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Alcohol and Depression Rehab
How Dual Diagnosis Treatment Works

If you suffer from a co-occurring disorder, you may need professional help from an alcohol and depression treatment centre. Here we explain the key issues.
When a person suffers from an addictive disorder like alcoholism – as well as a mental health disorder like depression – the combination is referred to as a dual diagnosis (also known as a co-occurring disorder). Several studies have confirmed that alcohol use disorders and depressive episodes are highly prevalent, frequently co-occur, and often produce worse outcomes when occurring together. Getting help for two different psychological disorders can make assessment, treatment, and recovery significantly more challenging than addressing either issue on its own.
In this article, you’ll learn more about:

What is alcohol and depression rehab?

Alcohol and depression rehab provides professional counselling, intensive care, and round-the-clock support for those suffering from co-occurring alcohol use problems and mental health conditions, such as depressive symptoms. By combining both medical and psychotherapeutic treatments to address alcohol dependency and underlying psychiatric conditions, rehab for alcohol abuse and depression aims to help you develop a range of coping strategies and life skills in order to go through life without the use of harmful substances.
Most alcohol and depression treatment programmes are abstinence-based, so treatment often begins with an alcohol detoxification process, followed by individual and group therapy sessions. Once primary treatment is complete, post-treatment care is normally offered to ensure that you receive continuous support on your road to recovery.

What is depression?

Depression is a mental health disorder characterised by a persistent feeling of sadness and loss of interest that lasts for a long period of time. It is normal to feel sad and discontent every now and then, particularly if something significant has happened in your life such as the loss of a loved one. But if these feelings persist over a long period, and if they start to impact your mental and physical health, you should seek treatment.

Gaining a better understaning of depression, and of its different types, can be the first step in getting help and feeling better. The most common types of depression are:
This is a condition that results in constant and overwhelming feelings of sadness, hopelessness and unhappiness. Major Depressive Disorder can be diagnosed in people who suffer these feelings for longer than a two-week period and whose daily lives are being impacted by negative feelings.
This condition is also known as Manic Depression and it causes severe mood swings. It can result in feelings of intense joy or euphoria for a period of time, and then experiencing a crash that results in severe depression.
This type of depression usually affects people living in cold climates where daylight hours are reduced at certain times of the year. Symptoms can include weight gain, heaviness in limbs, feeling sad and oversleeping – and usually worsen over the Winter months. SAD symptoms must persist for at least two consecutive years for a person to be given a formal diagnosis.
When depression symptoms become severe and include delusions, paranoia or hallucinations, a diagnosis of Psychotic Depression may be made. Individuals suffering through this condition can experience sleepless nights, the feeling that people want to harm them, and voices in their heads. Overtime, this condition can cause a person to lose interest in regular bathing and personal grooming.
This disorder is also known as dysthymia and results in regular symptoms of depression that persist for more than two years. Unlike Major Depressive Disorder, these symptoms are not uniform. Sometimes the individual will experience minor depression, other times they will be crippled by severe symptoms such as insomnia, anxiety and suicidal thoughts.

Symptoms of depression

According to The American Psychiatric Association (APA), an individual may be struggling with depression if they exhibit five or more of the following symptoms for at least two weeks on a daily basis:
  • Problems sleeping, such as sleeping too much or too little
  • Inability to feel joy and loss of interest
  • Suicidal thoughts and death
  • Inability to think, concentrate, or make decisions
  • Significant weight loss or weight gain
  • Feeling hopeless, worthless, and guilty
  • Low energy and physical fatigue
  • Feeling sad and depressed
  • Purposeless physical activity and slowed movements

The link between alcohol and depression

A 2014 booklet published by the National Institute on Alcohol Abuse and Alcoholism in the US confirms that depression often goes hand in hand with heavy drinking. People who are alcohol dependent are 2-3 times more likely to suffer from major depression. Due to the effects of alcohol on the body, it can be difficult to determine whether depression is a result, or a cause, of alcohol addiction.
Heavy consumption of alcohol alters the brain’s neural chemistry, changing the balance of dopamine and serotonin. Differing levels of these two chemicals can cause highs and lows, triggering depression or the need to drink. For this reason, an integrated dual diagnosis rehab programme that addresses both issues is the most effective way to achieve long-term sobriety.

How does alcohol affect depression?

