Rehab 4 Addiction

Many individuals meet the diagnostic criteria for a substance use disorder and one or more mental disorders simultaneously.

Dual diagnosis is the psychiatric term used to describe such cases, though it is sometimes referred to simply as a co-occurring disorder.

Overcoming the myriad challenges associated with addiction can be a crippling ordeal on its own, and is significantly worsened by the presence of a co-occurring mental disorder such as depression.

Due to its stimulating and euphoric effects, cocaine is one of the most widely found substances involved in dual diagnosis.

Dual diagnosis is a much more common issue than most people realise.

The statistics

The statistics

Those who have a mental health disorder have a twofold higher chance of suffering from a substance use disorder than the general population.

Similarly, individuals who regularly use drugs or alcohol are significantly more likely to develop a co-occurring mental health disorder.

It is estimated that 45% of people with a substance use disorder have also received a mental health disorder diagnosis. Similarly, up to 50% of people with mental disorders are also affected by substance abuse.

For instance, in the United States almost 20% of people diagnosed with a mental health disorder have a co-occurring substance use disorder.

Research indicates that the high prevalence of dual diagnosis may be due to:

Depression is one of the most common mental disorders today.

Many people with depression experience severe impairments that negatively interfere with their ability to function normally in day-to-day life.

Sadly, prevalence rates of depression have been continually on the rise.

In 2019, just under 20 million people over the age of 18 in the United States experienced at least one major depressive episode, representing 7.8% of all adults in the U.S.

People with depression often abuse and become addicted to cocaine, a highly addictive psychomotor stimulant drug.

In fact, stunning research from the National Bureau of Economic Research reports that people who have been diagnosed with a mental illness at least once in their lifetime consume 84% of cocaine in the United States.

The question of what comes first, the addiction or the depression, has been the centre of much scientific research and debate.

How to recognise dual diagnosis


In cases of dual diagnosis, both depression and cocaine addiction have their own unique symptoms.

Interestingly, these separate yet often related disorders also share some overlapping symptoms, which may cause confusion and/or uncertainty during psychiatric evaluations, in terms of correctly identifying appropriate diagnoses.

For instance, if we look at some of the signs and symptoms of cocaine addiction and compare them to those of depression, we can see how medical professionals may experience some difficulty distinguishing between the two in the absence of unique symptoms.

It is natural and quite common for people to be hesitant about admitting how frequently they use cocaine and/or experience symptoms associated with depression.

Individuals may be in denial regarding their level of drug abuse, or worried about distressing psychological symptoms, downplaying their significance as a consequence.

Signs and symptoms of cocaine use disorder 

  • Feelings of agitation if cocaine use reduced
  • Disregarding personal responsibilities and relationships
  • Lying to or manipulating family members and friends
  • Reckless behaviour
  • Increased impulsivity
  • Inability to experience pleasure
  • Damage to the nose
  • Damage to the cardiovascular system
  • Damage to the liver
  • Depression
  • Mood swings
  • Suicidality
  • Hypertension
  • Insomnia
  • Physical pain

Signs and symptoms of depression 

  • Loss of interest in hobbies and daily activities
  • Disregarding professional, familial, educational, or other personal responsibilities
  • Reckless behaviour
  • No appetite
  • A sense of helplessness
  • Feelings of hopelessness, worthlessness and/or despair
  • Inability to experience pleasure
  • Irregular sleeping patterns
  • Poor concentration
  • Irritability
  • Physical pain
  • Suicidality

Interaction and mutual influence

Cocaine use

To make things more difficult for clinicians, and the individual in question, the increasing severity of one disorder will exacerbate the other.

If a person with depression does not receive sufficient treatment, their cocaine addiction will most likely get worse. If their cocaine addiction becomes more severe, depression scores will typically increase.

That said, there are some warning signs for clinicians to watch out for that may help with the issue of overlapping symptoms to prevent misdiagnosis.

