Last Updated on April 16, 2017 by Morris Green

Substance abuse counselors face unique challenges, one of which is how to counsel a depressed substance user. Rooting out abusive habits, addressing addiction and dependency, and coming out on top is tough. Some struggle more than others, especially when depression becomes a factor of recovery.

Depressive symptoms can hit an addicted individual before, during, and even after recovery. For the recoveree who wrestles with depression during the process, saying no to their substance of choice can become nearly impossible. The desire to feel good versus unwell can trigger relapse and suicidal thoughts.

Understanding Depression’s Source

The average healthy person doesn’t like to talk about feelings of despair. According to Medical Daily, about 1 in 10 men have depression or anxiety and do not seek treatment. The LA Times reports that 7.6% of Americans (1 in 13) are depressed, but few seek help.

No one likes to feel sad or hopeless, and the statistics show that hardly anyone will admit to it. Substance users in recovery, attending group counseling, or completing ADETS or Drug Education classes are no exception. In fact, the clients that substance abuse professionals just like you and I see each day have one of the highest risks of developing depression and anxiety because they have abused at least one substance. How can we help?

Some of our clients will be more prone to depression than others. The exact trigger can be as individualized as, well, individuals. But a working knowledge of the most common triggers can pave the way to being on alert:

1. Death, especially of a loved one
2. Previous mental trauma
3. Volatile home or work environment
4. Arguments, especially at home
5. Major life changes like moving or changing jobs
6. Chronic illness, new or not
7. Medications including anti-depressants
8. A family history of depression or depressive symptoms

How to Spot Depression

Recognizing depressive symptoms is imperative because you cannot alter your counseling methods to accommodate your client’s needs without spotting depression if it’s present. Red flags that indicate a problem include:

• A return to alcohol or drug abuse
• Amplified guilt
• Lack of energy
• Suicidal thoughts or talk
• Low self-esteem
• Feeling and acting like life lacks meaning
• Pessimism regarding the future or feeling like things will never improve
• Poor concentration
• Memory difficulties
• Lack of joy in previously loved activities
• Comfort eating or loss of appetite
• Insomnia and irritability
• Aches and pains

Addressing depression is important, but some might be hesitant to recognize it. Be patient, and don’t give up if your initial attempts to discuss the possibility of these feelings is not well received. Avoid pushing the subject while working behind the scenes, as it were, to accommodate their unique makeup.

Treating Depressive Individuals that are in Recovery

Depression will need to be diagnosed so a proper treatment plan can be implemented. A qualified practitioner will need to make the diagnosis. You might find yourself collaborating to implement a viable treatment plan.

Prescription medications are one of the most successful means of treating depressive disorders, both temporary and chronic. An anti-depressant may be prescribed and monitored by a qualified physician or psychotherapist. Finding a medication that works will be the challenge. A period of trial and possibly error will ensue as a prescription with the desired impact is found. It can take several weeks on a single drug before results are seen.

Some anti-depressants are categorized as narcotics and can be addictive. For people with substance addiction issues, the use of such medications may pose a threat to their recovery. Alternatives to narcotic anti-depressants are available and should be discussed with the attending physician or psychotherapist.

Psychotherapy may be an effective treatment. Known as the “talking cure,” it is often combined with the prescription medication approach. The added benefit is active education and the discovery of coping strategies.

Counseling Substance Abusers Suffering From Depression

Perhaps one of the toughest challenges faced by substance abuse counselors is determining what came first, the depression or the substance abuse. The answer to this dilemma can dramatically impact how a substance abuse disorder is treated.

For example, for someone suffering from PTSD induced depression, the need to escape negative feelings might have led to substance abuse. Treating the root of the problem will ultimately prove to be the most effective approach.

But how do you counsel a substance abuser who is coping with depression? Here are a few tips you can use:

1. Don’t draw attention. Spotlighting is never a good idea. Don’t draw undue attention to a client’s depression. If they know it’s there, and you do too, no one else is in the need-to-know, aside from their medical team. Don’t put them on the spot during counseling or class.
2. Be honest and empathetic. False encouragement and reassurances are torture to a depressed individual. Avoid making empty promises. It may be tempting to say, “It will all be okay,” but you can’t guarantee it. Focus on empathy. See the world through their eyes and work to reduce frustration, irritability, and impatience.
3. Don’t judge. Substance abuse services are only successful in a judgement-free zone. Depression is just as much an illness as substance abuse and addiction. It’s not a choice your client makes. Don’t criticize, judge, or belittle.
4. Spark inspiration. People burdened by depression are tired. They lack motivation because they are burnt out. You can actively help relight their flame for life by offering solutions. Help them find and attain the resources they need to get help, rediscover enthusiasm, and retake their decision-making facilities.

According to the American Addiction Centers, some of the most successful and effective research-based interventions for depression include cognitive behavioral and family systems therapy. The combination of substance abuse and a depressive disorder demand a treatment plan that considers the client’s symptoms while simultaneously addressing their addictive behavior.

Depression should never be ignored, especially when in recovery. If you suspect a client is battling feelings of hopelessness and despair, don’t delay in addressing it. Your action could help prevent a relapse or even save their life.