As an atheist, Ackerman’s point of view is unique among recovery-oriented and 12-step literature. Many people struggling with addiction don’t try 12-step programs because of their emphasis on a “higher power.” Ackerman also focuses on what he believes are misconceptions surrounding 12-step programs.

I chose to review this book because it was different. I am a Christian. I also happen to have an eating disorder. As part of my treatment, I briefly participated in a 12-step group. Prior to reading this, I never knew that anyone who identified themselves as an atheist ever took part in such a group. I was excited to read about it from a new perspective.

Ackerman does a good job summarizing some of his experience into short, easy-to-digest sections that also are easily to relate to. As someone currently struggling with an eating disorder, I certainly related to his frustration with wanting to stop his behavior, but feeling powerless in doing so. I also greatly appreciated his brutal honesty.  His occasional humor was also a welcomed and unexpected surprise. This is definitely not your average 12-step book. However, he does leave much to be desired.

For one thing, Ackerman never explains the 12 steps themselves. This would confuse a reader unfamiliar with the structure of such programs. 12-step programs take participants through a series of “steps” to aid in recovery. These steps start with admitting there is a problem and seeking support. They end with a commitment both to aid others who are still struggling and to continue carrying the lessons learned through the rest of the participant’s life. Although this began with Alcoholics Anonymous (AA), the general idea has been tweaked many times over to fit everything from drug to sex addictions and more.

This is a book centered around the 12-step recovery model, and I realize that. However, Ackerman spends much of the book praising the program, without even mentioning the many other programs out there. Instead, he sings the praises of the 12-step recovery model as if it is the absolute cure-all for all addictions and mental illnesses. This is simply untrue. If Ackerman were right, there would be no need for any other rehabilitation centers or support groups for addicts and others who are mentally ill.

“No one comes into a 12-step program by the grace of God or with a firm belief in a Higher Power.” Bold statements such as this are common in Ackerman’s book. In the section titled, “God (?)” Ackerman defends his point by saying that addicts worship their drug of choice, not a higher power. While one can see his reasoning, I don’t think a person’s mental health issues translate into having no faith in God.

[A]Musings of a Spiritual Atheist left me conflicted. I liked some of it, while utterly disliking other parts. It was certainly an interesting and thought-provoking read.

[A]Musings of a Spiritual Atheist
By Andrew J. Ackerman
www.lulu.com: January 23, 2012
Paperback, 204 pages
$19.95

Complications of Diagnosing ADHD in Adults

• Adult symptoms vary and are harder to diagnose than those present in children.
• It is less well known that adults can have ADHD. Those who suspect they have it may be reluctant to seek help or be unaware that they should.
• General practitioners often attribute ADHD symptoms to more commonly diagnosed disorders such as depression, bipolar disorder, anxiety disorders or common negative lifestyle issues such as poor diet. Improper diagnosis ensures that ADHD remains untreated.
• Adults with ADHD may adapt to symptoms over time. In fact, some may enjoy or feel a benefit from the energy that can define the hyperactivity part of this disorder. Those who have lived with the illness, undiagnosed, for a long time—often since childhood—may not even be aware of their own erratic behavior.

Adults with undiagnosed ADHD also exhibit a much more frequent incidence of addictive behavior than those who do not suffer from the disorder. Reasons vary, but substance abuse often is connected to a need to self-medicate untreated ADHD symptoms.

The Prevalence of Addiction in Adults with Undiagnosed ADHD

Oxford University Press, on behalf of the Medical Council on Alcohol, published an investigative research paper focusing on ADHD patients and nicotine and alcohol dependence. The findings reported, “Several studies have shown that attention-deficit/hyperactivity disorder (ADHD) represents a significant risk factor for the onset and development of addiction” (Ohlmeier et al., 2007).

Although this research focused primarily on nicotine and alcohol addiction, the rate of addiction for all substance abuse, specifically drugs with stimulant properties, is much higher for ADHD sufferers than in the general populace. Carl Sherman, PhD, explains, “A recent survey found that more than 15 percent of adults with the disorder had abused or were dependent upon alcohol or drugs during the previous year. That’s nearly triple the rate for adults without ADHD” (2007).

