Alcohol Abuse, Alcoholism and Depression
December 30, 2007
Mental health professionals who treat alcohol abuse, alcoholism and depression have long known that these two illnesses occur together more often than not. In fact, it is quite common in medical settings for people to seek addiction treatment or alcohol rehab for either of these conditions. Not only is it true that in this setting the sensitive health care provider identifies the presence of the other illness 1, but it is also known that the earlier in one’s life that either of these two disorders develops, the greater the chance the other will also arise.
But what is known of the relationship between alcohol abuse, alcoholism and depression in people who are not seen in medical settings? In what order do they occur? This is obviously an important point in terms of understanding the development of these conditions, since people tend to seek help only in the later stages of a problem. A study recently done at the Harvard School of Public Health and a Harvard affiliated hospital has answered these questions.
Scope and aim of the study
The authors used data from a large survey that studied 14,480 people from 5 cities 3. In order to be included in the analysis, subjects could not have had a previous diagnosis of either major depression or alcoholism.
The American Psychiatric Association (APA) has established a set of criteria and symptoms that characterize various psychological disorders. In order to receive a diagnosis of major depression, a person must meet a specific number of criteria from the APA.
This means that someone may have some of the signs and symptoms of depression, but may not qualify to receive a diagnosis of the illness. Nevertheless, in practical terms, these symptoms can still affect the individual’s overall functioning and well-being. And by eliminating people with a diagnosis of depression or alcoholism, the researchers were able to more clearly evaluate the order of onset of new cases of depression, alcohol abuse and alcohol dependence.
Dual Diagnosis and Drug Rehab
December 25, 2007
Dual Diagnosis and Drug Rehabilitation: The New Hybrid Disorder and Addiction Treatment
Written by Rachel Hayon, MPH
Dual diagnosis is defined by the presence of both mental health disorders and substance abuse disorders (alcohol and/or drug dependence or abuse) [1]. There are a variety of different mental health disorders that can be associated with substance use and labeled dual diagnosis. Some of these disorders include: schizophrenia, bipolar disorder, anti-social personality disorder, narcissistic personality, and depression. A big question among the experts is which comes first- the mental health problem or substance use? It’s a difficult question to answer because so many of the symptoms associated with mental health disorders resemble the by product of substance use and vice versa. This is also an important topic right now because of the overwhelming amount of substance use cases and mental health disorders that overlap.
In a recent study conducted by the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), it was estimated that 17.6 million American adults meet the criteria for an alcohol use disorder and approximately 4.2 million meet the criteria for a drug use disorder [2]. In addition to this, 19.2 million adults can be diagnosed for independent mood disorders (major depression, dysthmia, manic disorder, and hypomania) and 23 million meet the criteria for independent anxiety disorders (including panic disorder, generalized anxiety disorder and specific social phobias) [2]. The NESARC also reported that approximately 20% of those individuals reporting a mental health disorder also reported a substance abuse disorder. Conversely, 20% of those individuals with a substance abuse disorder also displayed mental health problems [2].
When alcohol use is observed along with mental health disorders, alcoholics usually report that they “self-medicate” in order to alleviate symptoms of their psychiatric condition, such as depression [3]. One of the problems with using drinking as an emotional balm are the negative effects of heavy drinking as well as withdrawal from drinking- both can worsen an already negative mood state [4]. Having said this, it is interesting to see how different mental health disorders manifest themselves when substance use enters into the equation. Depending on what the disorder is, substances use is reported to be used for different reasons and also to either alleviate or bring on certain symptoms. For instance, in the case of bipolar disorder, though drinking may occur in both the manic and depressive phases, drinking is more prevalent during the manic phase [4]. Similarly, drinking may also produce symptoms that are similar to the manic phase of bipolar disorder such as grandiosity, irritability or physical agitation. In regards to anxiety disorder for instance, alcoholics usually report intense symptoms such as palpitations, sweatiness, and fear of objects or social situations which usually disappear with the discontinuation of alcohol use. However, individuals with agoraphobia or social phobia might drink in order to reduce the amount of anxiety they feel [5].
Understanding Dual Diagnosis
December 22, 2007
The term dual diagnosis is a common, broad term that indicates the presence of two independent medical disorders. Recently, within the fields of mental health, psychiatry, and addiction medicine, the term has been popularly used to describe the coexistence of a mental health disorder and drug addiction / alcohol addiction problems. The equivalent phrase dual disorders also denotes the coexistence of two independent (but invariably interactive) disorders, and is the preferred term used in this Treatment Improvement Protocol (TIP).
The acronym MICA, which represents the phrase mentally ill chemical abusers, is occasionally used to designate people who have an drug addiction / alcoholism disorder and a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder. A preferred definition is mentally ill chemically affected people, since the word affected better describes their condition and is not pejorative. Other acronyms are also used: MISA (mentally ill substance abusers), CAMI (chemical abuse and mental illness), and SAMI (substance abuse and mental illness).
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