Alcohol worsens depression. When you are suffering from depression, you are more likely to use alcohol to relieve the symptoms of your depression such as feeling down, worthless or hopeless. By continually self-medicating with alcohol to relieve your depression, you will build up a tolerance to alcohol, which will mean you’ll need to drink more to keep your depression away.
High levels of alcohol can bring on negative emotions that outweigh any positive feelings that you might have originally experienced when drinking. These habits create an unhealthy and dangerous cycle that may require integrated alcohol and depression treatment to break free from.
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When to seek alcohol and depression treatment

Long-term alcohol addiction has an impact on the nervous system that can be very similar to depression. Due to the similarities between symptoms of alcoholism and depression, it can be difficult to know what is causing your negative emotions.
According to the DSM–5, there are 11 indicators for assessing if a person is suffering from alcohol use disorder (AUD). The presence of 2-3 of the following symptoms indicate a mild disorder, whereas 6 or more indicate a severe disorder. If you or your loved one is experiencing at least 4 of these symptoms, you may require the help of an alcohol and depression rehab centre.
  • Increased quantity and frequency of drinking
  • Inability to cut back on alcohol use
  • Spending a lot of time drinking and recovering from the after-effects
  • Persistent desire to drink; you cannot think of anything else
  • Experiencing physical withdrawal symptoms once the effects of alcohol wear off
  • Inability to fulfil work, school, family, and social responsibilities
  • Having relationship problems with friends and loved ones
  • Social withdrawal and loss of interest in activities you used to enjoy
  • Engaging in dangerous behaviours while or after drinking
  • Continuing to drink despite negative emotional and/or physical impacts
  • Increased tolerance to the effects of alcohol

How rehab treats alcohol abuse and depression

An initial stage of alcohol detoxification may be necessary to stabilise the body, both physically and mentally, before proceeding with the course of addiction treatment. After the detoxification process is successfully completed, a professional treatment plan will be set into motion between the patient and their treatment centre. The treatment plan will be adaptable throughout the course of your treatment programme.
To overcome a dual diagnosis of alcoholism and depression, it is important that both conditions are treated simultaneously – preferably on a residential basis. By providing integrated alcoholism and depression treatment, your rehab will help you manage the associated physical and mental symptoms of both disorders.
A treatment plan will include elements of:

Alcohol detox and withdrawal

First and foremost, you will have to undergo the process of alcohol detoxification. This procedure helps wean you off alcohol to ensure that both of your conditions can be successfully managed. Medication may also be used to treat withdrawal symptoms such as headaches, nausea, tremors, anxiety, hallucinations and seizures.

Medication for depression

There are many different types of medications available to treat depression. These include:
  • Atypical antidepressants
  • Monoamine oxidase inhibitors (MAOIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants (TCAs)
  • Other medications or combinations of antidepressants
A full list of options can be discussed with your treatment centre.

Psychological therapies

A wide range of evidence-based therapies can be used to treat both alcohol addiction and depression, such as:
  • Cognitive Behavioural Therapy (CBT): A widely used form of evidence-based treatment, CBT is a conversational method that helps clients break free from negative thought patterns, and put themselves in a more positive frame of mind.
  • Dialectical Behaviour Therapy (DBT): DBT integrates several related themes of mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation, as a means of bringing the client to a healthier and more balanced state of being.
  • Assertive Community Therapy (ACT): ACT helps clients deal constructively and positively with their emotions. Rather than trying to fight one’s feelings, ACT lets people understanding them as an important part of being human.
  • Contingency Management (CM): CM uses positive reinforcement to reward constructive behaviour during the course of treatment, as a way of motivating progress toward abstinence.

12-Step-based approach

The 12 Steps were developed by the founders of Alcoholics Anonymous to promote a set of guidelines which can help people overcome their addiction to alcohol. Clients at a 12-Step-based rehab receive a variety of interventions and will work through the steps during their treatment programme. These rehabs may host AA meetings on-site, or take clients to offsite 12-Step meetings.