Often, those abusing any form of negative or illicit substances are not properly treated for the disorder or the resulting addiction — because they are unaware that they have ADHD and treatment for it is available.

Living with Undiagnosed Adult ADHD

I was not diagnosed with ADHD until age 24, so I have firsthand knowledge of the pain and difficulty that adults with ADHD face. I began to abuse stimulant drugs when I realized that they were able to slow me down — a paradoxical effect. For example, while cocaine speeds most people up, adults with undiagnosed, untreated ADHD often are slowed down. Illegal drugs affect the brain in a way similar to the medication commonly prescribed for ADHD — it is no wonder those unaware of their condition often turn to self-medication.

I abused alcohol for the same reason. It was a vicious cycle: My untreated disorder led to impulsive behavior (abusing drugs and alcohol). The relief they brought encouraged me to continue my substance abuse. This is far too common a problem among adults living with undiagnosed ADHD.

Why Is Addiction Such an Issue for Adults with Undiagnosed ADHD?

In his insightful article, “Addiction and ADHD Adults,” Carl Sherman quotes a study by Timothy Milens, MD: “In our study…only 30 percent [of participants] said they used substances to get high… Seventy percent are doing it to improve their mood, to sleep better, or for other reasons” (2007). Sherman goes on to elaborate that abuse of substances, when connected to adult ADHD, often is based on a need to self-medicate the symptoms: “…This kind of ‘self-medication’ seems especially common among individuals whose ADHD remains undiagnosed or who have been diagnosed but have never gotten treatment” (2007).

Stimulant drugs such as cocaine can provide temporary relief. Alcohol has a similar effect on the central nervous system. The medication used to treat ADHD has stimulant properties and affects the same area of the brain as stimulant drugs, though to a lesser degree. Primarily because of this, the potential for abuse among those being treated with adult ADHD, especially those who have a history of substance abuse, is difficult and requires a comprehensive approach.

Treating Adult ADHD When There is a History of Substance Abuse

Before I was prescribed medication for ADHD, I had to remain sober for a year—a reasonable amount of time. Once I was prescribed the proper medication (Concerta, a slow-release variety of Ritalin), I appreciated the ability to focus, and I found that recovering from addiction was easier, primarily because my impulsivity was lessened. Dr. Sherman also elaborated on the importance of this approach: “What’s the right way to get help? Recent studies suggest that it’s best to optimize the treatment for ADHD only after the individual has been sober for six weeks to a few months” (2007).

All stimulant-based drugs have the potential to cause addiction. For this reason, many doctors initially choose to prescribe non-stimulant medications. “Which ADHD medication is best for someone who has already battled substance abuse? For many doctors, the first choice is non-stimulant. These drugs may not be as effective as stimulants for treating certain symptoms… Other doctors choose to prescribe a stimulant…an extended-release formulation… These slow-acting meds are less likely to be abused” (Sherman, 2007).

Adults living with undiagnosed ADHD may engage in addictive behavior simply because they are medicating the primary diagnosis, which may be inaccurate. If they receive a proper diagnosis and proper treatment, they will be less likely to turn to drugs or alcohol and less likely to succumb to addiction.

Treating adult ADHD is difficult both for the primary caregiver and the patient. Because the incidence of addiction is so high among this population, treating the disorder with stimulant treatment regimens must be properly and thoroughly evaluated.

References

Ohlmeier, M.D., et al. (August 31, 2007). Nicotine and alcohol dependence in patients with comorbid attention-deficit/hyperactivity disorder (ADHD). Alcohol & Alcoholism, 42(6). Retrieved from http://alcalc.oxfordjournals.org/content/42/6/539.full.pdf

Sherman, C. Addiction and ADHD adults. ADDitude, February/March 2007. Retrieved from http://www.additudemag.com/adhd/article/print/1868.html

It has recently become popular on a worldwide scale, they explain. But regular use “can have adverse outcomes.” They examined those of most interest for public health – dependence, risk of vehicle crashes, bronchitis and other airway diseases, heart disease, and effects on lifestyle and mental health.

It is estimated that 166 million adults worldwide used cannabis in 2006. Use was highest in the U.S., Australia and New Zealand, followed by Europe. It typically began in teenage years and declined after obtaining full-time employment, getting married, and having children.

