What’s the Link Between Addiction and Depression?

Recovering from addiction is difficult but dealing with another mental health condition at the same time is even harder, but the two needed to be treated together for the best chances to recover from both, if you’re here because you want to learn more about the link between addiction and depression, you’re in the right place.

When addiction occurs alongside other mental illnesses, which occurs often, it is termed dual diagnosis.

The link between mental illness and addiction goes both ways. About 50% of people with a severe mental illness are also affected by a substance problem. Moreover, roughly 37% of alcohol abusers and 53% of drug abusers have at least one other serious mental illness.

Although statistics for South Africa are not available, in the United States it is estimated that 69% of all the nation’s alcohol and 84% of all the cocaine used in that country is consumed by people who have been diagnosed with another mental illness in their lifetime.

A common mental health condition that occurs in people with addiction and alcoholism is depression.

The link between addiction and depression

What is depression?

Depression is the most common mental illness in the world. Most people will feel depressed at some point in their lives but when it is persistent and severe it becomes a diagnosable mental illness called major depressive disorder or clinical depression.

According to the World Health Organisation, roughly five percent of adults globally suffer from depression.

Depression is defined as “a mood disorder that causes a persistent feeling of sadness and loss of interest”. Common symptoms include:

  • Feelings of sadness, hopelessness and emptiness
  • Tearfulness or crying
  • Irritability and angry outbursts
  • Loss of interest or pleasure in once enjoyable activities like sex, hobbies or sports
  • Sleeping too much or too little
  • Fatigue and lack of energy
  • Reduced or increased appetite and related weight loss or weight gain
  • Anxiety
  • Feelings of worthlessness
  • Difficulties with thinking and memory
  • Thoughts of death or suicide and suicide attempts

Most people with depression lose the ability to fully participate in life’s day-to-day activities.

Depression can be triggered or caused by a number of reasons including substance abuse, genetics, trauma and medical illnesses. But often, the exact cause will remain elusive.

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Department of Health South Africa
National Hospital Network South Africa

There is a strong link between depression and addiction. Roughly one third of people with an addiction also suffer from depression. Depression places a person at a higher risk for developing an addiction and vice versa. About 16.5% of people with depression are addicted to alcohol and roughly 18% have a drug addiction.

People with depression often seek relief from painful thoughts and feelings by using drugs and alcohol. But this kind of self-medicating often ends up making a person’s depression worse in the long-run.

People with addiction often begin to feel depressed from intoxication, withdrawal and/or from the consequences experienced as a result of their substance abuse.

People suffering from depression have an estimated 10% lifetime risk of suicide. But people with depression and alcohol or drug addiction have a 25% lifetime suicide risk.

It has been found that teenagers who have attempted suicide or more likely to have used marijuana than those who have not attempted suicide.

Treating addiction and depression

In a person with addiction and depression both conditions need to be treated simultaneously. Treating addiction alone can lead to a person relapsing on drugs or alcohol due to unresolved symptoms of depression. Untreated depression can also lead to a person failing to complete addiction treatment and dropping out early. Treating depression alone is often unsuccessful as continued substance abuse could cause depressive symptoms to persist despite treatment. Additionally, heavy alcohol use has been found to reduce the efficacy of antidepressant medication.

This is one of the reasons why addiction treatment centres should employ experienced psychologists and psychiatrists.

Treatment should include a combination of medication and therapy.

It is often difficult to differentiate between depression and routine signs of addiction as symptoms overlap. For example, both depression and addiction can cause a person to give up on social activities or hobbies, experience problems with relationships and isolate themselves from other people.

Quitting drugs and alcohol can lead to short-term depression or the worsening of symptoms of existing major depressive disorder that may resolve or improve after a longer period of abstinence.

This is another reason addiction treatment should employ specialised mental health professionals as well as make sure a client’s mental health is assessed for a period after completing rehab.

For example, research that followed up methamphetamine users with depression for three years found that those who abstained from the drug experienced significant declines in their symptoms of depression compared to those who continued to use.

According to the US-based Substance Abuse and Mental Health Services Administration, good dual diagnosis treatment will provide therapy for depression that:

  • Helps the client understand the nature of depression
  • Advises the client that it is possible to recover from both addiction and depression
  • Inspires clients to change their lives
  • Provides clients with skills and strategies to deal with negative thinking patterns
  • Helps clients identify and change addictive behavioural patterns

Are you looking for a rehab experienced in treating dual diagnosis (including addiction or alcoholism and depression)? Contact Changes Rehab today.

Brian Muhumuza is a Addictions Counsellor at Changes Rehab in JHB

Brian MuhumuzaRead Bio

Addictions Counsellor

Dedicated to addiction recovery.

