Like many young men at college, Doug felt that drinking was part of the culture—part of growing up and becoming an adult. While he had suffered from problems with both depression and anxiety when he was in high school, he felt he was far beyond them by the time he got into his first choice university. He was ready to enjoy the full college experience.

“There was a lot of drinking. At first, it didn’t seem like such a big deal to have a beer to celebrate Halloween or the end of finals. There was always some reason to ‘celebrate,'” he says, using finger quotes to accentuate the word celebrate. “But soon, it wasn’t just a beer. It was a lot of beers. And I wasn’t celebrating. I was coping. And all of a sudden, I realized that I was drinking way too much just trying to get a handle on all my stress and mood problems.”

He’s not alone in that experience. November brings about the beginning of the holiday season which consists of family gatherings and social parties – and, for many like Doug, a lot of alcohol-related “celebration.” But is it always just celebration? For some, all that drinking and substance abuse can be more sinister.

According to the Anxiety and Depression Association of America (ADAA), nearly 20 percent of Americans who have been diagnosed with an anxiety or mood disorder also have issues with alcohol or drug abuse. And just having a mental health disorder like depression makes an individual two to three times more likely to have problems with substance abuse than someone without that condition. With his past issues with depression and anxiety, Doug, for multiple reasons, was a prime candidate for substance abuse issues. In fact, the prevalence of depression and substance abuse is typical enough that many mental health practitioners simply refer to it as “dual diagnosis.”

So how are these two disorders, both disabling in their own right, connected?

It presents a bit of a chicken-and-egg problem. Many individuals who are suffering from mood or anxiety disorders “self-medicate,” or use alcohol and/or drugs to help alleviate symptoms like social anxiety, depressed mood, irritability, and sleep issues. Doug would fit into that category. And certainly, some studies suggest that mental health issues can predict later problems with drugs and alcohol.

But it would seem that individuals may develop such a “dual diagnosis” in the opposite manner, as well. Many individuals who abuse drugs and alcohol, over time, start to develop mental health symptoms. And many researchers hypothesize that the chronic use of those substances make critical changes to the brain’s emotion and motivation centers that can affect mood and mental health. Even with his past history, a few too many “celebrations” may have made subtle changes to Doug’s brain and made a depressive episode more likely.

It’s likely that this menacing co-morbidity works both ways. Which is why, most experts agree, that any effective treatment must focus on both conditions—and respect the strong connection between them. Some also suggest that clinicians who work with depressed or anxious adolescents carefully explain the probability and dangers of this “dual diagnosis” as part of regular treatment.

It’s important to understand that the combination of depression and substance abuse is very common. But it is also treatable. If you or a loved one needs help, SAMHSA offers an online toolkit with important treatment and support resources. Doug will tell you that it is not easy to recover from a “dual diagnosis,” but it is possible.

“I learned, for me, depression and drinking go hand in hand,” he says. “So now I find other ways to celebrate my accomplishments. So I’m, you know, really celebrating them and not putting my mental health at risk.”

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