The active component of cannabis is tetrahydrocannabinol (THC). Short-term side effects can include anxiety, changes in appetite, panic reactions and even psychotic symptoms. About nine percent of users will become dependent, compared with 32 percent for nicotine and 15 percent for alcohol. Withdrawal may trigger insomnia and depression.

Chronic bronchitis can develop, as cannabis smoke contains many of the same carcinogens as tobacco smoke. Heavy users are at higher risk of problems with verbal learning, memory, and attention. Use is also linked to poor educational attainment, but the experts say that the cause and effect of this relationship is unclear. It may be caused by pre-existing risk factors as well as cannabis use.

Because cannabis can slow reaction time and coordination, it brings an increased risk of road accidents. Its use in pregnancy could reduce birthweight, but does not seem to cause birth defects. Cannabis users are also more likely to go on to use other illicit drugs, including heroin and cocaine.

The potential link to schizophrenia causes widespread concern. Studies suggest the risk is more than doubled for people who have tried cannabis by age 18. An analysis published in the Lancet in 2007 found a 40 percent increase in risk of “psychotic symptoms or disorders” in people who had used cannabis, with the highest risk among regular users, particularly those with a vulnerability to psychosis. For depression and suicide attempts, the evidence is less clear.

The University of Queensland experts conclude that, “The most probable adverse effects [of cannabis] include a dependence syndrome, increased risk of motor vehicle crashes, impaired respiratory function, cardiovascular disease, and adverse effects of regular use on adolescent psychosocial development and mental health.”

In a separate study, the experts take an in-depth look at the possible risk of psychosis. They say that observational studies show “consistent evidence that cannabis is associated with an increased risk of schizophrenia, and more generally, psychosis.” But there is debate about whether cannabis is a true contributing cause.

Since 2004, there has been a great deal of research carried out regarding the link. Overall, these studies suggest that the association is unlikely to be due to chance. “The evidence suggests that it is more likely that cannabis use precipitates psychosis in vulnerable persons, which is consistent with other lines of evidence suggesting that there is a complex constellation of factors leading to psychosis,” they write.

“We argue that the evidence is as good as that for many other risk factors,” they add. “Psychotic disorders are associated with substantial disability, and cannabis use is a potentially preventable exposure.”

When the Australian team investigated whether cannabis is linked to higher overall risk of death, they found “insufficient evidence, mainly due to the low number of studies.” Some studies suggest that certain health outcomes may be elevated among heavy users, yet there is a lack of long-term research that follows cannabis users into old age, when harmful effects are more likely to emerge.

Conversely, cannabis has been tried as an experimental treatment for gastrointestinal conditions such as inflammatory bowel disease. Cannabinoid receptors are located throughout the gut, involved in the regulation of food intake, nausea and inflammation. Drugs based on cannabis that act on these receptors may have therapeutic potential, scientists believe.

Cannabis preparations are also used as a remedy for chronic pain. In a 2009 review, researchers state that cannabis is “moderately efficacious for treatment of chronic pain,” but the beneficial effects “may be partially (or completely) offset by potentially serious harms.” More evidence from larger trials is needed, they conclude.

References

Hall, W. and Degenhardt, L. Adverse health effects of non-medical cannabis use. The Lancet, Vol. 374, October 17, 2009, pp. 1383-91.

Degenhardt, L. et al. Should burden of disease estimates include cannabis use as a risk factor for psychosis? PLoS Medicine, Vol. 6, September 2009, e1000133.

Calabria, B. et al. Does cannabis use increase the risk of death? Systematic review of epidemiological evidence on adverse effects of cannabis use. Drug and Alcohol Review, Vol. 29, May 2010, pp. 318-30.

Martín-Sanchez, E. et al. Systematic review and meta-analysis of cannabis treatment for chronic pain. Pain Medicine, Vol. 10, November 2009, pp. 1353-68.

Those diagnosed with depressive disorder and alcoholism also may find it more difficult to attend 12-step programs, perceiving (rightly or wrongly) that people in Alcoholics Anonymous meetings and the like just don’t “get” what they are going through. For people who want to try a 12-step program, there are groups specifically designed for those struggling with both issues. One well-known group is a variation of AA called “Double Trouble in Recovery.” It does really help to have the support of people who can relate to what you are going through.