Ongoing recovery plan

Once you have successfully completed your primary treatment at a rehab facility, you may wish to participate in additional programmes to help prevent a relapse. Sober living houses, Alcoholics Anonymous, and outpatient treatment sessions can each help you cope with the difficulties of re-integrating with society.

alcohol abuse and depression facts

  • The risk of developing alcohol addiction or depression is higher for those with a family history of either condition
  • Over half the people who go to rehab for alcohol addiction, suicide ideation was reported among persons with depression 
  • Alcohol consumption can interfere with an accurate diagnosis of depression
  • Young people who suffer from depression are twice as likely to start drinking alcohol than their non-depressed peers
  • Alcohol is known to trigger depressive episodes that are more severe and frequent than non-alcohol-related depression

Outpatient vs inpatient rehab

Rehab for alcohol abuse and depression usually falls into two distinct categories – outpatient and inpatient. Outpatients are treated at a rehab facility on an ad hoc basis, while those seeking inpatient treatment for alcohol and depression will temporarily reside at a residential rehab facility as they undergo the rehab process. The latter provides round-the-clock care and a far more comprehensive range of services – albeit at a higher price. Each of these options typically revolves around evidence-based treatment approaches such as behavioural therapy, which enables you to transform your negative thoughts into a more positive outlook.
It is important to select the treatment programme that is suitable for your condition. Treatment is likely to involve a combination or sequence of services – and because people who use substances differ in many ways, you may need a different mix of services at different times.

Inpatient rehab for alcohol abuse and depression

Most outpatient rehabs and smaller clinics are not equipped to handle complex cases such as a dual diagnosis, which is more difficult to treat than a single condition. Clients often require support from multiple treatment providers in different segments of the healthcare system, which can lead to poor communication, fragmented services, medical errors, and insufficient continuity of care.
If you suffer from co-occurring disorders, you will require an integrated and intensive approach to therapy. The best place for this is an inpatient rehab centre where the stress triggers and distractions of daily life are removed and you can commit your time and energy into building a stronger sense of self-worth as well as better coping mechanisms. Residential rehab also gives you the chance to receive treatment for both conditions at the same time and in the same location, reducing the risk of relapse.
According to the US Substance Abuse and Mental Health Services Administration, the most common cause of alcohol relapse is an untreated underlying psychological condition. Treatment is only effective and long-lasting when both disorders are addressed simultaneously.

Benefits of inpatient rehab

Here are reasons why integrated care lends itself to a residential rehab:
  • Access to medications: such as antidepressants, mood stabilisers and antipsychotic agents to ease withdrawal and mental health symptoms
  • Psychological treatments: such as dynamic psychotherapy, behavioural psychotherapy, or cognitive psychotherapy may be provided individually, as part of a group, or as a family/couple session
  • Removal from distractions: your typical stressors and triggers of daily life will be eliminated completely
  • A range of resources: that provide support for your psychological, medical, physical, and psychosocial needs are available – all in the same location
  • Integrated treatment plans: that encompass detoxification, addiction, and mental health needs
  • Relapse prevention tools: you will learn coping skills and strategies to deal with everyday life triggers and prevent relapse
  • Identifying the root cause: you will have a chance to explore the relationship between your alcohol use and depression, while developing personal recovery goals
  • Bonding experience: there is a strong peer support offering social interaction and connection among clients in inpatient rehab
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Alcohol and depression rehab options in Thailand

As one of the key medical hubs in Asia, Thailand has some of the continent’s best rehab centres. The nation is ranked as the third most popular country in the world for medical tourism, and it offers substantial cost savings for treatment when compared to comparable levels of care in the UK, Canada, or Australia.

Most staff working in such treatment centres come from abroad, where they received a high level of professional training and education. It should also be noted that most alcohol and depression programmes in the country conform to recognised international standards.
By going overseas for your treatment, you can ensure both privacy and focus during your period of recovery. Freed from the distraction of your previous day-to-day routine, you will be able to dedicate your entire attention to learning the skills needed for sustainable improvement.
As part of a comprehensive treatment programme, you may also have the opportunity to experience some of the highlights of Thailand. These include the country’s jungles, remote hilltribe villages, and some of the finest beaches on the planet – as well as Thailand’s unique culture, world-renowned cuisine, and warm hospitality.

If you are considering rehab for alcoholism and depression, we can help. Please contact us at your own convenience for a confidential discussion about how we can support you on your journey to recovery.

Author
Cameron Brown
Psychologist
About the Author
  • DeVido, Jeffrey J, and Roger D Weiss. “Treatment of the depressed alcoholic patient.” Current psychiatry reports vol. 14,6 (2012): 610-8. doi:10.1007/s11920-012-0314-7
  • “What Is Depression?” Edited by Ranna Parekh, Psychiatry, The American Psychiatric Association (APA), www.psychiatry.org/patients-families/depression/what-is-depression.
  • National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help (NIH Publication No.14-7974). The National Institutes of Health. Retrieved from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help
  • “Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, 26 June 2019, www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm.

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