Depression and Substance Use: Signs Families Should Know and Treatment

Written by the medical team at Day One Rehabilitation Center, Nakhon Nayok, Thailand · Medically reviewed by Dr. Pichayut Kasemphakdeephong (Psychiatrist)

Depression isn’t just feeling sad or upset for a while — it’s a condition in which mood, thoughts, motivation, sleep, eating, and the ability to function change continuously, to the point that it can affect school, work, relationships, and self-care.

When depression occurs alongside substance use, the problem tends to become more complex. Some people start using alcohol, cannabis, sedatives, or other substances trying to feel better, fall asleep more easily, stop their thoughts, or escape from distress, while others begin to develop depressive symptoms after continued substance use or during withdrawal.

It shouldn’t be concluded right away that “the depression is because of the drugs” or “the drug use is because of the depression,” because both problems can come first, come afterward, and affect each other. Appropriate treatment therefore needs to assess both the depressive symptoms and the pattern of substance use, in order to understand what’s keeping the symptoms going and what should be treated together.

What does depression look like when it occurs alongside substance use?

People with depression don’t necessarily cry or look sad all the time. Some show it as fatigue, numbness, irritability, not wanting to talk to anyone, or losing interest in activities they used to enjoy. Families may therefore assume the person is lazy, irresponsible, or not trying, even though these changes may be part of the illness.

Signs to watch for include

Feeling sad, down, or empty for a sustained period
Losing interest in or no longer enjoying things they used to like
Getting tired easily, having no energy, and not wanting to do things
Sleeping too much, being unable to sleep, or waking at unusual times
Losing appetite or eating noticeably more than before
Reduced concentration, slower thinking, or difficulty making decisions
Feeling guilty, worthless, or like a burden
Withdrawing from family and friends
Declining performance at school or work
Becoming easily irritated, especially in teenagers and certain groups
Neglecting self-care
Using more alcohol or other substances to manage emotions
Feeling hopeless, or having thoughts or behaviors of self-harm

Many of these symptoms can also result from the direct effects of a substance or from withdrawal — for example, insomnia, lack of energy, irritability, loss of appetite, reduced concentration, or low mood. So finding these symptoms in someone who uses substances doesn’t mean depression can be diagnosed right away.

A psychiatrist will consider the history of symptoms before substance use began, the type and amount of substance used, the timing of when symptoms appeared, changes after stopping the substance, and any prior psychiatric history, in order to distinguish depression from mood symptoms related to the substance as clearly as possible.

Why do depression and substance addiction occur together?

For some people, depression develops before substance use. When feeling sad, lonely, unable to sleep, or caught in repetitive thoughts, drinking alcohol or using a substance may bring temporary relaxation or relief from distress, leading to a learned pattern of turning to the substance whenever things feel bad.

This pattern is called self-medication — using a substance to relieve emotional symptoms on one’s own. People who do this may not intend to become addicted, but may feel the substance helps them stop thinking, fall asleep, feel brave enough to talk to others, or avoid facing sadness and stress at that moment.

However, substances don’t treat the underlying cause of depression, and the improvement they provide is usually only temporary. Once the effect wears off, mood may drop even lower, or anxiety, irritability, insomnia, and guilt may follow. Using the substance more, or more often, to recreate that same sense of relief can lead to problems with sleep, finances, work, relationships, and health, which in turn increases stress further and makes the depression more severe.

A cycle can form in which feeling sad or stressed leads to substance use; the substance use causes harm, which brings more guilt and hopelessness; and the person then uses the substance again to avoid feeling that distress. Understanding this as a self-medication cycle helps families see that substance use may be both a problem and a way the person is coping with distress they already have, even though that method makes the problem worse in the long run.

In another group, substance use comes first. Certain substances can change mood while they’re active or after their effects wear off, especially stimulants like yaba, crystal meth (ice), or cocaine — a period of intense brain stimulation can be followed by fatigue, lack of energy, excessive sleep, low mood, and a lack of desire to do anything.

Alcohol can also make depressive symptoms more complicated. Even though some people drink because they believe it helps them relax or sleep more easily, continued drinking can disrupt sleep quality, emotional control, and decision-making.

For this reason, treatment needs to work out how the two problems relate to each other in each individual, rather than assuming everyone shares the same underlying cause.

Co-occurring depression and substance use: what signs mean a family should seek help right away?

Someone with both depression and substance use should have their safety seriously assessed, because during intoxication, withdrawal, or a period of severe low mood, the ability to control impulses and make decisions may be reduced.

