iStock_000004241123XSmallThis case involved a 28 year old man who attempted suicide a little more than a year into recovery. It’s clear the attempt was deliberate, and it was only by a miracle that he was found and revived.

His problems began in elementary school, mostly related to conduct and ADHD. The family was able to provide the best in psychological care, the latest meds, access to special schooling. Results were mixed. At age 12 he began experimenting with marijuana, then gradually introduced other, harder drugs. His developmental problems seemed to fade in importance in the wake of concern about his escalating substance dependence.

As a young adult there were multiple treatment episodes. The year prior to his suicide attempt represented his longest period of recovery. No clear crisis precipitated the act — just an acknowledgment of continuing profound unhappiness.

This is not an unfamiliar story. An addict hoped that recovery would bring lasting relief from depression. When it didn’t, the disappointment must have been overwhelming. For years people had been after him to stop using — and in those terms, he was now officially a success.

Except he was still depressed.

Given a history of adjustment problems since childhood, this probably shouldn’t have come as a surprise. It’s likely his addiction masked another disorder that emerged again in its absence. That’s a rule of thumb for identifying a co-occurring mood disorder: the substance use has finally stopped, yet the depression persists. Or perhaps grows worse.

There’s plenty of evidence that treatment for depression works, and that people with co-occurring disorders can and do get a whole lot better. Some improve faster than others. Given the chance, medication and other therapies are effective, even with very difficult cases.

But if the patient expects recovery to have ‘fixed’ it — that can be a problem in itself.

It works in reverse, too. Many alcoholics seek psychotherapy in the hope that it will somehow ‘cure’ their drinking problem. This is not usually a successful strategy. It’s when the patient begins to regard substance use and depression as co-disorders — both in need of treatment and each capable of impacting the other, for good or ill — that results seem to improve.



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