“These afflicted teens are being driven by something that makes them act in ways that hurt themselves and those around them. That “something is what we call “ depression…”

~ Gary E. Nelson, A Relentless Hope: Surviving the Storm of Teen Depression

What is the relationship between depression and substance abuse among teenagers?

As it turns out, the relationship may be closer – and more common – than you might think. In fact, each condition can help cause – and be partially caused by – the other.

What Is Depression?

Major depression is a serious mood disorder that affects millions of teenagers in the United States. At its most severe, the condition disrupts a person’s daily lives. It affects their feelings, thoughts, and ability to function normally – eating, sleeping, socializing, and schoolwork.

A teenage experiencing a major depressive episode experiences any or all of several persistent negative emotions:

• Sadness
• Anxiety
• Hopelessness
• “Emptiness”
• Worthlessness
• Helplessness
• Powerless
• Guilt
• Shame

These emotions negatively impact how they function and how they interact with others:

• Irritability
• Isolation
• Social withdrawal
• Loss of interest in formally-enjoyed activities and hobbies
• Poor performance at school or work
• Neglecting responsibilities

A depressive disorder affects a person both mentally and physically:

• Lack of energy/Constant fatigue
• Talking or moving more slowly
• Inability to sit still/Restlessness
• Memory problems
• Impaired concentration
• Inability to make decisions
• Worsened self-esteem
• Sleep disruption – insomnia, poor sleep, wakefulness; alternately, oversleeping
• Body aches and pains without a physical cause or remedy
• Digestive problems
• Changes in appetite
• Rapid weight gain or loss
• Sexual “acting out” – promiscuity, unsafe sex, etc.
• Self-harm – cutting, burning, etc.
• Preoccupation with dying
• Suicidal ideation or attempts – untreated depression is the #1 cause of suicide among teenagers

Depression manifests differently in every person, so it is unlikely that they will experience every single symptom. However, for a medical diagnosis to be made, a minimum of 4 symptoms must be present for at least 2 weeks.

How Common Is Depression among Teenagers?

According to the National Institute of Mental Health, depression is quite common among American youths. In 2015, approximately 3 MILLION adolescents between the ages of 12 and 17 experienced at least one major depressive episode. This represents 12.5% of that age group – roughly 1 in 8.

That is a HUGE increase from 2005, when just 8.7% of teens suffered an MDE.

The risk of depression among teenagers is so high that the American Academy of Pediatrics recommends screening for people between the ages of 11 and 21.

Which Teenagers Are Most at Risk for Depression?

Although there is no single identifiable cause of depression among teens, there are several known risk factors that often contribute to the development or worsening of the condition:

• A family (genetic) or previous personal history of depression
• Major life changes or trauma –
• Bullying/Cyber Bullying – chronic recurring humiliation is the biggest cause of teenage trauma
• Parental divorce
• Moving
• Separation from family members or close friends
• Relationship breakups
• Serious illness, either personal or in a loved one
• Death of a loved one
• Accidents or injuries that result in lingering pain
• Stress, typically tied to performance/expectations
• Graduation
• Violent or sexual assault
• Substance abuse

The NIMH statistics show that teenage girls are far more likely to be depressed than boys. 19.8% of teen girls struggled with depression in 2015, compared to just 5.8% of boys. That is a disparity of almost three-and-a-half times between the genders.

The most at-risk ages are between 15 and 17, and the rates of depression are highest among multi-racial teens.

The Genetic Connection between Depression and Addiction

Both depression and addiction are associated with the amygdala – the region of the brain that controls how a person responds to stimulus.

In clinically-depressed people, the amygdala is overactive when responding to set stimuli, and underactive when responding to positive stimuli.

Likewise, the amygdala of a person with an addictive disorder becomes overactive when the person experiences a substance-related cue. This is why even watching a video that contains alcohol or drug use can trigger immediate and irresistible cravings.

In addition, in 2012, researchers discovered a specific gene variation that is present in people with schizophrenia, major depression, alcohol dependence, and/or opioid dependence.

How Depression Drives Teen Substance Abuse

“These are extraordinarily strong relationships.  You read the newspaper and the cancer scare of the week is about something that raises risk by 30%. Here, we’re talking thousands of percentage points.”

~ Dr. Vincent Felitti, ACE study, founder and the former Head of Preventive Medicine at San Diego’s Kaiser Permanente

Part of the reason that many depressed teenagers turn to alcohol and/or drugs is because of negative urgency.

Negative urgency is a tendency among some individuals to act rashly or impulsively in response to painful or negative emotions.  Teens with this psychological trait are unable to control their behavior when experiencing feelings such as fear, anger, or sadness.

Of special relevance, poor impulse control has long been linked to addictive behaviors. In the case of teenagers with depression, negative urgency can lead them to “self-medicate” with alcohol or drugs in an attempt to alleviate painful symptoms.

Additionally, as demonstrated above, depression is often closely linked to some kind of trauma or stress. Psychologists call this an ACE-an Adverse Childhood Experience. Interestingly, the type of ACE matters less than the cumulative effect from multiple factors.

How big of a factor are these experiences? Compared to a child with no ACEs:

• A child with 6 ACEs is 3 times more likely to smoke as an adult.
• 4-5 ACEs – 5 times more likely to be an adult alcoholic.
• A boy with 4 ACEs is 46 times more likely to be an IV drug use or as an adult!

How Substance Abuse Fuels Depression

But here’s the thing – any “relief” provided by drug abuse or excessive drinking is temporary at best. At worst, the drinking and drugging leads to MORE trauma and WORSENED depression.

For example, substance abuse leads to a higher incidence of accidents, violence, sexual assault, and poor school performance – all traumatic stressors that directly affect depressive development.

It is an extremely vicious cycle that self-perpetuates and intensifies without effective treatment that is tailored to the unique needs of a teenager.

How to Help a Teenager with Co-Occurring Depression and Addiction

Because depression and addiction are so closely intertwined, it is virtually impossible to successfully treat one condition without simultaneously addressing the other.

Rather, treatment services should be offered concurrently – each provider should work cooperatively via a unified strategy of recovery.

For nearly 40 years, Teensavers Treatment Centers has been the most-trusted resource for Orange County teenagers and families struggling with behavioral and addictive disorders. If these problems have made your life unmanageable, contact Teensavers today to transform your lives for the better.

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