While alcoholics may find it hard to get through social occasions without a drink, those alcoholics with a depressive disorder may find it even harder. If you are depressed, a happy occasion like a birthday or a holiday can trigger thoughts and feelings that precipitate thoughts such as: “Everyone else is happy, what is wrong with me that I can’t be happy on special days?” Therefore, feeling bad about being depressed itself can be a trigger for a drink—and create additional anxiety about whether recovery is really possible.

So, is it harder for people with both depression and an addiction — especially an addiction that can masquerade as “socially acceptable” in some circumstances. such as drinking –to beat an addiction? The short answer is: Yes. The long answer is: Not necessarily.

In part, that’s because someone who is accurately diagnosed with depression can be prescribed medications which will stabilize their depressive symptoms. Also, like others with alcoholism they can be prescribed anti-craving medications, as well. For people who do not want to take medications, their recovery generally will be more difficult.

In either case, the following tips will help those suffering from depression in their recovery from alcoholism as well:

1. Build a solid, social-sober support network, and try to include people who also suffer from depressive disorders and are in recovery.

2. Avoid people, places, and things that trigger cravings and urges or that you find triggers depressive symptoms. However, if you have holidays or birthdays or weddings or other special events that you want to attend but that might trigger cravings for alcohol or make you feel down, bring someone from your support network with you. Also, have a specific purpose and a time limit in mind when you attend. For example, go with the plan that you are going to greet the people at the event, congratulate them, and then begin to say your farewells after thirty minutes and commit to being out the door after 45 minutes. If it is a family dinner, like Thanksgiving, that triggers your depressive symptoms or cravings for alcohol, you might not be able to go to these, at least while your recovery is still in the early phases. Or, just show up for dessert.
3. You are responsible for your own sober recovery as well as taking care of your own depression. You can’t expect the world to change around you. Others will not stop drinking — nor are they required to. They will not stop asking you to do things that may not be good for you. So ask your therapist to help you work on refusal skills — that is, the ability to say “no.”
4. For people with depression, who tend to withdraw from their friends and families anyway, it may be harder to make new, sober friends. Start with friends from your support groups and then go from there.
5. If you are taking medications for alcoholism, depression or both, be sure to report any unusual symptoms to your doctor immediately. If they are severe, go to the nearest emergency room. Also, advocate for yourself. If you are concerned about symptoms or the longer-term effects of your medication, read up on the pharmaceutical company’s web site. Make sure your doctor is giving you the requisite blood tests (if recommended), and is monitoring your response and reaction to the medication as advised by the drug’s producers.

Depressive disorders often cause acutely uncomfortable feelings such as overwhelming sadness, hopelessness, numbness, isolation, sleep disorders, digestive and food-related disorders. It is tempting, if medications aren’t being prescribed or used properly, for people suffering from depression to self-medicate.

This can compound the depression and make it far worse. A drink or two, a line of cocaine or two, might temporarily relieve some symptoms, but the backlash when the chemical leaves the body brings the depression to new lows. This “withdrawal depression” happens each time an abused chemical leaves the body, though many people don’t experience severe symptoms at first. The withdrawal depression itself can trigger the use of more alcohol or drugs because they will help get rid of the bad feelings.

Another compounding problem is that if drugs and alcohol are being used while medication is being taken, the alcohol or drugs can actually potentiate—make stronger—or deactivate the medication. Either way, this can put the person in medical danger.

Because of their personal life-shattering experiences with substance abuse, some people in recovery are leery of using any drugs, even prescribed ones. They have faced traumatic experiences with addiction and have a difficult time coming to terms with the necessity for medication intervention. In fact, I have had patients who have quit drinking or drugging the hard way—through willpower or cold turkey—yet are willing to endure the horrible symptoms of depression rather than take medication. Very often their social sober support network advises them to refrain from taking meds. Usually, this is not within the realm of the advisor’s authority. Dually-diagnosed patients (those with both mental illness and addiction) should speak with their psychiatrist about this issue, not a friend, no matter how well-intentioned.

One question I get asked frequently from addiction-treatment patients who are diagnosed with depression after they are diagnosed with an addiction is “did my drinking or drugging cause the depression?” The initial answer is always a resounding “maybe.” A well-trained psychotherapist will often be able to tease out the source of the depression and find out if it existed before the patient came in for addiction treatment. Therapists use a psychosocial evaluation and reports from family, friends, employers, court and police records and the like to help determine which condition occurred first.

