I’ve heard a thousand variations of this problem: “My brother is depressed, but he also drinks a lot, which is probably causing the depression. So which do you treat first? The alcoholism or the depression?”
The two conditions are so intertwined that it can be impossible to separate them.
Just last week I met with an executive director of a behavioral health program here in Annapolis. We were discussing how to start a faith-based initiative.
“Should we also include substance abuse?” he asked.
“Why?” asked a director of a separate program for those with severe mental illness.
“Because substance abuse and mood disorders almost always occur with each other,” the first guy responded.
It’s the chicken-egg thing. People get depressed after ingesting a depressant liquid like whiskey. And people drink to self-medicate the pain of depression. When the initial buzz wears off, they need even more of the whiskey to achieve the same result, causing even more depression. And so the vicious cycle begins.
And let’s not forget that alcohol is mostly sugar, the nemesis of depression. As I mentioned in my recent tirade against stuff, I believe that most people who fight chronic depression and severe mood disorders are allergic to sugar. At the very least, it throws another downer into the mix.
They are frenemies, alcohol abuse and depression. Where you find one, you almost always find the other, even if they spend their time stabbing each other in the back.
“Some form of substance dependence and/or abuse is found in as many as 32 percent of individuals with any affective disorder,” writes J. Raymond DePaulo Jr., MD, professor of psychiatry at the Johns Hopkins University School of Medicine in his book Understanding Depression. “People with manic depression are particularly at risk. One study suggests that perhaps 60 percent of those people with Bipolar I, the more severe form, have substance or alcohol problems at some time in their life. The same study indicated that the probability of having alcohol or drug dependence and/or abuse is several times greater in people with manic depression than in the population at large, while the risk is about two times greater in unipolar depressed patients compared to the general population.”
So you’d think that a person would feel much better if she stopped emptying two bottles of chardonnay a night.
Not so simple.
A person without depression feels much better once she sobers up — that is, once she’s past the withdrawal period. A person with depression feels worse, at least until you start treating the underlying mood disorder.
It took me three years to figure out something else was going on. I liked waking up in my own bed (versus someone else’s closet) and not having to apologize to the world for my behavior the night before; however, once you took away my pacifier, OUCH. I was extremely uncomfortable within my own skin.
I couldn’t swallow the gratitude stuff that was being force fed to us at 12-step meetings because I wanted so desperately to die. It wasn’t until my sponsor gave me these words of advice that I figured it out: Treat the primary problem first. So I channeled all of the energy it was taking to get to three meetings a week and memorize the Big Book toward treating my mood disorder. Only then did I start to make progress and stop wanting to hurt the person who was telling me that gratitude was my answer.
However, that order may be different for a 62-year-old man who downs a bottle of gin before noon every day and has a bad case of cirrhosis of the liver. His primary problem could very well be the pacifier itself. Just as I had little memory of a life with sadness, he probably has no context for living without gin. So my guess is that he should start cutting the rubber ends off of his binkies — clearing the house of his safety items.
Even more important than order, though, is that both get addressed at some point. It’s pretty darn hard to stay sober if you’re depressed, and, according to DePaulo, “Nothing makes the job of a psychiatrist treating depression and manic depression harder than alcohol and drugs.” For him and his colleagues, “there is no question that the most common destructive behavior affecting depressed patients, barring suicide, is alcohol or any substance abuse.”
I thought it was appropriate to write about this today, as it is my 26th year anniversary of sobriety!
Continue the conversation on Project Beyond Blue, the new depression community.
Originally posted on Sanity Break at Everyday Health.
Alcoholic photo available from Shutterstock