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Co-occurring substance abuse and mood disorders refers to the presence of both a substance use disorder and a mood disorder, such as major depression or bipolar disorder.  It is very common for someone with a substance use disorder to also be suffering from a mood disorder. For example, people with bipolar disorder are particularly susceptible to substance use disorders, with 40 to 60% misusing drugs and/or alcohol during their lifetime. Those with depressive disorders rates of substance use and/or abuse at 30% to 40%, which is about double the rate of substance users found in the general population.

These co-occurrences are very common, so much so that it is more likely the rule, and not the exception. The kinds of drugs being abused usually reflect what people are commonly using in a particular community. We certainly see alcohol and marijuana being abused, but in the current climate there are epidemics of cocaine and opiate abuse, as well as other substances.

The Differences Between Symptoms and Disorders

How co-occurring substance abuse and mood disorders interact together is very complex. Historically this has been viewed as a form of self-medication on the part of people that have mood disorders using drugs/and alcohol to numb themselves. But when you look at studies on the course that symptoms usually take, this doesn’t seem to be the case with most patients.

The truth seems to be that the development of a substance dependence and/or addiction goes beyond the positive reinforcement effects of using alcohol and/or drugs. Apparently it results from a combination of other factors including the negative experiences that come along with stopping alcohol and drug use. The theory that people use substances for self-medication may only be true in a small number of cases.

Three factors seem to contribute to the rise in the rate of drug and alcohol use among people with mood disorders: drugs and alcohol do cause symptoms in some people, drug and alcohol use result from having a mood disorder and there are certainly shared risk factors.

It isn’t easy to know for sure with each patient whether or not there is a causal link between the co-occurring substance abuse and mood disorder, or no link at all. Therefore, we must be concerned with treating both conditions separately in a lot of cases. This is important since there are very few effective treatments that work on both co-occurring substance abuse and mood disorders, which means you can “kill two birds with one stone.” 

Evaluating Co-occurring Substance Abuse and Mood Disorders

Don’t forget that co-occurring substance abuse and mood disorders happen frequently. If a patient presents with a mood disorder, it is important to find out if they use drugs, alcohol and/or smoke. And if someone comes in to be treated for drug and/or alcohol abuse, you need to assess whether or not they have a mood disorder. Mood disorders are more extreme in primary alcohol and drug users.

Co-occurring Substance Abuse and Mood Disorders are Closely Linked 

When in treatment for a co-occurring substance abuse and mood disorder, if either problem is not managed or treated fully it will most likely fail or at the very least lead to poor outcomes for one or the other. These conditions are very closely linked, and one will influence the improvement of the other.

An example of this would be if someone depressed drinks alcohol, which is considered a depressive agent it would just worsen their symptoms, making them even more depressed. If they continue drinking, it makes it very difficult to ascertain whether their treatment for depression is actually working.

On the other hand, depression may interfere with someone’s ability to fully participate in treatment, which makes his or her chances of gaining sobriety less likely. For treatment to be effective in co-occurring substance abuse and mood disorders, it requires that both be carefully assessed and aggressively managed.

Cognitive-behavioral Therapy in Combination with Other Treatment 

Cognitive-behavioral therapy (CBT) is not being used enough when treating co-occurring substance abuse and mood disorders. Aspects of CBT can used in managing mood disorders and in treating drug and alcohol abuse. A combination of treatments can be successfully incorporated into CBT for good results.

Clinicians should identify the treatment goals for each of the conditions, the co-occurring substance abuse and mood disorder, before embarking on a course of action. This is going to take time and patience for both the therapist and the patient.

Treatment for co-occurring substance abuse and mood disorders can be highly effective.

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