Depression and Substance Abuse: Breaking the Vicious Cycle

There is an established link between depression and addiction. Depression is a side effect of all substance abuse, so during certain stages of recovery from substances, depression will need to be faced. Additionally, some women have what’s called dual diagnosis depression – a problem with depression that exists with or without substance use. For such women, a pre-existing depression may be part of why they used substances in the first place. In any case, along the journey of mental health recovery, many women will have some experience with the symptoms of depression.  

Dual diagnosis depression is common. Women with substance abuse disorders are more likely than their male treatment peers to have pre-existing mental health symptoms, including depression. These problems with feeling happy even without the destabilizing effects of substances pre-date and are worsened by their substance use. Women are also more likely than men with the same substance abuse problems to have a significant trauma history, due to the higher incidence among women of having experienced sexual abuse in childhood and sexual assault or intimate partner violence as adults. Depression is a symptom of traumatization as well as a mental health disorder. Women may be more likely in general to struggle with debilitating depression symptoms as a result of adverse childhood experiences, things like physical abuse, attachment injuries, and neglect. 

The team of clinical experts at Villa Kali Ma is ideally suited for helping women with substance abuse problems to also heal their depression, whether that depression is primarily a trauma symptom, a side effect of substance abuse, or a purely physiological issue. 

It is our belief here at Villa Kali Ma that healing depression needs to happen in a sensitive and integrated approach that blends clinical with holistic perspectives. In this post, we’ll say a little more about what it takes to break the vicious cycle that interlinks depression and substance abuse. 

How Depression and Substance Abuse Fuel Each Other

Depression is caused by many factors, and there are many ways to look at it, ranging from the purely biological to the spiritual. At Villa Kali Ma, we do our best to address all layers that present themselves for healing during the course of our work with a particular women. 

It is perhaps easiest to begin with the body, where depression manifests primarily as a lack of vital life force and energy. Women with depression tend to feel very tired, sleep too much or too little, and feel generally drained. It is as though the energy that would be helpful for fighting off the blues, making changes, and experiencing different results in the world are mysteriously absent from the body. This lack of energy results not only in feeling drained, tired, foggy, and low-energy, but also manifests as being weepy, sad, negative, unable to defend or protect oneself, and not feeling up to the basic tasks of life. Stereotypically, it is the “I don’t want to get out of bed” feeling. There can also be depression symptoms that manifest like physical illness. 

What’s going in physiologically in the body, that is producing this experience of energetic depletion, can be caused by substance abuse itself. Substance use disrupts nearly every function of the body, and may be metaphorically understood as robbing the bank of the body’s store of beneficial neurotransmitters and hormones. When the body’s resources have been spent through substance use, the body needs time to replenish the stores. 

The body replenishes through sleep, rest, down time, and parasympathetic activation. If the body isn’t able to get the rest and down time that it needs to be able to replenish, it will start to shut down, even during hours that would normally be reserved for wakefulness and energy. Paradoxically, the symptoms of depression are actually the body trying to heal itself from the substance abuse.

The problem is that most women feel so overwhelmed with the symptoms of their depression, especially in a context of needing to keep up with the demands of life, that they may be tempted to use substances all over again, to try to counteract the body’s attempt to restore itself through down time. For many women, depression is both a cause and a side effect of substance abuse. 

Recognizing the Warning Signs of Co-Occurring Depression

Depression is a widespread, and to a certain extent, normal human experience. Every woman will have times in her life when she feels downhearted or blue. It is standard to feel tides of lower and higher energy and mood following the patterns of the menstrual cycle, for example. Some depression is purely physiological, and can be healed relatively easily with changes in nutrition, sleep, and exercise.

It’s also important to understand that depression is a side effect of substance abuse, and will likely be felt in the early stages of recovery for withdrawal reasons alone. 

However, depression can also present as a serious mental health problem that is being generated for reasons that transcend our substance abuse, hormones and diet. We may come to realize that our substance abuse and diet actually serve our depression, attempting both to help us cope and paradoxically anchoring that depression in place. 

If our depressed state is chronic rather than adaptive to changing circumstances in life, and especially if it interferes with our ability to function in life, we may be looking at a depression which is not only physiological in nature, but rather a co-occurring condition. In such cases, depression should be treated with respect and regard as a psychological matter in its own right, even though other factors are likely contributing to that depression. 

When depression is a feature of our personality, it means that we had reasons for relying on depression as a way to cope in the past. This means, essentially, that having low energy, a negative rather than positive outlook, or keeping our anger internalized was deemed advantageous for our survival in one way or another. 

