Alcoholism and Substance Abuse

Alcohol has been called the universal solvent It dissolves stomachs, livers, brains, jobs, families, bank accounts, credit ratings, drivers licenses, and the future hopes and dreams of those who suffer from alcoholism. 

Substance use disorders (SUDs) are collectively the most common coexisting condition that therapists will see in their patients who present with relationship problems, depression, or anxiety disorders. SUDs are common and often unrecognized, at least in the initial evaluation of the patient and family. This chapter does not propose to be a comprehensive treatise on the management of SUDs. It focuses on some features germane to the collaboration of physicians and nonphysician therapists in treating SUDs. We discuss alcoholism first, as the most common and the prototype of the SUDs, and then touch on selected features of several other types of SUDs. 

A person is said to suffer from the medical disorder called alcoholism if he or she continues to drink alcohol in spite of the knowledge that this continued use will lead to dire consequences in health, school, employ- 

Adapted from American Psychiatric Association (2000). Copyright 2000 hy the American Psychiatric Association. Adapted by permission. 

Several terms warrant discussion as we talk about alcoholism and other substance use disorders  

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Gilliland, K., Bullock, W., Caffeine A potential drug of abuse. Advances in Alcohol and Substance Abuse 3(1-2), 53-73, 1984. 

Patients with mixed states often have comorbid alcohol and substance abuse, severe anxiety symptoms, a higher suicide rate, and a poorer prognosis. 

The neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) is widely distributed in the CNS, subsuming a variety of functions including drive satiety, mood, aggression, anxiety, and compulsive and impulsive behaviors. It may be an important neurotransmitter in psychiatric symptoms commonly associated with PTSD such as aggression, obsessive/intrusive thoughts, alcohol and substance abuse, and suicidal behavior (Friedman, 1990). Suicidal behavior is known to be associated with both childhood maltreatment and low 5-HT functioning (Van der Kolk et ah, 1991 Benkelfat,... 

White, William L. Slaying the Dragon The History of Addiction Treatment and Recovery in America. Bloomington, Ill. Chestnut Health Systems/Light-house Institute, 1998. A comprehensive history of the many movements and systems that have attempted to treat alcohol and substance abuse in the United States since the 19th century. 

Acute endogenous depression is not generally considered to be an indication for treatment with lithium. Alcohol and substance abuse have a high association with bipolar illness. However, recurrent endogenous depressions with a cyclic pattern are controlled by either lithium or imipramine, both of which are superior to a placebo. 

Mersy, D. J. Recognition of Alcohol and Substance Abuse. American Family Physician 67 (2003) 1529-1532. 

Referring the patient to alcohol and substance abuse rehabilitation programs that will help him or her to ... 

Erectile dysfunction (ED), the inability to achieve or maintain a penile erection sufficient to permit satisfactory sexual intercourse, is estimated to affect over 100 million men worldwide, with a prevalence of 39% in those of 40 years. Its numerous causes include cardiovascular disease, diabetes mellitus and other endocrine disorders, alcohol and substance abuse, and psychological factors (14%). While the evidence is not conclusive, drug therapy is thought to underlie 25% of cases, notably from antidepressants (SSRI and tricyclic), phenothiazines, cypro-terone acetate, fibrates, levodopa, histamine H -receptor blockers, phenytoin, carbamazepine, allopurinol, indomethacin, and possibly adrenoceptor blockers and thiazide diuretics. 

The distribution of consumption approach to the prevention of alcohol-related damage An overview of relevant research and current issues. Advances in Alcohol and Substance Abuse, 5, 9-32. 

Bipolar mixed episode (previously known as mixed state, dysphoric mania, or depressive mania) is defined as the simultaneous occurrence of manic and depressive symptoms. Mixed mood states occur in up to 40% of all episodes, and are more common in younger and older patients and in females. Mixed episodes are often difficult to diagnose and treat because of the fluctuating clinical presentation. Patients with mixed states often have comorbid alcohol and substance abuse, severe anxiety symptoms, a higher suicide rate, and a poorer... 

Severe psychiatric illnesses such as bipolar disorder often manifest themselves during adolescence and young adulthood, and result in disruption of educational, occupational, marital, and other pursuits. Residual symptoms are often common between mood episodes, and more than one-half of bipolar patients manifest some degree of functional disability after the onset of the hlness. Poorer outcome is associated with rapid cycling, mixed states, concurrent alcohol and substance abuse, nonadherence to treatment, and poor psychosocial support. 

Therapy. Horticulture and gardening are therapeutic for those with learning, mental health, and physical disabihties. The American Horticultural Therapy Association is one of several organizations involved in this growing practice. Horticultural therapists incorporate gardens into wellness programs, and this type of therapy has become popular in programs to treat alcohol and substance abusers. 

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