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Dual Diagnosis: Depression Treatment

Dual Diagnosis: Depression

Hope Rehab Dual Diagnosis Depression

Hope Rehab Recovery Center in Thailand offers residential treatment for Depression and Anxiety disorders. Our healing program is also suitable for clients suffering from Stress, PTSD and Burn-out issues. Hope’s therapeutic program was originally designed to treat Addiction. However, this also includes all the necessary treatment for mental health issues.

Hope’s intensive residential therapy addresses the following conditions:

What is Depression?

Depression is one of the most common mental health concerns of modern times. While depression rates are high for substance users and non-users alike, the lifetime prevalence of depression for substance users is approximately 24% higher than in the general population. Worldwide, depression has risen to unprecedented proportions and the World Health Organization now predicts epidemic levels of depression by the year 2020. In clinical terms, depression is sometimes referred to as Depressive Disorders or Mood Disorders.

Below you find some general information on depression, its symptoms, causes, triggers, and the treatment we offer at Hope Rehab. Please feel free to reach out to us for a free consultation or if you should have any questions.

Many people use the term depression to describe sad mood or feeling ‘blue’. This, however, is far from the experience of clinical depression which can take on different forms, including:

A Major Depressive Episode,

which lasts at least two weeks during which we experience symptoms such as

These symptoms are so severe that they greatly impact individuals’ ability to work or study, and/or be able to maintain meaningful relationships.

Persistent Depressive Disorder (Dysthymia):

This is considered a milder form of depression, with some of the same symptoms as described above, but lasting for at least 2 years. Individuals experiencing dysthymia have a tendency to look at the glass half empty, and typically cannot recall a time in their lives when they have ever been truly happy or even content. In the past, this type of depression was referred to as Depressive Personality Disorder.

Bipolar Illness (formerly called manic depressive illness):

Individuals experience extremes in mood, alternating between periods of extreme depression and mania. The hallmark of the latter are excessive energy and a decreased need for sleep, typically accompanied by a sense of grandiosity and high risk behaviours such as drug use, promiscuity or gambling. Unlike major depressive illness which may be recurrent but is very much treatable, bipolar illness is chronic in nature and requires skilled intervention that includes medication. Not surprisingly, Bipolar illness is the most frequently misdiagnosed mental illness in the context of substance use, given that the ups and downs in moods caused by substance use can easily be mistaken as depression and mania to the untrained eye. Bipolar illness can take on various forms such as bipolar I or II, rapid cycling bipolar, all of which causing individuals difficulties in functioning to at least some degree.

Types of Depression

How is Depression Linked to Substance Use?

In the context of substance use and recovery from addiction, depression can show up in various ways, including but not limited to:

A depressed mood is a common consequence of coming down from a substance induced ‘high’. For example, stimulant users often report experiencing depressed mood, profound lack of energy and disabling physical fatigue at the tail end of heavy use, during withdrawal and early abstinence.

Individuals suffering from depression may use alcohol or other substances to cope with difficult symptoms, especially when these become chronic. For example, research shows that depression precedes methamphetamine use.

Post-acute withdrawal symptoms are similar to symptoms of depression, including decreased motivation, lack of physical energy, difficulties concentrating and insomnia.

The overlap of bipolar illness and substance abuse is 60%.

Individuals suffering from depression are twice as likely to develop substance abuse problems as compared to the general population.

Marijuana use is shown to impact cognitive abilities and motivation, and chronic use may cause depression in some individuals.

Depression is common in illicit opiate users and symptom severity increases with heavier substance use; symptoms typically improve or subside during treatment.

Alcohol is a central nervous depressant, and chronic alcohol misuse been shown to cause symptoms of depression.

On that note: Addiction can have serious repercussions on a person’s life. Not only can it lead to financial and legal troubles, impaired thinking and judgment but it can also be the reason for failing relationships. All the above-mentioned things cause stress and might make you lose all hope for a better future. Therefore you’re more likely to feel depressed.

Symptoms of Depression

How is Depression Treated?

