Depression and Substance Abuse: The Chicken or the Egg?

By Richard Zwolinski, LMHC, CASAC, SAP, ADS and C.R. Zwolinski

There’s a saying in the recovery movement: Alcohol and drug addiction can cause mental illness but mental illness does not cause addiction. However, some mental illnesses, especially those that are not quickly diagnosed and treated, can trigger the use of alcohol and drugs.

Depressive disorders often cause acutely uncomfortable feelings such as overwhelming sadness, hopelessness, numbness, isolation, sleep disorders, digestive and food-related disorders. It is tempting, if medications aren’t being prescribed or used properly, for people suffering from depression to self-medicate.

This can compound the depression and make it far worse. A drink or two, a line of cocaine or two, might temporarily relieve some symptoms, but the backlash when the chemical leaves the body brings the depression to new lows. This “withdrawal depression” happens each time an abused chemical leaves the body, though many people don’t experience severe symptoms at first. The withdrawal depression itself can trigger the use of more alcohol or drugs because they will help get rid of the bad feelings.

Another compounding problem is that if drugs and alcohol are being used while medication is being taken, the alcohol or drugs can actually potentiate—make stronger—or deactivate the medication. Either way, this can put the person in medical danger.

Because of their personal life-shattering experiences with substance abuse, some people in recovery are leery of using any drugs, even prescribed ones. They have faced traumatic experiences with addiction and have a difficult time coming to terms with the necessity for medication intervention. In fact, I have had patients who have quit drinking or drugging the hard way—through willpower or cold turkey—yet are willing to endure the horrible symptoms of depression rather than take medication. Very often their social sober support network advises them to refrain from taking meds. Usually, this is not within the realm of the advisor’s authority. Dually-diagnosed patients (those with both mental illness and addiction) should speak with their psychiatrist about this issue, not a friend, no matter how well-intentioned.

One question I get asked frequently from addiction-treatment patients who are diagnosed with depression after they are diagnosed with an addiction is “did my drinking or drugging cause the depression?” The initial answer is always a resounding “maybe.” A well-trained psychotherapist will often be able to tease out the source of the depression and find out if it existed before the patient came in for addiction treatment. Therapists use a psychosocial evaluation and reports from family, friends, employers, court and police records and the like to help determine which condition occurred first.

Why is it important to know when the depression first occurred? Because someone who had depression before they began to abuse substances will most likely need treatment, including medication intervention, for a longer period of time compared to someone whose depression was caused by the cycle of addiction. Someone whose depression was caused by substance abuse generally will not need the same treatment as someone whose depression preceded his or her substance abuse.

Sometimes when someone comes in for addiction treatment and has a depressive disorder that was caused by addiction, they aren’t able to accurately report what is going on for them. They may be too numb or sad or unable to focus. Or perhaps a less-than-thorough psychosocial evaluation is done. Lack of reporting or inadequate evaluation may prevent the full understanding of whether the depressive disorder preceded or was caused by the substance abuse.

If a patient whose depression was caused by chemical abuse is referred to a treatment track for those who were depressed first and chemically dependent later, within a few weeks he or she usually is asking “what am I doing here? I don’t have these kinds of problems!” In these cases this isn’t necessarily a function of denial but a valid observation due to an original lack of understanding about whether the depression or the addiction came first.

Respect it, Dream it, Do it!by Donna Gibson 

Please respect my fears as they may be different than your own.  Please respect my dreams and vision because they are the only ones I own.  Please respect the decisions I have made, even the ones that haven’t been so good.  I am only leading by the examples that have been previously set for me and understand some of these examples are hard to speak of and not so good.  Please respect that I am trying to make my way in this world and live the life I have been given to explore.  I may have been someone you have seen outside carrying a sign “will work for food” or someone you passed by and handed that dollar to.  I might need help learning and moving ahead.  I am slowly creating new visions, better examples and positive outcomes instead.  Please don’t do things for me.  I want to stand on my own.  Walking beside me means I am never truly alone.  

Donna Gibson is the Bridges Out of Poverty and Parent Support Program Coordinator at Mental Health America of Licking County   

An Increase in the Suicide Rate

Posted in The New Your Times April 26, 2016

To the Editor:

Re “Sweeping Pain as Suicides Hit a 30-Year High”                                    (front page, April 22):

The report showing a 24 percent increase in suicides should be                         a wake-up call to our country. If we saw numbers like this for any           other cause of death, people would demand action.

