Drug and Alcohol Treatment for Comorbid Depression and Substance Abuse

Many different mental health problems can cause severe problems, both for the sufferer and the people they know. Substance abuse and addiction affects 22.5 million Americans (NSDUH, 2011) and is highest among people in their late teens and twenties. Recent research shows that of the 8.3% of people who need for substance abuse, 95.3 percent—19.3 million people—are not receiving it from drug rehab centers. Another 3.3 percent feel they need treatment but are not making effort to get it, and 1.5 percent feel the need treatment and have made an effort to receive it.

Currently, only 1% of people requiring an intervention for substance abuse have access to drug addiction treatment centers. This figure is much worse when a secondary, comorbid mental health disorder is also present.  A National Epidemiologic Survey on Alcohol and Related Conditions (Conway et al., 2006) found that 22% of people with a mood disorder also suffered with severe drug abuse problems. Bovasso (2001) also found that cannabis abuse can lead to 4x higher likelihood of developing depressive symptoms, particularly suicidal ideation and anhedonia (the inability to feel pleasure).

Comorbid disorders, those involving both a substance abuse disorder and a mental health disorder, are extremely difficult for a patient to live with, and complicate treatment. Substance abuse costs the healthcare system and economy billions of dollars each year (alcohol costs $235 billion dollars each year, and illicit drugs cost $193 billion dollars (National Drug Intelligence Centre, 2010); Rehm et al., 2009).  When a secondary mental health disorder is also present, the cost is much higher (Hoff and Rosenheck, 1999) If, however, just one disorder is treated and the other is not, it is much more likely that neither disorder will be successfully treated. The link between substance abuse and depression has been highly researched however, and treatment options have been studied which are currently providing evidence that comorbid disorders can be treated successfully, giving hope to the millions who suffer these highly comorbid disorders.

A strong link has been found between negative emotions and substance abuse cravings, which leads to relapse and increased use (Witkiewitz and Bowen, 2010). The authors found that the relationship between depressive symptoms and substance abuse is often mediated by cravings. In other words, depressive symptoms can trigger cravings, which then leads to substance abuse. The authors also found that after teaching relapse prevention strategies that targeted a patient’s reaction to cravings, depressive symptoms were subsequently much less likely to illicit cravings which would lead to substance abuse. In 2011, Witkiewitz, Bowden and Donovan assessed whether a combined behavioural intervention could replicate these results. They found that one year after treatment, those who took part in relapse prevention strategies also showed a much weaker relationship between depressive moods and alcohol abuse. These two studies confirm what we know in practice.  Namely, there is hope for people with comorbid depression and substance abuse as combined treatment for depression and relapse prevention results in a reduction in substance abuse up and depressive symptoms.

Cognitive Behavioural Therapy (CBT), a very popular treatment choice for many mental health disorders, has also been shown to provide good outcomes for reducing depressive symptoms and substance abuse behaviour. In 2011, Watkins et al studied the effects of group CBT on those with comorbid depression and substance abuse and found that when combined with a substance abuse treatment, patients reported significantly fewer depressive symptoms, had improved mental health functioning, fewer days of substance abuse and alcohol consumption. Following up this study, Watkins et al (2012) found that this intervention worked not only for those with mild or moderate depression, but with severe depression also.

These studies continue to add to a growing body of research that shows providing integrated treatment in drug addiction treatment centers for depressive disorders and substance abuse are effective.  Because our drug rehab center relies on evidence based practices, our Substance Abuse Intensive Outpatient Program shares many common methods with other successful rehab programs.  The foundations of our treatment program for substance abuse also rely on the principles of harm reduction, motivational interviewing, stages of change and cognitive behavioral therapy to promote recovery from alcohol abuse and drug treatment.  In fact, our Intensive Outpatient Program in Memphis, TN that has been proven to be effective in the treatment of alcohol abuse and drug treatment in peer reviewed treatment outcome studies.   Our treatment center  provides services to those who need more treatment than one hour a week, but less than 24 hour care, by providing three hours of treatment per day, three to five days per week, in an intensive outpatient setting.  If you or a loved one is showing signs of alcohol abuse or needs drug treatment rehab, they should be assessed by a trained mental health professional who can help design a treatment plan that can result in recovery.  Treatment for substance abuse can be highly successful.  Call us at 901-682-6136 to schedule an appointment.