The Connection Between Teen Depression and Substance Abuse

Teen depression and substance abuse have a bidirectional relationship, meaning one condition often contributes to or worsens symptoms of the other. 

For example, teens with depression may abuse drugs or alcohol to cope with feelings of isolation or emotional pain. In return, drug and alcohol use worsen symptoms of depression, creating a negative feedback loop.  

Comprehensive substance abuse and teenage depression treatment includes dual diagnosis, addressing both addiction and mental health. Addiction is treated with detox, counseling, relapse prevention strategies, and peer support. Depression treatment includes evidence-based therapies such as CBT, family therapy, and medication. 

The Rates of Depression and Substance Abuse

According to the National Institute of Health, 1 in 5 teens struggles with depression or anxiety. Of course, not every teen who experiences depression goes on to abuse drugs. However, drug use is a leading factor in teen depression [1]. 

Below are several key statistics to highlight the connection between substance abuse and teenage depression [2]: 

• Up to 45% of teens who struggle with a mental health disorder also have a substance abuse disorder
• Depression is the most common co-occurring mental health disorder among teens with SUD
• 1 in 4 teens in SUD treatment struggle with major depressive disorder
• 28.7% of teens diagnosed with depression report abusing illicit drugs (prescription pills, stimulants, psychedelics, marijuana) 
• 22% of teens diagnosed with depression report using marijuana regularly 
• 6.2% of teens diagnosed with depression report binge drinking 
• According to data from the WHO, 3.9 million teens struggle with depression, and of those, 922,000 also have an SUD [3]. 

How Drugs and Alcohol Make Depression Worse 

Although teens may use drugs and alcohol to cope with symptoms of depression, they often only feel short-term relief. Over time, substance abuse has been shown to worsen depression due to several biological factors and behavioral mechanisms. 

Some of the ways drugs and alcohol affect the depressed brain include [4]: 

• Neurotransmitter Imbalance: Drugs and alcohol alter neurotransmitters in the brain that regulate functions such as mood, appetite, and sleep. For example, stimulants such as cocaine increase dopamine in the brain, causing a spike in euphoria. However, when these initial effects wear off, it depletes the brain, causing adverse effects such as depression. 
• Structural Changes: Long-term substance abuse causes structural changes in regions of the brain, such as the prefrontal cortex (PFC), amygdala, and hippocampus, that control functions such as stress response, emotional regulation, memory, and mood. Dysfunction in these regions, particularly the PFC, is linked to an increased risk of depression. 
• Sleep Disruption: Drugs disrupt the sleep cycle by affecting essential sleep hormones, such as melatonin. Lack of sleep worsens symptoms of depression, such as trouble focusing, memory loss, fatigue, and irritability.  
• Interference With Treatment: Substance abuse can reduce the effectiveness of mental health medication, such as antidepressants, or increase the risk of adverse side effects. 

Red Flags To Watch For In Your Teen 

Several symptoms of depression and substance abuse can mimic one another, such as isolation, changes in personality, and irritability. Other red flags to be mindful of that are signs of substance abuse and co-occurring depression include: 

• Finding drugs or alcohol in their room or belongings 
• Coming home visibly drunk or high
• Drastic mood swings
• Decline in self-care 
• Changes in sleep or appetite 
• Anxiety, restlessness 
• Trouble concentrating
• Dilated or pinpoint pupils, or bloodshot, glossy eyes 
• Unexplained physical symptoms such as nausea, vomiting, diarrhea, fatigue, or muscle and joint pain 

The Importance of Dual Diagnosis Treatment 

For successful recovery, it’s essential that treatment addresses both substance abuse and depression in teens. This is known as “dual diagnosis” or “co-occurring treatment”. Teens participate in conventional substance abuse treatment, such as detox, counseling, group therapy, and 12-step. They also receive evidence-based mental health treatment for depression, such as cognitive behavioral therapy (CBT), family therapy, psychiatric services, and mindfulness-based activities. 

These therapies help teens reframe harmful thoughts and perspectives about themselves or the world that often drive addiction. Therapists also help teens build a personalized toolbox of coping skills to use during episodes of depression, moments of high stress, or triggering situations where relapse is a risk. 

Family therapy can explore unhealthy family dynamics and improve skills such as communication, collaboration, and showing respect. Mental health medication can be helpful if combined with effective therapy and positive lifestyle changes when monitored under the supervision of a psychiatrist. 

Dual diagnosis programs also emphasize the importance of aftercare services to help teens transition back to their communities and daily routines. These may include case management, individualized education plans (IEPs) and academic support, continuing outpatient therapy or an intensive outpatient program (IOP), peer support groups, and ongoing medication management. 

How Families Can Be Part of The Healing Process 

Families play an important role in the healing process and research has linked family involvement to improved treatment outcomes. Involving family in the recovery process can help foster connection, improve communication, reduce the risk of relapse, and ensure teens have a stable home environment for healing [5]. 

Some of the ways teen substance abuse and co-occurring mental health treatment programs involve family in the recovery process include: 

• Family Therapy: These sessions create a safe and structured place for teens or parents/caregivers to address concerns, resolve conflicts, develop crisis safety plans, and improve overall family dynamics that support teen recovery.  
• Active Participation: It’s important for parents to take an active role in their teens’ recovery, such as attending family therapy, educating themselves about youth mental health, and staying in regular communication with treatment providers. Studies found that each family therapy session attended increases the odds of treatment completion by 1.4 times [5].
• Psychoeducation Classes: Some teen treatment centers offer psychoeducation classes and other resources to parents to help them better understand addiction, depression, and other mental health challenges their teen is experiencing. 
• Family Support Groups: Organizations such as Narateen, Nar-Anon, Al-Anon, and Parents of Addicted Loved Ones (PAL) provide family members with coping skills, resources, education, and emotional support. 
• Social and Community Events: Teens and their families are often provided with opportunities to attend family or alumni events, activities, or therapeutic outings to help foster a sense of community, connection, and reduce symptoms of depression, such as isolation or loneliness. 

Dual Diagnosis Treatment for Teens in Texas 

Clearfork Academy residential facility is a licensed treatment program with 24/7 supervision, helping teens recover from depression and co-occurring substance abuse disorders. 

We provide around-the-clock care and support to teens on their journey toward sobriety and wellness. We offer evidence-based treatments such as CBT, DBT, and EMDR and strive to educate parents about mental health.

Contact our admissions team today to see how we can support your family.

Sources 

[1]  National Institute of Mental Health. 2023. Major Depression. 

[2] Brown, A. (2019). Adolescent Depression and Substance Use: the Protective Role of Prosocial Peer Behavior. Journal of Abnormal Child Psychology, 47(6), 1065–1074.

[3] World Health Organization. 2024. Mental Health of Adolescents. 

[4] National Institute on Drug Abuse. 2020. Drugs, Brains, and Behavior: The Science of Addiction. 

[5] Fenkel, C. (2023). The Impact of Family Therapy Participation on Youths and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis. JMIR formative research, 7, e45305.