High-Functioning Depression and Substance Use

The Hidden Struggle Behind “I am Just Tired”

For many St. George, Utah households, depression does not necessarily always appear to be dramatic. Sometimes, it appears responsible. Capable. Or even prosperous.

Your loved one leaves for work. They settle bills. Attends family gatherings. Slowly, though, you pick up signs of something else. A drink every other day becomes every night. The use of prescription medicines has increased. Weekends revolve more around “unwinding” activities.

When asked how they are feeling, they always respond, “I am just tired.” Now, this is what high-functioning depression looks like.

Substance abuse and high-functioning depression frequently coexist. Developing substance use disorders are twice as common in people with mood disorders in comparison to the general population (Quello et al., 2005). Many people use drugs or alcohol to relieve chronic stress, numb emptiness, and quiet racing thoughts rather than for pleasure most of the time.

At High Desert Counseling, we regularly witness clients who seem stable on the surface but are actually dealing with a lot–depression and unhealthy coping strategies–on the inside.

Functioning does not necessarily mean flourishing.

Why Depression and Substance Use Often Overlap

The brain’s reward system is affected by depression, which lowers the activity levels of dopamine and reduces the capacity for pleasure. Substances provide momentary relief by temporarily raising dopamine levels. However, this cycle contributes to one’s dependence and depression over time (Volkow et al., 2016).

According to national data, 21.2 million adults in the United States suffer from both substance use disorder and a mental health disorder (SAMHSA, 2024). Co-occurring disorders are especially crucial to be treated early in Utah, where substance-related fatalities and suicide remain a major public health concern.

Let us look at Alex’s experience, one of our clients at our IOP program. As a firstborn, he took care of his family while juggling both full-time work and sideline gigs. However, alcohol became his way to release some steam every night. He did not think of himself as someone having a substance issue until he realized that he could not seem to relax when nothing was going on, or could not sleep without it.

Research reports that untreated depression significantly raises the risk of substance abuse, especially for high-functioning individuals who are ashamed to seek help because of stigma (Pescosolido et al., 2010).

Self-medication is one of the many ways that substance use begins. However, over time, it becomes the cause of the very symptoms it was intended to soothe.

How High Desert Counseling Treats Co-Occurring Disorders in Southern Utah

We at High Desert Counseling treat substance use and mental health issues together rather than separately for our clients in St. George, Utah.

Our Intensive Outpatient Program (IOP) and Partial Hospitalization Program (PHP) offer clients the structured, evidence-based care that they need, which targets substance use behaviors as well as mental health.

Our approach consists of:

• Cognitive Behavioral Therapy (CBT) to reduce dependency on substances for solace and to challenge pessimistic thought patterns.
• Dialectical Behavior Therapy (DBT) is used to help develop emotional regulation and distress tolerance skills without the use of drugs or alcohol.
• Seeking Safety, a present-oriented model, is designed for people specifically dealing with both substance use and trauma concerns.

By improving emotional awareness and impulse control, DBT has been proven to dramatically reduce substance use in people with co-occurring mood disorders (Dimeff & Linehan, 2008).

Archie, one of our clients, first thought that going to therapy was unnecessary because he believed he was “still managing life.” However, his drinking and irritability rose over time, and he realized that managing is different from living well. He was able to rebuild substance-free coping strategies with the help of structured therapy.

Many people put off treatment because they think they can and should manage things on their own in Southern Utah, where independence is often valued. However, coordinated treatment, rather than isolated treatment, is the most effective approach for co-occurring disorders.

Practical Ways Families Can Respond

Early support is important if you suspect both substance use and depression are present. Families can:

• Gently say something like, “I have noticed that you seem exhausted a lot lately and are drinking more, and I am worried about you,” without making any accusations.
• Avoid making any demands unless safety is at risk because shame tends to make people more secretive.
• Encourage assessment by a certified specialist with experience in co-occurring disorders.
• If the risk increases, get prescription medications.
• If someone expresses suicidal thoughts, get help right away.

According to Chetty et al. (2023), compared to treating substance use and mental health issues independently, integrated treatment greatly improved recovery outcomes.

Access to structured outpatient programs in St. George, Utah, enables people to receive intensive support while remaining involved with their families and work.

Long-term risk is decreased by early intervention.

Looking Beneath the Surface

Substance abuse paired with high-functioning depression frequently masquerades as productivity and responsibility. Everything looks perfect and intact on the outside. However, on the inside, reliance and exhaustion slowly creep in.

Here at High Desert Counseling in St. George, Utah, we recognize that healing requires addressing the coping strategies that arise in response to emotional pain. Through IOP, PHP, CBT, DBT, Seeking Safety, and trauma-informed care, we help people replace self-medication with sustainable resilience.

Trust your instincts if a loved one appears to be capable but is becoming more distant, exhausted, introverted, or even reliant on substances to get through daily life. Substance abuse and depression are workable and treatable, especially when they are addressed together.

Recovery is not about just looking fine. It is about genuinely being well.

Professional support can be helpful if you or someone you care about is experiencing emotional exhaustion with substance abuse. Contact our team at High Desert Counseling to provide you with the appropriate treatment program you need, including PHP, IOP, and outpatient care in St. George, Utah.

Disclaimer: Composite stories are created from common patterns observed in our practice. Any resemblance to specific individuals is coincidental.

References:

Chetty, A., Guse, T., & Malema, M. (2023). Integrated vs non-integrated treatment outcomes in dual diagnosis disorders: A systematic review. Health SA = SA Gesondheid, 28, 2094. https://doi.org/10.4102/hsag.v28i0.2094

Dimeff, L. A., & Linehan, M. M. (2008). Dialectical behavior therapy for substance abusers. Addiction science & clinical practice, 4(2), 39–47. https://doi.org/10.1151/ascp084239

Pescosolido, B. A., Martin, J. K., Long, J. S., Medina, T. R., Phelan, J. C., & Link, B. G. (2010). “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American journal of psychiatry, 167(11), 1321-1330.

Quello, S. B., Brady, K. T., & Sonne, S. C. (2005). Mood disorders and substance use disorder: a complex comorbidity. Science & practice perspectives, 3(1), 13–21. https://doi.org/10.1151/spp053113

Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States. https://www.samhsa.gov

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363–371. https://doi.org/10.1056/NEJMra1511480