How Common is Feeling Depressed After Substance Abuse?

Why do some people feel depression and anxiety after addiction recovery?

When people go into in-patient treatment, or rehab, they typically picture a whole new life waiting for them after they get out. They plan to come out of rehabilitation stable, healthy, and productive, ready to take on new challenges successfully, leaving behind the difficulties of the past. To experience depression symptoms after rehab, then, can be disheartening. It is not uncommon, however, because transitioning from rehab can be an emotionally complicated process. Why? Consider this: what is rehabilitation but a place to take a break from life, detoxify the body, and gain perspective on the reasons for addictive behaviors? Leaving rehab means going back to all the old stressors and triggers and having to face the issues that were contributing to the disease in the first place. This can be overwhelming, leading to feelings of depression and anxiety.

How Addiction is Used to Deal with Depression in the First Place

People struggling with addiction use substances to help them avoid reality, cushioning them against things that are painful. There are two behaviors intrinsic to the psychology behind addiction: coping and feeling comforted. Avoiding painful things is a coping mechanism, and using substances every day becomes a comforting ritual. Entering substance abuse treatment causes a person to shake up the routine and begin to face reality, and this feeling of experiencing what has previously been avoided can cause anxiety.

Brain Chemistry

Another thing to consider when thinking about addiction and depression is the way the brain’s reward system works. During active addiction, the influence of the substance being abused takes over the brain’s normal functioning. The substance provides the person struggling with addiction with dopamine, and this causes the brain to stop producing its own dopamine. Taking away that substance means the brain needs to adjust and begin to function normally again. It is easy to understand, then, why one of the most common withdrawal symptoms would be the absence of joy, while the brain is trying to regain its ability to produce feel-good chemicals. Depression is considered a post-acute withdrawal symptom (PAWS), and it is common for life to feel flat and dull for weeks or even months after detox.

Co-Occurring Depression (Dual Diagnosis)

Additionally, it is very common for people struggling with substance use disorders to have co-existing mental health disorders. The primary co-occurring conditions are anxiety and depression, and drugs or alcohol are used to self-medicate and manage the mental health condition. On the other hand, for some people, substance abuse can exacerbate a mood disorder. Drug and alcohol addiction can bring a set of difficulties and challenges that lead to negative life consequences, and these mounting consequences can cause depression. Whether the depression is a core disorder or a residual effect of substance abuse, it may need to be targeted for long-term treatment.

Adjustment Period

The substance abuse that results from addiction is a side effect of distorted thinking. Rehabilitation provides not only the time and space to detoxify physically, but also to gain insight into the distorted thinking that fuels the addictive behaviors. After leaving the safe space of rehab and facing the world with sobriety as a goal, people have many challenges to overcome. They will need to find new friends who are supportive of their recovery, hobbies and activities that do not involve substance use, and they may have to face the fallout from their addiction. Financial issues, job loss, health problems, damaged relationships, and other issues that are the consequences of addiction can make a person feel depressed after rehab, but most of these issues will eventually be resolved. There can also be feelings of depression connected to chemical changes to the brain from substance use, and it is important to remember that post-acute withdrawal symptoms can last for a year or longer during recovery from substance abuse. Brain fog, lack of mental clarity and focus, racing thoughts, and difficulty with attention can all be the result, because the body needs time to adjust to the removal of toxins.

Managing Depression in Addiction Recovery

How can you cope with feelings of depression after rehab? Remember that there are different types of depression. If what causes the depression is situational, you may find that it resolves once you have dealt with some other issues in your life. For major depressive disorder, however, you will need targeted treatment. Remember, too, that depression can manifest in different ways, depending on the person. While signs of depression in women typically include persistent low mood, withdrawal from interactions with others, and low self-esteem, men often manifest depression through things like escapism, anger, and physical symptoms. Depression can be a serious threat to sobriety because the negative feelings that are symptoms of depression can create a temptation to relapse, so it must be dealt with to support recovery. No matter how your depression is manifesting itself, some common coping strategies can help.

• Healthy Eating and Exercise: Balanced nutrition and regular physical exercise are both important to maintaining not only physical health but also brain health and functioning. Aim for a diet low in processed foods and high in lean proteins, fruits and vegetables, and whole grains, and an exercise routine that involves three or four 30 to 60-minute workouts each week.
• Quality Sleep: Experts recommend at least seven hours of sleep each night, and getting enough sleep on a regular basis is vital for good mental health.
• Self-Help Support Groups: It can be easy to self-isolate when depressed, but surrounding yourself with support can help. Support groups like Alcoholics Anonymous and Narcotics Anonymous are a big part of the recovery process because they help remind you that you are not alone, and the battle is not just yours.
• Regular Therapy Sessions: Individual therapy and counseling, along with group therapy, after leaving a treatment program can help you readjust to life in “the real world” and understand your depression and addiction, and help you live a happier, more fulfilling life.
• Replacing Old Negative Habits with New, Positive Habits: Letting go of substance abuse requires finding new habits to replace your old, damaging habits. As you regain your strength, both physically and mentally, it will be easier to be involved in activities you enjoy but may not have done for years. Keep a journal, spend time in nature, try new things, attend sober events that are interesting, and volunteer in your community.
• Yoga and Meditation: Mindfulness techniques, yoga, and meditation all tap into the mind-body connection, and this can help alleviate depression symptoms by reducing stress and increasing feelings of calm.

Brevard Health Alliance is Here to Help

Whether you need a behavioral health specialist or a primary care physician, Brevard Health Alliance, Inc. is here for you. Brevard County’s only Federally Qualified Health Center, BHA offers extensive health care services on a sliding-fee scale, so that we can treat residents regardless of their ability to pay. We’re committed to providing an extraordinary quality of care for our patients in order to improve the health status of Brevard County. Our focus is on continually improving the quality and efficiency of our care, and on ensuring that every patient we serve is heard, encouraged, and respected. As your family health care provider, we strive to provide not just acute care but also preventive care and healthcare-related education. Our board-certified physicians, advanced practice nurse practitioners, and physician assistants provide primary care that includes well-child checkups, well-woman care, and physicals, along with chronic disease management. In fact, since 2005 we’ve provided not only primary care services, but also behavioral health services, dental services, diagnostic services, resource management services, pharmacy services, women’s health care and obstetrics, Hepatitis C and HIV services, extended hours pediatric walk-in care, and specialty referrals. For more information, to find a location, or to make an appointment, contact us through our website.