Clients Questions

How do clinicians tell whether the depression came first or the drugs caused the low mood?

We don’t guess—there’s a clinical detective process. We look at timing (did the low mood exist before heavy use?), pattern (mood that improves after a few weeks of abstinence usually points to substance-induced depression), family history, severity (psychotic features or suicidal planning suggest a primary mood disorder) and objective measures like mood scales and collateral history from family or employers. In Johannesburg practice we often start with a medically supervised detox so you can be reliably assessed off substances; but even if the depression looks substance-induced, you still treat symptoms—psychotherapy, support for sleep and nutrition, and psychiatric follow-up—because untreated mood symptoms drive relapse. Bottom line: determining origin matters for long-term medication decisions, but in the first days and weeks both withdrawal and mood must be managed together.

Can antidepressants be started if someone is still drinking, smoking tik, using nyaope or on ART/TB treatment?

Yes—sometimes you must start medication while the person is still using, but it isn’t plug-and-play. SSRIs are commonly tolerated, but expect interactions: alcohol increases sedation and risk-taking; stimulants and bupropion raise seizure risk; antiretrovirals and rifampicin (TB treatment) change blood levels of many antidepressants. Methadone and some antipsychotics can prolong QT interval when mixed with certain SSRIs. That means a psychiatrist or medically trained clinician must review liver function, current meds (including ARVs and TB drugs), and the substances used, then choose dosing and monitoring accordingly. Don’t stop or start prescription meds without supervision—South African public and private clinics can coordinate this, and where opioid substitution exists it should be part of the plan.

My family in Joburg says he’s “just stressed” and refuses help—what actually works to get someone with depression and addiction into treatment?

Stop the polite denial and act clinically: get an assessment, not a lecture. Call a local dual-diagnosis clinic, SADAG for a referral, or emergency services if there’s suicidal behaviour. Families should prepare concrete specifics—examples of decline, missed work, erratic behaviour—and request a formal assessment from a GP, psychiatrist or substance-use service; that makes it harder to dismiss. Use short-term safety steps (remove lethal means, supervise medication), offer evaluations rather than ultimatums, and be prepared to use leverage—medical aid authorisations, workplace referrals, or temporary admission when risks are high. An intervention guided by a clinician or social worker is far more effective than confrontation or moralising; it gets the person into integrated care where depression and substance use are treated together.

What does "integrated treatment" actually look like in Johannesburg clinics—not buzzwords but daily practice?

Integrated care is multi-disciplinary and coordinated: medical detox if needed, a psychiatric assessment within days, combined psychotherapy (CBT/DBT and trauma-focused work) that targets both craving and low mood, regular medication reviews, nursing and counselling support, family sessions, and social work to sort housing, employment and benefits. Teams meet weekly to align meds, behavioural plans and relapse-prevention work; patients move from inpatient stabilisation to structured outpatient therapy and community supports (AA/NA, SMART, peer groups) with clear handovers. In plain terms: you get one plan that treats withdrawal, mood symptoms and the social problems that keep people using—rather than separate, siloed services that blame the patient for falling through the cracks.

If depression returns and there’s a relapse, what should my family do first—practical steps we can take immediately?

Treat relapse as a medical emergency, not a moral failing. First, assess safety: suicidal intent, overdose risk, access to lethal means. If opioids are involved, have naloxone available and call emergency services for overdoses. Get an urgent psychiatric review to reassess diagnosis, check medication levels and consider inpatient stabilisation or electroconvulsive therapy in severe, treatment-resistant depression with suicidality. Re-engage the addiction services—harm-reduction measures, re-initiation of opioid substitution (where available), and structured aftercare reduce repeated cycles. Document what changed, involve a social worker to address triggers (housing, income, exposure) and reset a clear relapse plan with boundaries—firm, clinical, and immediate—so the next response is fast and focused rather than reactive and punitive.

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Content on this website is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. Always speak to a qualified health professional about any medical concerns.
Changes Addiction Rehab PTY LTD (‎2013/152102/07) is licensed by the South African Department of Social Development (Practice No. 0470000537861) and the Department of Health, and is a registered detox facility and practice with the Board of Healthcare Funders. Our treatment programme is led by counsellors registered with the HPCSA, working alongside a multidisciplinary team of medical professionals under a unified practice. We are proud, standing members of the International Certification & Reciprocity Consortium (IC&RC), the Occupational Therapy Association of South Africa, the South African Council for Social Service Professions, the South African Medical Association, the South African Nursing Council and the South African Society of Psychiatrists. Changes Addiction Rehab has been in continuous professional operation since 2007, when it was founded by Sheryl Rahme, who has worked in the addiction treatment field since 1984. Our core clinical team brings over 100 years of combined professional addiction recovery experience.