Opioid Addiction: Managing Depression During Long-Term Recovery

Man struggling with Opioid Addiction

Depression and opioid abuse are common among all age groups. Through recent research new findings have emerged about the connection between depression and opioid addictions.

Being able to manage your long-term recovery from both struggles is a process and can be managed with a mix of therapies, treatment, and aftercare support.

Opioids Role in Depression

In a study conducted by St. Louis University, over 100,00 individuals from the Veterans Health Administration and two private hospitals were studied for opioid abuse and comorbid disorders.

The study found that 10% of the 100,000 individuals developed depression after opioid use for 30 days or more [1]. Interestingly enough, none of the patients had a prior diagnosis of depression and all were consistent across all three treatment settings.

The research lead believes that depression can be onset with opioid use due to changes in the reward and pleasure areas of the brain, as well as lower testosterone levels due to opioid ingestion.

There is no debating that opioid abuse and addiction have become a fast and furious epidemic within the United States. Opioid prescribing has contributed to 183,000 people dying from overdoses between 1999 and 2015 according to the Centers for Disease Control [2].

Almost 37 million Americans with mood disorders are using opioids to help manage symptoms, compared to 5% of the general population [2]. This equates to about 60 million prescriptions annually for individuals with a mood disorder-a startling number.

Opioids may have a short-acting anti-depressant property to it, luring individuals with a mood disorder to seek prescriptions from their primary physician.

Importance of Treatment

Both mood disorders and addiction can be treated concurrently. Often relapse occurs due to one co-occurring issue affecting the other.  It can be difficult to reach or maintain recovery if only the addiction or mood disorder is being treated [3].

Shoes standing on a step

Effective and comprehensive treatment is imperative and needs to include medical detoxification to manage withdrawal symptoms from the opioids.

A full evaluation and assessment to identify all risk-factors, medical, behavioral, and mental health comorbidity for best care and treatment.

Individualized treatment goals and a solid treatment plan should include traditional therapies, alternative therapies, holistic care, support and therapeutic groups for long-term skill building and support.

Medications may also be necessary but strictly monitored especially if there is a concern about prescription medication abuse or misuse.

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Multiple Treatment Options for Long-Term Recovery

Dual diagnosis is when a person is struggling with a drug addiction and mental health disorder. Over 10 million Americans suffer from a severe mental illness, and 8.2 million have a co-occurring disorder [4].

A common occurrence is individuals struggling with opioid addiction and depression. In 2015 it was estimated that there were enough opioids prescribed in the United States alone, for every American to be medicated 24 hours a day for three weeks [4].

Opioids can change the brain’s chemistry and hormone levels which may lead to depressive symptoms. With continued opioid use and abuse, the symptoms can worsen and can remain even if the addiction has ceased.

Around 40% of individuals receive treatment for either disorder and about 5% access treatment for both addiction and mood disorder [4].

Therapies such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT) are highly effective for treating both issues. Using traditional therapies with more holistic ones such as animal therapy, mindfulness, art, and expressive therapies can aid in long-term recovery coping skills and support plan.

CBT works to identify and counter negative thoughts, feelings, and behaviors due to depression and addictions. DBT can work to help understand emotions both cognitively and physically. It works by using mindfulness and learning how to manage self-destructive behaviors.

Holistic therapies such as meditation, yoga, nutrition, meal planning and self-care skills can help empower individuals to gain internal control over self.

Struggling with opioid abuse and depression can be bidirectional and means that when someone suffers from one, it increase the risk of the other. Often those using opioids may turn to heroin use as it can be cheaper and easily accessed.

Heroin, also an opiate, is incredibly addictive, with one-fourth of users becoming addicted to heroin [5]. Feelings of hopelessness, despair, and guilt are often a part of depression, and up to 35% of those who abuse opioids are at a higher risk of suicide.

Signs of Addiction and Mood Disorders

Signs of depression can include increased fatigue, muscle weakness, chronic pain, lack of interest in activities, and isolation from friends. Often there are changes in sleep patterns, eating habits with weight loss or gain.

Man looking at his watch

Many individuals will report feelings of guilt or despair and lack of energy as well when suffering from depression. Signs of opioid addiction may include taking an increasing amount of drugs to feel the same effect and having difficulty cutting back or stopping drug use.

The opioid-addicted individual may spend an excessive amount of time trying to gain access to, using, or recovering from the drugs. They may have strong urges or cravings to use opiods again.  They may fight rapid, all-consuming thoughts of using oxcontin, oxycodone, etc. again.

Continued drug use causes issues in multiple life areas such as social, occupational, educational, and interpersonal relationships.

Comprehensive Treatment

Comprehensive treatment is available for both depression and opiate abuse [5]. Medication can help with withdrawal effects and dependence, coupled with antidepressants to help with mood disorder symptom management.

Inpatient and residential treatment is the first line of treatment when working on long-term recovery. Often the first step is detoxification and continues with peer and support groups, individualized counseling and medical assistance and support.

Recovery and healing are possible from both mood disorder and opioid abuse. Being able to reach out for treatment and continued aftercare support is essential in the recovery process.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Long Term Opioid Use May Cause Depression. (2016, January 14). Retrieved October 22, 2017, from https://www.painnewsnetwork.org/stories/2016/1/14/long-term-opioid-use-linked-to-depression
[2] 51 percent of opioid prescriptions go to people with depression and anxiety. (2017, June 26). Retrieved October 22, 2017, from https://www.statnews.com/2017/06/26/opioids-depression-anxiety/
[3] Depression and Opiate Addiction: The Connection. (2016, July 28). Retrieved October 22, 2017, from https://www.greenhousetreatment.com/blog/depression-and-opiate-addiction-the-connection/
[4] Dual Diagnosis: Treating Depression and Opioid Addiction. (n.d.). Retrieved October 22, 2017, from https://lifeskillssouthflorida.com/dual-diagnosis-treating-depression-and-opioid-addiction/
[5] Depression and Opioid Abuse: How Painkillers Affect Your Mental Health. (n.d.). Retrieved October 22, 2017, from https://www.psycom.net/depression.central.opioid.abuse.html

The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Published on January 2, 2018
Published on AddictionHope.com

About Jacquelyn Ekern, MS, LPC

Jacquelyn Ekern founded Addiction Hope in January, 2013, after experiencing years of inquiries for addiction help by visitors to our well regarded sister site, Eating Disorder Hope. Many of the eating disorder sufferers that contact Eating Disorder Hope also had a co-occurring issue of addiction to alcohol, drugs, and process addictions.