It’s very important to address depression if it exists as a co-occurring disorder, because this means most likely not only that we have unresolved traumatization, but also that we could benefit greatly from making changes at the personality level. Changes at the personality level means that we allow ourselves to grow beyond our past solutions, learning to think different kinds of thoughts, feel different kinds of feelings, and to behave differently out in the world. There is an enormous opportunity for improved levels of joy, latent in any diagnosis of depression. 

The most recognizable indicator of depression is a loss of hope. Feeling down in the dumps, like nothing good will ever happen, and a low-grade, background anger at yourself, are all signals of depression. 

But since depression has many forms, and can hide quite easily in those who have been living with it for a long time, let’s review some of the signs which are generally used as diagnostic criteria when considering whether a woman has a depressive disorder: 

• Feelings of hopelessness and bleak outlook, thoughts of death, suicidal thoughts and attempts to take one’s own life
• Persistent sad, anxious, or empty mood most of the day, most days
• Feelings of low worth and/or guilt
• Loss of engagement, interest or ability to enjoy hobbies and activities that used to bring pleasure (including sex)
• Ongoing fatigue and lack of energy 
• Excessive difficulty thinking clearly, concentrating, or remembering things that used to be more readily retrievable
• Sleep problems, including insomnia or hypersomnia (sleeping too much) 
• Change in appetite or weight, in either direction 
• Physical restlessness or feeling that great effort is needed, like things are physically difficult

The above list is a very general guidepost and should be interpreted only with professional help. 

If you recognize your experiences in the above list, we encourage you to get profession help in determining whether you may be in need of support to heal your depression. 

Evidence-Based Treatments for Depression and Addiction

At Villa Kali Ma, we address any co-occurring depression, trauma history, and addiction together in the same course of treatment. We use evidence-based clinical models in combination with gentle holistic approaches. 

The following approaches that we offer work well to address the problems of substance abuse and depression together:

• Mindfulness and Self-Compassion
• Cognitive Behavioral Therapy
• Acceptance and Commitment Therapy
• Dialectical Behavior Therapy
• Somatic Therapy
• Expressive Arts Therapy
• Equine Therapy 

Additionally, we provide gold star trauma treatments in our licensed trauma facility, the Retreat, including: 

• Eye Movement Desensitization and Reprocessing.
• Ketamine Assisted Therapy 
• Brainspotting

In general, we work with a phase-oriented model that prioritizes stabilization of sobriety first, and addresses co-occurring depression and trauma soon after withdrawal. Stabilization is an important phase that requires stopping substance use and any other life-threatening activities, to make sure that basic safety is achieved. Stabilization often requires being in a secure environment in which to undergo treatment, such as an inpatient rehabilitation facility like Villa Kali Ma’s the Villa.

 As soon as a woman is safe and stable, however, the focus of treatment shifts to encompass mental health symptoms and trauma healing. 

Find Hope with Integrated Mental Health Treatment

The best news about a co-occurring diagnosis of addiction and depression is that both conditions are treatable, through substance abuse treatment, natural interventions, talk therapy, nutritional support, and exercise, among other approaches. All therapies should be coordinated together, and a sufficient intensiveness of therapeutic support is usually necessary, but many women find these changes in lifestyle, thoughts, and behavior to have many unexpected benefits. Although it takes significant up front work to get better, the rewards of healing depression and addiction are enormous, representing a new life chapter of joy and freedom beyond imagining.  

We here at Villa Kali Ma do feel it’s important to find the right team of healers, practitioners, therapists and treatment professionals for you. Healing requires that you feel profoundly safe and reasonably understood by the people who will be guiding you on your journey. Recovery is deep, intimate, and important, so it’s good to apply discernment in picking out the right healing team for you. 

Villa Kali Ma is a provider of integrative substance abuse, mental health, and trauma treatment based in northern San Diego County. We offer holistic addiction recovery services designed for women, spanning a range of levels of care. Our facilities address needs for medical detox, partial hospitalization, residential/inpatient, and outpatient treatment, providing several options for creating the right stepped-down pathway for each woman. We also offer mental health services and trauma treatment, for women who don’t need help with substance abuse, but would still like to experience holistic integrative mental health treatment. Each of our programs treats women’s mental health needs and incorporates the most effective trauma treatments available, where appropriate. Villa Kali Ma also provides therapeutic yoga, Ayurveda, breath work, shamanic healing, massage, mindfulness, nutrition, acupuncture, and other holistic modalities in all of our programs.