuck up your liver. So – and I knew that! And that’s why I took Tylenol, which is like, it’s, ridiculous. But, yeah, and I did that, like I would pass out, and my partner would come over and be like, “You know you, you could have died, like accidentally, even if that wasn’t your intention, like, you, could have done that.” … I don’t know.
And then I started, doing it for attention I think? Like there were so many points in time where I literally was just like, “Fuck it, no one cares about me.” And I, I don’t think I wanted to die, I just wanted, to not think about it anymore. Because, I was so used to like obsessing, I wanted to just like, numb myself.

DEP Julia
Profile Info
Age at interview: 22
Sex: F
Age at diagnosis: 16

Background: Julia is a family therapist. She is single and lives alone in an apartment with a cat and a dog. She takes medication and sees a therapist. She is Caucasian.

Click here to view Julia's profile page

Deciding to no longer use substances and getting help for addiction

Tia says stories at Alcoholics Anonymous about others that used substances inspired her to quit alcohol. She described, “this guy was a lawyer and he had a beautiful house and car, and family and [then he became] addicted to drugs and is homeless and doesn’t have his family and probably never, [will] get it back.… it was sort of a reminder to help me not engage in that activity anymore.”

Whitney received help from a formal dual diagnosis program after prison. She describes learning “how my depression and my other, other things that I, you know, had been diagnosed with kind of coincide with one another and how drugs and alcohol are a huge factor and it’s impacted me more.” Myra realized there were alternatives to alcohol that could help her feel better. She now realizes that taking care of herself, checking in with her fiancée, and reading or listening to music are other options.

For more information see ‘Depression and strategies for everyday life’ and ‘Depression and healing’.

References

*”DrugFacts: Comorbidity: Addiction and Other Mental Disorders.” National Institute on Drug Abuse, March 2011, Web. 7 February 2016.

*1 Kurlansik, Stuart L., and Annamarie D. Ibay. “Seasonal affective disorder.” American family physician 86.11 (2012): 1037-41.

*2 Volkow, Nora D., et al. “Unbalanced neuronal circuits in addiction.” Current opinion in neurobiology 23.4 (2013): 639-648.

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