Families should take it seriously if the person starts saying they don’t want to go on living, feels like a burden, sees no way out, gives away important belongings, says unusual goodbyes, withdraws further, rapidly increases their substance use, or shows thoughts or behaviors of self-harm.

These statements shouldn’t be dismissed as just seeking attention, and the person shouldn’t be left alone in a situation assessed as high risk. They should be brought in for a medical evaluation as soon as possible.

If there is confusion, loss of consciousness, abnormal breathing, seizures, overdose, or immediately dangerous behavior, emergency services should be used — the situation should not be left to improve on its own at home.

How is depression treated when it occurs alongside substance addiction?

Treatment shouldn’t aim for “quit the drugs completely first, then treat the depression” for everyone, because if depression is one of the factors driving the person back to substance use, leaving it untreated can make recovery harder.

On the other hand, treating depression alone without addressing the substance use can also disrupt continuity of care, so both should be planned for together, based on the severity and needs of each individual.

Assessing symptoms after the substance wears off and during withdrawal

In the early stages, the treatment team will assess the type of substance, frequency, amount, duration of use, use of multiple substances together, and the timing of when depressive symptoms began.

This information helps distinguish which symptoms may be related to the substance’s effects or withdrawal, and which are more likely to represent co-occurring depression. Ongoing monitoring after stopping the substance is therefore more important than a single assessment made while still under its influence.

If the substance is one where stopping suddenly can be dangerous, such as alcohol or certain sedatives, a medical evaluation and a safe withdrawal plan are needed — severe withdrawal symptoms shouldn’t be managed alone.

Using antidepressant medication when clinically indicated

Antidepressants are one approach to treating depression. A psychiatrist will consider whether medication is necessary based on the severity of symptoms, treatment history, physical health conditions, substances used, and other medications being taken.

Antidepressants don’t improve mood immediately after one or two doses, and the response to medication varies from person to person, so progress needs to be monitored and treatment adjusted based on symptoms.

People in treatment shouldn’t stop, increase, or reduce their medication on their own when they feel better or experience side effects — they should tell their psychiatrist so the approach can be reassessed.

Another important point is that before starting treatment for depression, a psychiatrist may assess whether there’s a history of abnormally elevated mood, sleeping little without feeling tired, talking a lot, racing thoughts, spending large amounts of money, or unusually risky behavior, because these symptoms may point to bipolar disorder, which has a different treatment approach from depression.

Treating the thoughts, emotions, and substance-use behavior

Therapy helps the person in treatment see the connection between their emotions and their substance use, such as

“When I feel worthless, I want to drink so I don’t have to think.”

“After arguing with people at home, I usually go back to using because I don’t know how else to handle the feeling.”

Once these cycles become clearer, treatment helps build new ways of coping — managing negative thoughts, planning activities for days with no energy, asking for help when mood drops, managing conflict, and coping with cravings without acting on them immediately.

For those who aren’t yet sure whether they want to quit the substance, motivational conversations can help explore both what the person feels the substance helps with and the harm it’s currently causing, without blaming or forcing an immediate change.

Restoring sleep, routine, and relationships

With depression, a person may feel they don’t have enough energy to do anything, so simply saying “think positive” or “go do something” usually isn’t enough. Recovery should start with realistic goals — waking at roughly the same time each day, showering, eating, going for a walk, doing short activities, and gradually adding activities that feel meaningful.

Sleep matters a great deal, because both depression and substance use can disrupt the sleep cycle. Adjusting sleep schedules is therefore part of treatment, not just a matter of discipline.

Families themselves should receive guidance on communication and boundaries, because helping doesn’t mean taking over every responsibility or giving money that might be used to buy substances — it means supporting the person in getting treatment and gradually taking back responsibility for their own life as they’re ready.

What should families do when someone has both a substance problem and depression but won’t admit it?

Saying “you’re like this because of the drugs” or “quit first and everything will get better on its own” can make the other person feel their distress isn’t being understood, especially if they feel they’re using the substance because they’re already suffering.

Families should start with what can be observed, such as: “This past month I’ve noticed you’re barely sleeping, not leaving your room, and haven’t gone to work for several days. I’m worried you’re exhausted.”

You might then ask, “What’s been the hardest thing for you lately?” “What did using help with in the moment?” or “Has anything happened after using that’s made life harder?”

Asking in this way doesn’t mean agreeing with the substance use — it helps the person talk about their own reasons without immediately needing to be defensive. Once cooperation starts to build, it can lead into an evaluation of both the mood and the substance use.

If the person isn’t ready for treatment yet, the family can consult a specialist first, to assess risk, set boundaries, and prepare ways to talk that reduce confrontation.

Treating depression and substance addiction at Day One Rehabilitation Center

People with co-occurring depression and substance addiction should have both problems addressed in a connected way, because low mood can be a trigger for returning to substance use, while the effects of substance use can worsen sleep, mood, relationships, and the ability to function.

At Day One Rehabilitation Center, the treatment team assesses the type and pattern of substance use, withdrawal symptoms, mood, sleep, risk of self-harm, psychiatric treatment history, and related life problems, before planning treatment suited to each individual.

Residential treatment helps the person in treatment separate from the substance and its triggers in the early stages, provides clear structure for daily life, and allows for continuous monitoring, including evaluation by a psychiatrist, medication when indicated, individual therapy, group therapy, craving management, sleep restoration, and building new routines.

Being in a substance-free environment also lets the treatment team observe how mood changes once the substance’s effects and withdrawal have passed, which helps clarify the problem and plan the next stage of treatment more precisely.

Not everyone with depression and substance use needs residential treatment. If symptoms aren’t severe, the person can stop using the substance, safety is not a concern, and there’s a supportive environment, outpatient treatment may be more suitable. But if there’s been repeated relapse, severe low mood, significant disruption to daily life, safety concerns, or a current environment that makes stopping the substance difficult, residential care may be a better option to consider.

Frequently asked questions about depression and substance use

Does becoming depressed while using drugs mean it’s clinical depression?

Not always. Low mood can come from depression itself, the direct effects of a substance, the period right after its effects wear off, withdrawal, or several factors combined. History should be assessed and symptoms tracked after stopping the substance before concluding the cause.

Are people with depression more likely to develop a substance use problem?

Depression can occur alongside substance use problems. Some people use substances trying to reduce sadness, stress, loneliness, or sleep problems, but using substances to manage emotions can develop into a cycle that worsens both the substance use and mental health.

Can yaba and crystal meth (ice) cause depression?

After using stimulants like yaba or crystal meth (ice), some people may experience a period of low mood, fatigue, lack of energy, excessive sleep, or loss of interest in things — especially after continued use. These symptoms can resemble depression, so they need to be tracked and evaluated together with the substance use history.

Does drinking alcohol when feeling sad help?

Alcohol may create a temporary feeling of relaxation or relief from distress, but it doesn’t treat depression, and it can disrupt sleep, emotional control, and decision-making, making treatment more complicated.

For someone with both depression and a substance use problem, which should be treated first?

It doesn’t have to be one or the other. In many cases, depression and the substance use problem should be treated together, with priority set based on safety, withdrawal, the severity of the illness, and each person’s physical condition.

Can antidepressants help someone quit drugs?

Antidepressants treat depression when there’s a clinical indication for them — they aren’t a medication that directly helps someone quit any and all substances. Treating substance use also requires considering the specific substance, therapy, craving management, and relapse prevention.

If a family member is depressed and says they don’t want to go on living, what should we do?

This should be taken seriously, and safety should be assessed as soon as possible — especially if there is co-occurring substance use, thoughts or behaviors of self-harm, or an inability to care for oneself. The person shouldn’t be left to face a high-risk situation alone, and should be brought in for a medical evaluation.

If residential treatment isn’t yet an option, the family or the person experiencing symptoms can start by consulting a specialist about depression and substance use at Piti Clinic, our outpatient mental-health clinic in Bangkok (Pradiphat Road, Saphan Khwai), to assess symptoms, risk, and the appropriate treatment approach before deciding on the next form of care.

Depression and substance use can be treated together

When a family watches someone who used to function normally gradually withdraw, lose energy, stop wanting to do things, sleep at irregular hours, and use substances more, it’s easy to feel unsure where to start. What matters is that no one has to figure out on their own, before seeking help, whether depression or substance use came first.

A proper evaluation will clarify how the two problems relate to each other, and from there, a plan can be made for safely stopping the substance, treating the depression, addressing thoughts and emotions, restoring sleep, and preventing relapse.

The goal isn’t only to stop substance use or improve mood temporarily — it’s to help the person in treatment regain the ability to care for themselves, build relationships, function in life, and cope with hard days without needing to turn back to a substance.