Drug-induced symptoms of depression often clear with prolonged abstinence and may not need any specialised treatment. Additionally, many therapeutic interventions helpful for the treatment of addiction are equally helpful in the treatment of depression, such as cognitive behavioural therapy (CBT). If symptoms persist, treatment is readily available, and the choice of treatment strongly depends on type, severity and chronicity of symptoms, as well as individual preferences.

For example, mild to moderate depression can be treated with short-term cognitive behavioural therapy (CBT) and changes in lifestyle. This type of treatment includes a focus on challenging and changing negative thoughts, setting small behavioural goals to achieve healthy routines as they pertain to physical exercise, diet and sleep. Severe depression and Persistent Depressive Disorders on the other hand typically require a combination antidepressant medication and psychotherapy for best and lasting results. Bipolar disorder I is one of the most debilitating mental health disorders and typically requires long-term and multi-faceted interventions that include medicationcommunity support and specialised forms of therapy, such as Interpersonal and Social Rhythm Therapy.

Triggers for Depression

Depression and Alcohol Addiction

Alcohol is a depressant and has a sedative effect on the brain. Therefore, it exaggerates depression because of it’s direct neurotoxic effects. A drink or two, smoking cannabis, a line of cocaine, might temporarily relieve some symptoms, but each time a chemical leaves the body, it usually brings the depression to new lows known as “withdrawal depression”.

When people suffer from depression, it is difficult to imagine not being depressed in the future. You can’t always think your way out of depression and if you can’t say anything positive to yourself, it’s best to think nothing at all.

The expression “looking at the world through rose-colored glasses” means everything seems wonderful. It is a distortion of reality. Just as “looking at the world through depression glasses” always distorts things in a negative way.

Depression: Common Negative Self-Talk

What Hope Rehab Offers for those Suffering from Depression:

Hope Rehab Center draws on multiple therapeutic interventions helpful in addressing not only the symptoms of depression, but also contributory and causal factors. These interventions include:


Individual Counselling Sessions: Every resident has two weekly individual counselling sessions to address issues specific to the individual, such as blocks to creating a healthy anti-depression lifestyle, negative Core Beliefs or interpersonal issues.

CBT & Group Therapy

Daily Gratitude Circle: Learning to focus on what we have, on what is working, on what we do well is a helpful tool in countering depression’s focus on personal failures and shortcomings, and on the proverbial ‘the glass half empty philosophy’.


Mindfulness & Mediation: At Hope Rehab, we offer daily guided meditation practice, as well as weekly individual and group mindfulness sessions. These practices can be helpful to individuals suffering from depression as they learn to disengage from negative thoughts, tolerate difficult emotions and intentionally direct their focus on positives rather than negatives.


Daily Gratitude Circle: Learning to focus on what we have, on what is working, on what we do well is a helpful tool in countering depression’s focus on personal failures and shortcomings, and on the proverbial ‘the glass half empty philosophy’.


Yoga: Research shows that a regular yoga practice supports individuals’ journey towards improved physical, emotional and mental health and spiritual healing. At Hope Rehab Center, we offer various styles of yoga to ensure everyone can participate in, and harvest yoga’s vast benefits. Types of yoga offered include flow yoga, hot stone meditation and yoga or restorative yoga.

Healthy Lifestyle

Healthy Lifestyle: At Hope Rehab, we emphasize a healthy lifestyle, which includes daily physical exercise, healthy nutritious meals, solid routines around bedtime, mandatory therapy sessions, and a strong community focus to enhance social and emotional health.

Activities & Excursions

Afternoon Activities & Weekly Excursions: Following our mandatory morning program, residents have the opportunity to engage in sports, such as Muay Thai boxing, or art and social activities. Through participation in initially challenging activities, individuals with anxiety counter avoidance behaviours and gradually regain self-confidence. Participation in weekly art activities may help anxious individuals to express and self soothe difficult emotions through art.

