Substance Abuse and Depression

Substance abuse and depression are linked in teens. This article defines depression, explains substance abuse, offers tips on recognizing depression in teens, gives an overview of the relationship between depression and substance abuse amongst teenagers.

What Is Depression?

Depression is actually a group of disorders with two main subypes. Non-pathological depression is a normal reaction to the disappointing and difficult events of life. It is temporary and resolves within several weeks.

As a type of mental disorder, depression is more serious. It can appear as major depressive disorder (also called major depression or unipolar depression), which is episodic; dysthymic disorder (or dysthymia), which is chronic; or bipolar disorder (formerly called manic depression), which involves moods that swing from depression on the one hand to elation (either mania or hypomania) on the other.

All of these types of depression may be experienced by teenagers. In fact, according to a review of childhood and adolescent depression from 1986 to 1996 reported in a National Institute of Mental Health report, up to 8.3 percent of U.S. teens are depressed. However, depression may look different in teenagers.

Recognizing Substance Abuse and Depression in Teens

Some symptoms of depression are common to both teens and adults, while other symptoms may be associated with depression in teens but are not necessarily or usually associated with depression for older people. In the first category, one finds  the following:

  • pervasive sadness or irritableness
  • withdrawal
  • changes in eating habits and/or weight
  • changes in sleep habits
  • sluggishness, fatigue, and lack of energy
  • difficulty in concentrating
  • repeated thoughts of suicide or death

Major depression is not indicated unless five of these are present for more than two weeks. Even then, diagnosis by a mental health professional is important for certainty.

Symptoms that may (or may not) be associated with depression in teens include the following:

  • frequent, but unspecific, complaints of physical pain (such as headaches, muscle pain, or stomachaches) or tiredness
  • boredom
  • outbursts of anger, complaining, irritability, or crying
  • extreme sensitivity in the face of rejection or failure
  • recklessness
  • difficulty with communication and relationships
  • social isolation
  • planning, attempting to, or talking about running away from home
  • poor school performance or attendance
  • alcohol or substance abuse (see below for more details)

Note that each of these symptoms could be the indication of something else entirely different from depression. Various of these symptoms could be caused by, for example, an incorrect placement in school (too low or too high), hormones, missing the school bus and having to walk home, coming down with the flu, etc. Because of this, it is important not to jump to conclusions.  The idea is that if the immediate and obvious explanations for a teen’s behavior turn out not to apply, then these are behaviors for which you might consider depression as a backup possibility, one worth checking with the teen’s pediatrician about, if you have concerns.

Another Explanation for Substance Abuse and Depression

Many people associate substance abuse among teens with a host of other poor choices or defiant behavior. But another explanation has been offered for abuse not only of alcohol and drugs, but also of food and tobacco. The explanation is that - in some cases - teens who are depressed and who have probably not been diagnosed are simply seeking a release from the overwhelming hopelessness of depression.

The problem then may become that the substance abuse masks the depression. The teen may be seen as acting out, defying authority, breaking the rules. The substance abuse may even be treated. But the underlying depression that is the root of the issue may not be treated unless people know to look for it, and it is seen and diagnosed. This is not the pattern in all cases. But a number of adolescents have a depression disorder, and for teens who are both depressed and abusing substances, combined treatment is considered the best option, although more research needs to be done in this area.

Depression in Children and Adolescents: A Fact Sheet for Physicians
Written by National Institute of Mental Health (NIMH)
Friday, 13 February 2009 12:36 - Last Updated Thursday, 19 February 2009 15:14 access at:

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