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AS@W...Substance Use and Mood Disorders

What is comorbidity?

• Comorbidity is when two or more health disorders occur at the same time. In this case, it is when an individual with depression also has a substance use disorder (for example, use of alcohol or non-prescription drugs).

 

How common is substance use amongst individuals with depression?

• A significant percentage of individuals with depression engage in alcohol or non-prescription drug use. Alcohol is one of the most common ‘self-medications’ for depression.

• Similarly, a significant percentage of individuals who engage in harmful levels of alcohol or non-prescription drug use have depression.

• Almost 20% of individuals will struggle with alcohol use at some time in their life.

• One-third (1/3) of individuals with depression will struggle with alcohol use at some point in their life.

• Certain individuals are at higher risk for having depression and struggling with alcohol or non-prescription drug use: higher risk populations include females, younger adults, and those that are unemployed.

 

What are some consequences of comorbid substance use and mood disorders?

• Individuals with comorbid alcohol or non-prescription drug use and depression require longer and more intensive treatment than individuals who struggle with either alcohol or non-prescription drug use, or depression.

• Individuals with depression who struggle with alcohol or non-prescription drug use are more likely to relapse when compared to individuals that struggle with alcohol or non-prescription drug use, or depression.

• The effectiveness of psychotherapy or pharmacotherapy for individuals with depression can be significantly compromised when alcohol or non-prescription drugs are being used.

• Individuals who struggle with alcohol or non-prescription drug use and have a co-occurring mood disorder have greater disability and are higher users of health services when compared to individuals that struggle with either alcohol or non-prescription drug use, or a mood disorder.

• Alcohol and non-prescription drug use has been found to be associated with a higher level of suicidal ideation and actual suicide attempts amongst depressed individuals in comparison to individuals who are not depressed.

 

What treatments are recommended for comorbid substance use and mood disorders?

• A meta-analysis of treatments for depression in patients who struggle with alcohol or non-prescription drug use found that:

• It is generally recommended that an evidence-based psychosocial intervention should be the initial treatment followed by antidepressant medication if depressive symptoms do not improve.

• Antidepressant medication has been found to have a modest positive effect for individuals with comorbid depression and substance use however it is not recommended as a stand-alone treatment. Therapy that targets the alcohol or non-prescription drug use is recommended for delivery alongside the therapy for depression.

 

References

Burns, L. & Teesson, M. (2002). Alcohol use disorders comorbid with anxiety, depression and drug use disorders: Findings from the Australian National Survey of Mental Health and Well Being. Drug and Alcohol Dependence, 68, 299-307.

Greenfield, S. F., Weiss, R. D., Muenz, L. R., Vagge, L. M., Kelly, J. F., Bello, L. R., & Michael, J. (1998). The effect of depression on return to drinking: a prospective study. Archives of General Psychiatry, 55, 259–265

Sanchez-Craig, M. (1995). DrinkWise: how to quit drinking or cut down. Copies may be ordered from http://www.camh.net/Publications/CAMH_Publications/drinkwise.html

 

About AS@W

How was Antidepressant Skills at Work developed?

The guide was developed by British Columbia Mental Health and Addiction Services (BCMHAS), an agency of the Provincial Health Services Authority. The guide and accompanying materials have been authored by Dr. Dan Bilsker, Dr. Merv Gilbert, and Dr. Joti Samra – registered psychologists and scientist-practitioners with expertise in issues relating to workplace mental health. These psychologists are with the Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University. The guide was written on the basis of a review of the scientific literature; consultation with employers, unions, mental health providers and employee groups; and adaptation of existing self-care depression programs.

How can the manual be accessed?

The manual is available for viewing and free download at www.carmha.ca/antidepressant-skills/work/ or from www.bcmhas.ca/research. Individuals or organizations are free to print and make multiple copies of the guide, with permission from CARMHA. Print copies and audio CDs are available at a low cost from our ordering page at www.comh.ca/ordering/