Recovery Meetings

Recovery Meetings: Hope Rehab Center offers addictions focused recovery meetings three times weekly, each with a slightly different focus. This allows attendees to connect with others through sharing of individual struggles and stories of survival pertaining to addictions and mental health recovery. For individuals struggling with social anxiety, in particular, learning to share one’s story in front of a group and being nevertheless accepted into a community, can be powerful exposure therapy and thus counter typical avoidance behaviours.

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Hope Medication Policy

Note: Please bring your doctor’s contact details with you so you and the Hope team can seek appropriate advice if necessary.

Prescribed Medications: Any long-term medications from your Doctor, are best to bring in a plentiful supply to cover you for up to 2 months minimum. Most clients extend longer than a month. We can source some meds from our local Doctor and Hospital.

Medication storage: All medication must be handed over to Hope staff on admission. We generally store all medication in our safe and dispense from the support office at structured times, whether prescribed by your doctor or ours. After a client settles in, we may decide to allow some meds or vitamins deemed harmless, to be taken to rooms and self-supervised.

Narcotic (intoxicants) medications (including pain meds and Benzodiazepines)

Some “mood-altering” drugs and medications (e.g. Xanax/Codeine) are not encouraged in the Hope therapeutic program, as we require all clients to be on a similar emotional level in the community. So, substitutes or careful reduction may be necessary and are effective and manageable. This may require consultation with your doctor or our local doctor. Please let your doctor know about our specific policy regarding this group of medications, as they may be willing to help change medications before you join us.

Anxiety and sleep medication

Beta blockers for enduring anxiety and natural sleep meds are allowed at Hope, so long as they are supervised. Simple and mild medications such as low dose ‘Seroquel’ for short periods can be highly effective in helping clients through difficulties in the early stages of our program. Our resident nurse or hospital doctor will screen anyone requiring such help. The team at Hope have valuable experience and training that we use to help our clients in accordance with accepted good practice.

General medication issues

Many clients arrive on anti-depressants and mood-stabilizers prescribed by their doctors. Clients often ask to stop these meds which is a healthy sign of commitment to recovery. However, Hope staff are not permitted to make these kinds of decisions. So we ask that before coming to Hope you contact the prescribing doctor to get his/her feedback and consent. We can also help you contact the doctor for advice once you have arrived. Family and people close to you may also provide a different perspective so may be consulted. You may additionally be asked to sign a waiver stating that you have taken appropriate advice and are making an informed decision with our support.

Psychiatric medications are very sensitive and must be properly adhered to for safety. We feel it would be irresponsible for Hope staff to allow clients to stop taking psychiatric drugs. If not carefully coordinated by the prescribing doctor, this could trigger unnecessary MH episodes. When making changes to medications, it may also be a good idea to get feedback from those people who are closest to you.

Please arrange to bring the correct supply of your regular medication. Some meds are not available in Thailand or are very expensive and timely to acquire. We suggest at least two months’ supply.

Standard detox (Heroin and Alcohol)

At Hope Rehab we follow common detox protocols for Alcohol and Heroin detoxes. We work together with doctors at our local hospital who provide Diazepam prescriptions for alcohol detox. We also work together with the Bangkok Methadone/Subutex program who provide the prescriptions covering opiate detox and reductions. Some clients bring their own detox medication from their country of origin. Staff at Hope are specially trained by the Royal College of General Practitioners UK to administer and coordinate standard detox programs. We aim to keep all clients safe and comfortable whilst withdrawing. You may be asked to take anti-seizure meds for a short period to ensure safety. For more information please check our detox page.

ADHD & ADD medication

Stimulants such as Adderall, Concerta, or Ritalin are not suited to the Hope community or program. These drugs are far from ideal for addicts as they pump up the human reward system. Some clients who are prescribed these meds have found it triggered their addiction and caused serious life problems so are keen to stop, which we support. Some clients wish to continue using these medications, so we ask them to reduce to a low dose. This is because we have noticed hyper-manic behavior and a lack of emotional connection with others. We suggest Strattera (non-stimulant) as an alternative appropriate ADHD medication. Please let your prescribing doctor know about our policy.

Thank you for your co-operation


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