It is a well-established fact that there is a strong connection between substance use and mental health disorders. This is a bidirectional relationship where each feeds off or predisposes to the other. When a person is found to suffer from both, the substance abuse disorder and mental illness, it is known as a dual diagnosis or co-occurring disorder.

Depression is one of the most commonly occurring mental illnesses and frequently tends to co-occur with substance abuse disorders. People who abuse substances are more likely to suffer from depression, and it is also true the other way around. People who are depressed tend to drink or abuse drugs in an attempt to feel better and break away from depressing thoughts. However, many of these drugs of abuse, such as alcohol, lead to an increase in the feelings of sadness or fatigue after a short burst of euphoria or pleasure.

How can you tell if someone is depressed? It is very important to identify these patients. According to one study, among individuals with recurrent major depression, up to 20% have underlying depression or another mental health issue. The clinical picture of the drug use disorder can mimic that of depression, which can make it difficult to diagnose depression in a patient who is actively using. Typical signs/symptoms of depression include lack of interest in activities, changes in sleep patterns, changes in appetite, feelings of guilt or despair, lack of energy, trouble concentrating, suicidal thoughts, etc.

Here are the key questions to ask when you need to screen someone for drug abuse:

• Do you use drugs or alcohol for longer or in larger amounts than you anticipated?
• Have you tried to cut back your use unsuccessfully?
• Do you spend a lot of time using, obtaining, or recovering from drugs or alcohol?
• Do you experience cravings to use or drink?
• Does substance use interfere with work, school, or home life?
• Do you continue using even though substance use causes problems in relationships?
• Do you use drugs or alcohol in situations where it is physically hazardous to do so?
• Over time, do you need more of the substance to create the desired effect?

Once the diagnosis is made, the treatment for both depression and substance use should commence. Antidepressants are conventionally prescribed for patients with depression or anxiety disorders along with a substance use disorder. But medication alone is not helpful. It has to be complemented with counseling and behavioral support. Patients with dual diagnosis tend to cope well with counseling, medical support, and group therapy. But in some cases, they may require intensive inpatient or outpatient treatment programs. While relapses are possible, patients undergoing comprehensive treatment have very high odds of achieving full recovery. But it is important to get diagnosed early so that timely treatment may begin, which significantly improves the chances of success.