I’m Sober, So Why Do I Feel Depressed? Depression in Addiction Recovery
Alcohol misuse has been associated with the onset or worsening of depressive symptoms.1 If you or a loved one is recovering from alcohol use disorder (AUD), signs of depression may appear during the recovery process.
In this article:
Depression and Addiction
A person who has AUD or major depressive disorder has double the risk of developing the other disorder.2 Either disorder can contribute to or cause the other.
AUD may lead to the development of profound depressive symptoms or a clinical diagnosis of major depressive disorder as the physical effects of alcohol as a central nervous system depressant manifest and the negative consequences of addiction become apparent. 2
Depression can lead to AUD if alcohol is used to manage mental health symptoms or to self-medicate in other ways, such as to assist with sleep. This pattern of using alcohol to treat depression can turn into physical dependence and addiction. 2
It is common for people with AUD to experience depression—studies report that these diagnoses co-occur for between 16% and 68% of people with one diagnosis or the other. 2
It can be difficult to tell if you have clinical depression while you are experiencing moderate to severe AUD symptoms. Even people who are not depressed in the clinical sense may feel strong depressive symptoms caused by the physical effects of alcohol misuse.
Many people in recovery experience depression without being able to identify it. Awareness that you may be experiencing depression is the first step in treating it. Symptoms of depression may include the following:2
- Lack of energy
- Difficulty concentrating
- Significant loss or increase in appetite
- Feeling hopeless
- Memory problems
- Loss of interest in things you previously enjoyed
- Body or muscle aches for no reason
- Digestive issues
- A feeling of emptiness and lack of purpose
- Restlessness and anxiety
Depression can also result in suicidal ideation. If you experience suicidal thoughts, reach out for help. In the United States, the National Suicide Prevention Lifeline is available 24/7 at (800) 273-8255. 3 You should also report these thought patterns to your medical and behavioral health providers.
It is possible to experience these symptoms as part of post-acute withdrawal symptoms (PAWS) when you stop using alcohol. Still, depression and recovery often need to be addressed with professional help and proven recovery tools, such as 12-step programs.
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Depression and Addiction Recovery
It is important to seek out tools to deal with your depression and addiction simultaneously. Your depressive symptoms may improve when you are in recovery from your AUD, but failing to address them directly can leave you vulnerable to the risk of relapse, especially if you have untreated major depressive disorder.
Medications for co-occurring AUD and depressive disorders focus mostly on antidepressant medications.4 Research shows that combinations of antidepressants and AUD medications (e.g., sertraline with naltrexone and acamprosate with Lexapro) show promise for the treatment of dual diagnosis disorders, with positive recovery rates for both AUD and depressive symptoms.4
However, if you have used a certain antidepressant with alcohol, your providers may change or combine your antidepressants. For example, if you have mixed a selective serotonin reuptake inhibitor (SSRI) like Lexapro with alcohol, your providers may recommend taking another SSRI, combining Lexapro with a complementary second medication, or switching to another class of antidepressants.
Medication is one type of treatment; however, a comprehensive approach using psychotherapy and 12-step support along with medication may provide a stronger foundation in depression and addiction recovery and is recommended by the majority of clinicians.4,5 This recommendation is made, in part, due to the fact that both AUD and depression develop as the result of complex factors that can include trauma history, biological factors, and learned behaviors. Medication can only treat the neuropsychiatric causes of AUD and depression, which may leave gaps in your care and complicate your recovery if you do not address the other contributing factors.
Effective behavioral and psychosocial therapies for co-occurring AUD and depression include:4.5
- “LETS ACT”—A life enhancement treatment for substance use that is a modification of behavioral activation therapy for people with substance use disorders.
- Cognitive-Behavioral Therapy (CBT) —Helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs.
- Motivational Interviewing—Works with people’s readiness to change their behavior and enter treatment.
- Holistic Therapies—Alternative approaches (e.g., yoga, meditation, and breathing techniques) can be highly beneficial therapies. Some clinicians may use these therapies to help individuals improve emotional and somatic (physical reactions) self-regulation. Holistic therapies are not a replacement for medication.
