Depression & Substance Use
Some people use to feel anything. Some people use to feel less. Both directions are real, and both are ways the depression has been negotiating for you. We work with both.
The link between depression and substance use is so common it's almost a default — particularly with alcohol and cannabis, which are both nervous-system depressants and often deepen the very thing they were used to soften. Treating either alone, without the other, has a worse outcome than treating both together. That's how we work.
What this can feel like
- The drinking, the smoking, the using is the only reliable break in the day. Without it, the day is too long.
- You can't tell anymore whether you're depressed because you drink, or you drink because you're depressed.
- Mornings are heavy. You've stopped trying to schedule things before noon.
- The list of things you used to like has been quietly shrinking for two years.
- You've thought about disappearing — not actively, but persistently — and you've never quite said it out loud.
- You've tried medication once and it "didn't work" — but you were drinking through it and never told the prescriber.
If you are having thoughts of suicide right now, please call or text 988. We are an outpatient practice and not an emergency service.
How therapy can help
The two most evidence-supported approaches for depression are Cognitive Behavioral Therapy and Behavioral Activation — both of which translate well to a co-occurring substance picture. Behavioral Activation, in particular, is structurally honest about how depression works: small acts that you don't want to do, done anyway, build the energy that the depression has been hoarding.
For some clients, antidepressant medication is part of the picture. We coordinate with prescribing providers, and we always factor active substance use into medication conversations — many antidepressants interact meaningfully with alcohol, and effective response is usually difficult while drinking is heavy.
Group therapy treats one of depression's loudest symptoms — isolation — directly. The structure of "you have to be somewhere on Tuesday at 6:30, and people will notice if you're not" is medicinal in itself.
You don't have to figure this out alone
The first session is exactly what depression makes hardest: showing up. Once that part is done, the rest is week-to-week.