The vast majority of people who die as a result of suicide have a    psychiatric condition like depression, bipolar disorder,               schizophrenia or post-traumatic stress. To decrease the number                   of suicides, we need to improve access to care by enforcing the               insurance parity laws so that people are not denied treatment.

We also need to reduce stigma and prejudice against people                       who have a psychiatric illness so that people are not embarrassed                 to seek help. And just as we declared a war on cancer and                     increased funding for research, we need to declare a war on                       mental illness and accelerate the funding of research to improve           treatment.

JEFFREY BORENSTEIN

New York

The writer, a psychiatrist, is president and chief executive of the             Brain & Behavior Research Foundation.

Internship Experience 

by Jessica Phillips

My name is Jessica Phillips and I am a professional writing intern for Mental Health America of Licking County.  I was given the opportunity to take this internship as a part of my degree program’s coursework.  Throughout the semester we met once a week with our peers, who were also part of the internship program, to discuss what was happening at each internship site.  We also completed various assignments which helped us learn what skills we will need going out into the professional world.  As a final assignment we were asked to write a note to the “future generation” as they enter into the professional world themselves.  Being an intern was my first step, and here was my advice:

“You may not get an internship or job with the exact job description that you are hoping for, but that is the beauty of it.  Be excited about the new path, scared about the unknown, and praise the challenges that got you where you are.  Working with MHALC has taught me a lot about the professional world and how to navigate through the challenges and be flexible.  So my advice is to plan, plan, and plan again.  Always have your dream plan in mind, but keep changing it because life will end up doing it for you anyways.  Be flexible, be scared, and most of all be you.” 

Allowing yourself to be scared or afraid is so important to me.  I believe that overcoming the things that give us fear is what will give us the confidence to do better and do more.  Working with MHALC has been such a rewarding and inspiring experience; every single person in their office is so passionate about their work that it has become contagious.  I am very thankful for my time spent with MHALC and their wonderful staff and especially thankful for time spent with my mentor, Jill Goddard.  

Jessica Phillips was an intern from The Ohio State University Newark Campus

Do You Know What Mental Illness Feels Like?

We often hear the clinical terms used by doctors and other professionals to identify the symptoms of mental illnesses but if someone hasn’t gone through it, would they know how to recognize it? So often, clinical terms don’t do justice to what life with a mental illness feels like. 

We know that two people with the same diagnosis can experience the same symptom and describe it in very different ways. Understanding the signs of a mental illness and identifying how it can feel can be confusing—and sometimes can contribute to ongoing silence or hesitation to get help. It’s important for people to talk about how it feels to live with a mental illness. 

May is Mental Health Month and Mental Health America of Licking County (MHALC) is raising awareness of the importance of speaking up about mental health issues. We know that mental health issues are common and treatable, and help is available. But not everyone knows what to look for when they are going through those early stages, and many simply experience symptoms differently. We all need to speak up early — Before Stage 4 — and in real, relatable terms so that people do not feel isolated and alone. 

MHALC wants everyone to know that mental illnesses are real, that recovery is always the goal, and that the best prospects for recovery come when we act Before Stage 4 (B4Stage4). Addressing mental illnesses B4Stage4 means not burying feelings and refusing to talk about them, and not waiting for symptoms to clear up on their own. B4Stage4 means more than wishing that mental health problems aren’t real, and hoping that they will never get worse. B4Stage4 means more than thinking that someone on the edge of a crisis will always pull himself or herself back without our help, and praying that someone else will intervene before a crisis occurs.

B4Stage4 means, in part, talking about what mental illnesses feel like, and then acting on that information. It means giving voice to feelings and fears, and to hopes and dreams. It means empowering people as agents of their own recovery. And it means changing the trajectories of our own lives for the better, and helping those we love change theirs. 

So let’s talk about what life with a mental illness feels like, to voice what we are feeling, so others can know they are not alone. Through “Life with a Mental Illness” MHALC is asking individuals to share what life with a mental illness feels like by tagging social media posts with #mentalillnessfeelslike. Posting with our hashtag is a way to speak up, to share your point of view with people who may be struggling to explain what they are going through—and to help others figure out if they too are showing signs of a mental illness. “Life with a Mental Illness” is meant to help remove the shame and stigma of speaking out, so that more people can be comfortable coming out of the shadows and seeking the help they need.

Whether you are in Stage 1 and just experiencing and learning about early symptoms, or are dealing with what it means to be in Stage 4, sharing how it feels can be part of your recovery. You are not alone!

Penny Sitler

Executive Director, Mental Health America of Licking County

www.mhalc.org