Why is it important to know when the depression first occurred? Because someone who had depression before they began to abuse substances will most likely need treatment, including medication intervention, for a longer period of time compared to someone whose depression was caused by the cycle of addiction. Someone whose depression was caused by substance abuse generally will not need the same treatment as someone whose depression preceded his or her substance abuse.

Sometimes when someone comes in for addiction treatment and has a depressive disorder that was caused by addiction, they aren’t able to accurately report what is going on for them. They may be too numb or sad or unable to focus. Or perhaps a less-than-thorough psychosocial evaluation is done. Lack of reporting or inadequate evaluation may prevent the full understanding of whether the depressive disorder preceded or was caused by the substance abuse.

If a patient whose depression was caused by chemical abuse is referred to a treatment track for those who were depressed first and chemically dependent later, within a few weeks he or she usually is asking “what am I doing here? I don’t have these kinds of problems!” In these cases this isn’t necessarily a function of denial but a valid observation due to an original lack of understanding about whether the depression or the addiction came first.

While 85 percent of Americans recognize that schizophrenia is a disorder, only 24 percent are actually familiar with it. And according to a 2008 survey by the National Alliance on Mental Illness (NAMI), 64 percent can’t recognize its symptoms or think the symptoms include a “split” or multiple personalities. (They don’t.)

Aside from ignorance, images of the aggressive, sadistic “schizophrenic” are plentiful in the media. Such stereotypes only further the stigma and quash any shred of sympathy for individuals with this illness, writes Dr. Torrey. Stigma has a slew of negative consequences. It’s been associated with reduced housing and employment opportunities, diminished quality of life, low self-esteem and more symptoms and stress (see Penn, Chamberlin & Mueser, 2003).

So it’s bad enough that people with schizophrenia are afflicted with a terrible disease. But they also have to deal with the confusion, fear and disgust of others. Whether your loved one has schizophrenia or you’d like to learn more, gaining a better understanding of it helps demystify the disease and is a huge help to those who suffer from it.

Below are some pervasive myths — followed by actual facts — regarding schizophrenia.

1. Individuals with schizophrenia all have the same symptoms.

For starters, there are different types of schizophrenia. Even individuals diagnosed with the same subtype of schizophrenia often look very different. Schizophrenia is “a huge, huge range of people and problems,” said Robert E. Drake, M.D., Ph.D, professor of psychiatry and of community and family medicine at Dartmouth Medical School.

Part of the reason that schizophrenia is so mysterious is because we’re unable to put ourselves in the shoes of someone with the disorder. It’s simply hard to imagine what having schizophrenia would be like. Everyone experiences sadness, anxiety and anger, but schizophrenia seems so out of our realm of feeling and understanding. It may help to adjust our perspective. Dr. Torrey writes:

Those of us who have not had this disease should ask ourselves, for example, how we would feel if our brain began playing tricks on us, if unseen voices shouted at us, if we lost the capacity to feel emotions, and if we lost the ability to reason logically.

2. People with schizophrenia are dangerous, unpredictable and out of control.

“When their illness is treated with medication and psychosocial interventions, individuals with schizophrenia are no more violent than the general population,” said Dawn I. Velligan, Ph.D, professor and co-director of the Division of Schizophrenia and Related Disorders at the Department of Psychiatry, UT Health Science Center at San Antonio. Also, “People with schizophrenia more often tend to be victims rather than perpetrators of violence although untreated mental illness and substance abuse often increase the risk of aggressive behavior,” said Irene S. Levine, Ph.D, psychologist and co-author of Schizophrenia for Dummies.

3. Schizophrenia is a character flaw.

Lazy, lacking in motivation, lethargic, easily confused…the list of “qualities” individuals with schizophrenia appear to have goes on and on. However, the idea that schizophrenia is a character defect “is no more realistic than suggesting that someone could prevent his epileptic seizures if he really wanted to or that someone could ‘decide’ not to have cancer if he ate the right foods. What often appears as character defects are symptoms of schizophrenia,” write Levine and co-author Jerome Levine, M.D., in Schizophrenia for Dummies.