- Psychotherapy—A form of one-on-one therapy, also called “talk therapy,” psychotherapy involves meeting with a trained mental health professional regularly to discuss issues related to AUD and depression.
- Group Therapy—Group therapy meetings are facilitated by a licensed clinician and may focus on any treatment modality that best suits the group’s needs. One of the most common types of group therapy is process groups where individuals can share their experiences and receive feedback. Therapy groups usually have the same members every meeting and may be designed to bring together people struggling with similar challenges.
- Mutual Support Groups—Groups like SMART Recovery and online recovery groups can provide community support in recovery.
Depression can be overwhelming, especially in the early stages of recovery. Understanding and recognizing your triggers can help you prevent relapses. Common triggers of relapse can include the following:
- Financial problems
- Relationship issues
- Certain people or places
- Family problems
Learning to recognize when you are triggered and how to choose healthy coping mechanisms. These healthy coping mechanisms may include:
- Reaching out to your therapist
- Attending a 12-step meeting
- Checking in with a recovery buddy
- Using movement to improve your mood
A recovery support community is key to managing your triggers. If you have attended an inpatient or outpatient program or are currently a resident, the base of your recovery network will be built in to your treatment program. You may want to save your recovery contacts on your phone in case you need to make an emergency call. 6,7
Twelve-step programs are based on the foundational principles of Alcoholics Anonymous (AA) —the largest community-based support group for alcohol-related issues—and are one of the most popular therapeutic approaches in the United States. 6,7 The 12-step program of recovery uses a 3-pronged approach: Unity (the fellowship, traditions, and principles of the program), service (chairing meetings, commitments, sharing, sponsorship), and recovery (working the 12 Steps under the guidance of a fellow program member).6
Research supports the benefits of acquiring a 12-step sponsor.7 Attending meetings, working the steps with a sponsor, and service work are all predictors of increased abstinence from drug use.7 Working the 12 Steps of recovery is a cornerstone of most, if not all, Anonymous programs.
Twelve-step fellowships (e.g., Narcotics Anonymous and Alcoholics Anonymous) are the most widely accessible addiction recovery tool in the United States, with 12-step meetings becoming a cost-effective and meaningful approach to promoting recovery from alcohol and depression, both in and after treatment.6
If you need help finding a treatment program for co-occurring depression and addiction or are experiencing depression in recovery, help is available. Call our support line at 800-839-1686Who Answers? for more resources.
- Ramsey, S. E., Engler, P. A., & Stein, M. D. (2005). Alcohol use among depressed patients: the need for assessment and intervention. Professional Psychology, Research and Practice, 36(2), 203–207.
- Kuria, M. W., Ndetei, D. M., Obot, I. S., Khasakhala, L. I., Bagaka, B. M., Mbugua, M. N., & Kamau, J. (2012). The association between alcohol dependence and depression before and after treatment for alcohol dependence. ISRN psychiatry, 2012, 482802.
- National Suicide Prevention Lifeline. National Suicide Prevention Lifeline.
- McHugh, R. K., & Weiss, R. D. (2019). Alcohol use disorder and depressive disorders. Alcohol Research: Current Reviews, 40(1).
- National Institute on Drug Abuse. (2020, July 24). Treatment Approaches for Drug Addiction DrugFacts.
- Laudet, A. B., Morgen, K., & White, W. L. (2006). The Role of Social Supports, Spirituality, Religiousness, Life Meaning and Affiliation with 12-Step Fellowships in Quality of Life Satisfaction Among Individuals in Recovery from Alcohol and Drug Problems. Alcoholism treatment quarterly, 24(1-2), 33-73.
- Greenfield, B. L., & Tonigan, J. S. (2013). The general alcoholics anonymous tools of recovery: the adoption of 12-step practices and beliefs. Psychology of addictive behaviors: journal of the Society of Psychologists in Addictive Behaviors, 27(3), 553-561.