The use of cocaine for the following reasons may be indicative of co-occurring depression:

  • To cope with traumatic memories or unpleasant feelings
  • To manage pain
  • To get by anxiety-inducing/uncomfortable situations
  • To stay focused on tasks

The following questions may also help clinicians and concerned loved ones to identify co-occurring depression:

  • Does the patient get depressed after a cocaine binge?
  • Does the patient use cocaine when they experience anxiety?
  • Has a family member suffered from depression?
  • Does the patient feel depressed when sober?
  • Has the patient previously received treatment for cocaine use or a mental health issue?
  • Was previous treatment for cocaine use unsuccessful because of mental health complications, or vice versa?

What comes first?


In addition to the challenge of distinguishing between depression and cocaine addiction, clinicians and researchers often experience considerable difficulty in establishing which disorder came first.

Depression is a mental disorder that is frequently co-occurring with substance use disorders.

In particular, cocaine use often co-occurs with depression.

However, this does not necessarily mean that one is caused by the other.

The relationship between depression and cocaine use disorder is bi-directional.

This means that people who abuse cocaine are more likely to suffer from depression, and people with depression are more likely to use cocaine.

Because cocaine has energetic effects and an ability to induce intense euphoria, people with depression may use this substance to improve their mood, or as a means of escaping from distressing negative emotions.

On the other hand, cocaine addiction can either exacerbate existing depression or increase the likelihood of developing depression.

Continued abuse of cocaine can lead to the development of a tolerance whereby an individual requires increasing quantities of the substance to reach a satisfying state.

Cocaine increases the amount of dopamine in the brain, a neurotransmitter that allows people to feel pleasure, satisfaction and motivation.

Eventually, the brain of a regular user will begin to lose its ability to effectively regulate the secretion and reuptake of dopamine.

As a result, cocaine-addicted persons come to depend on the drug to experience pleasure.

Dual diagnosis treatment


Co-occurring disorders deteriorate if they don’t receive the required treatment.

Unfortunately, over 50% of people diagnosed with co-occurring depression and cocaine addiction never receive treatment for either disorder.

It is vitally important that individuals with dual diagnoses find an integrated treatment programme that addresses both addiction and depression as interrelated conditions.

Although relapse occurs quite often, patients give themselves the best possible chance of making a full recovery when both depression and substance use are treated simultaneously.

Integrated treatment is considered the gold standard of care for the treatment of dual diagnosis, and is associated with numerous benefits and positive outcomes.

The combination of substance use disorder and a depressive mood disorder can cause considerable stress and requires the assistance of both mental health professionals and addiction experts.

Integrated treatment at a residential rehab is highly recommended, as patients can avail of expert medical care and attention in a structured, safe setting, and are guaranteed treatment that addresses their specific presentation.

Research indicates that patients who attend integrated treatment programmes in residential rehab are more likely to maintain sobriety, see a significant reduction in depressive symptoms, be hospitalised less, and enjoy enhanced independence.

Integrated treatment programmes should:

  • Have expertly trained medical professionals with experience addressing various substance use and mental health disorders
  • Allow patients to be involved in the decision-making process and goal setting
  • Provide education on each patient’s specific diagnosis
  • Provide medically-assisted detox
  • Provide psychiatric medication
  • Offer a variety of therapy modalities
  • Teach patients psychological skills that will help them to eradicate substance use from their lives and improve their mental health
  • Provide aftercare support

When seeking treatment for dual diagnosis, patients may initially require medically-assisted detox to effectively address cocaine withdrawal symptoms.

A period of abstinence may be necessary before mental health professionals can provide appropriate treatment.

It is important that patients do not attempt to quit “cold turkey” by themselves, as this is likely to worsen the individual’s mental state. 

Research supports the efficacy of various therapeutic modalities for the treatment of dual diagnosis. Integrated cocaine treatment programmes offer a wide range of evidence-based therapeutic techniques, including:

In addition to therapy treatment, antidepressant medications such as selective serotonin reuptake inhibitors (SSRI) can be effective in reducing depressive symptoms.

Research suggests that antidepressant medication is more effective when taken in conjunction with therapy.

Recovering and moving on

moving on

Living with co-occurring disorders can be incredibly challenging to navigate.

However, the way we approach treating these disorders has improved greatly in recent years.

Modern, efficacious, evidence-based treatment programmes now mean that it is possible for individuals to not only learn how to successfully manage debilitating disorders but also how to make a full recovery and continue flourishing in life.



Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline.