Addiction and Depression: What Comes First?

The recent story about the ex-footballer Clarke Carlisle and his arrest for drink driving, after suffering heavy gambling losses in a casino, followed by a suicide attempt has brought to widespread attention two syndromes that treatment providers, like us at The Providence Project, have been aware of for some time. The first is the problem of cross-addiction and the second is the link between addiction, whether that be to alcohol or another substance or to a type of behaviour, and depression.

Addiction and depression are deeply intertwined, with research revealing substantial comorbidity between the two conditions. Approximately 40-60% of individuals with a substance use disorder (SUD) also experience major depressive disorder (MDD) at some point in their lives. This significant overlap often arises from shared neurobiological pathways and environmental stressors.

For instance, changes in the brain’s reward system, particularly involving dopamine and serotonin pathways, are common to both conditions, creating vulnerabilities. Some individuals may use substances like alcohol or opioids to self-medicate depressive symptoms, while others develop depression as a result of the neurochemical imbalances caused by chronic substance use. These intricacies emphasise how each disorder can exacerbate the other, trapping individuals in a destructive feedback loop.

Understanding the shared mechanisms of addiction and depression is critical for developing effective treatment approaches. Both conditions disrupt circuits responsible for regulating mood, stress response, and reward processing. Chronic stress or trauma, especially during developmental stages, further increases the risk of comorbidity by altering these neurobiological systems.

Current treatment models emphasise the need to address both disorders simultaneously to improve outcomes. Comprehensive approaches that integrate pharmacological interventions, such as antidepressants or medication-assisted treatments for addiction, alongside behavioral therapies like Cognitive Behavioral Therapy (CBT), can help address these overlapping issues. Studies suggest that this dual-focused treatment not only alleviates symptoms but also reduces relapse rates, highlighting the importance of interdisciplinary care strategies for managing these complex conditions.

Put quite simply cross-addiction happens when one form of addiction leads to another. Francis Rossi, the lead singer of the hugely successful band Status Quo, said during an interview on BBC recently “…it was definitely alcohol that led me to cocaine. I would never have touched it otherwise.” Clarke Carlisle has admitted that he had problems with both alcohol and gambling and it is not important to consider which came first, both must be dealt with. At our treatment centre we have seen many people who come to us admitting one problem but genuinely unaware of the existence of other addictive issues. We have seen people struggling with an alcohol addiction who are shocked when therapy reveals how their addiction is present in their gambling, sexual behaviour, shopping or eating patterns. For this reason we have a very careful and detailed assessment process prior to admission and we are constantly aware to look out for these patterns throughout the period of treatment.

We do not intend to try and diagnose the level of Clarke Carlisle’s depression, nor the most appropriate treatment for it but we do know just how common depression is among the men and woman who come to us looking for help with their alcohol problem. The chicken and egg question they often ask themselves is, am I depressed because of my alcohol problem or do I drink because I am so depressed? We are only concerned to deal with the problem, first by removing the dependency on alcohol and then by dealing with the causes of the problem. If a client is on any anti-depressant medication our highly experienced medical team will continue to monitor the prescription throughout treatment.

The Providence Project has delivered a successful programme of rehabilitation for over 25 years and we are aware that the problem we are presented with is often just part of something much deeper. We have one of our professional and highly qualified counsellors available to speak to you in strictest confidence if you or a loved one could be in need of our help.