4. Cognitive decline is a major symptom of schizophrenia.

Seemingly unmotivated individuals most likely experience cognitive difficulties with problem solving, attention, memory and processing. They may forget to take their medication. They may ramble and not make sense. They may have a tough time organizing their thoughts. Again, these are symptoms of schizophrenia, which have nothing to do with character or personality.

5. There are psychotic and non-psychotic people.

The public and clinicians alike view psychosis as categorical — you’re either psychotic or you’re not — instead of symptoms residing on a continuum, said Demian Rose, M.D., Ph.D, medical director of the University of California, San Francisco PART Program and director of the UCSF Early Psychosis Clinic. For instance, most people will agree that individuals aren’t simply depressed or happy. There are gradients of depression, from mild one-day melancholy to deep, crippling clinical depression. Similarly, schizophrenia symptoms are not fundamentally different brain processes, but lie on a continuum with normal cognitive processes, Dr. Rose said. Auditory hallucinations may seem extraordinarily different but how often have you had a song stuck in your head that you can hear pretty clearly?

6. Schizophrenia develops quickly.

“It’s quite rare to have a big drop in functioning,” Dr. Rose said. Schizophrenia tends to develop slowly. Initial signs often show during adolescence. These signs typically include school, social and work decline, difficulties managing relationships and problems with organizing information, he said. Again, symptoms lie on a continuum. In schizophrenia’s beginning stages, an individual may not hear voices. Instead, he may hear whispers, which he can’t make out. This “prodromal” period — before the onset of schizophrenia — is the perfect time to intervene and seek treatment.

7. Schizophrenia is purely genetic.

“Studies have shown that in pairs of identical twins (who share an identical genome) the prevalence of developing the illness is 48 percent,” said Sandra De Silva, Ph.D, psychosocial treatment co-director and outreach director at the Staglin Music Festival Center for the Assessment and Prevention of Prodromal States (CAPPS) at UCLA, departments of psychology and psychiatry. Because other factors are involved, it’s possible to reduce the risk of developing the illness, she added. There are various prodromal programs that focus on helping at-risk adolescents and adults.

Along with genetics, research has shown that stress and family environment can play a big role in increasing a person’s susceptibility to psychosis. “While we can’t change genetic vulnerability, we can reduce the amount of stress in someone’s life, build coping skills to improve the way we respond to stress, and create a protective low-key, calm family environment without a lot of conflict and tension in hopes of reducing the risk of illness progression,” De Sliva said.

8. Schizophrenia is untreatable.

“While schizophrenia is not curable, it is an eminently treatable and manageable chronic illness, just like diabetes or heart disease,” Levine said. The key is to get the right treatment for your needs. See Living with Schizophrenia here for details.

9. Sufferers need to be hospitalized.

Most individuals with schizophrenia “do well living in the community with outpatient treatment,” Velligan said. Again, the key is the right treatment and adhering to that treatment, especially taking medication as prescribed.

10. People with schizophrenia can’t lead productive lives.

“Many individuals can lead happy and productive lives,” Velligan said. In a 10-year study of 130 individuals with schizophrenia and substance abuse — which co-occurs in nearly 50 percent of patients — from the New Hampshire Dual Diagnosis Study, many gained control over both disorders, reducing their episodes of hospitalization and homelessness, living on their own and achieving a better quality of life (Drake, McHugo, Xie, Fox, Packard & Helmstetter, 2006). Specifically, “62.7 percent were controlling symptoms of schizophrenia; 62.5 percent were actively attaining remissions from substance abuse; 56.8 percent were in independent living situations; 41.4 percent were competitively employed; 48.9 percent had regular social contacts with non–substance abusers; and 58.3 percent expressed overall life satisfaction.”

11. Medications make sufferers zombies.

When we think of antipsychotic medication for schizophrenia, we automatically think of adjectives like lethargic, listless, uninterested and vacant. Many believe medication causes these sorts of symptoms. However, most often these symptoms are either from schizophrenia itself or because of overmedication. Zombie-like reactions are “relatively minor, compared with the number of patients who have never been given an adequate trial of available medications,” according to Dr. Torrey in Surviving Schizophrenia.

12. Antipsychotic medications are worse than the illness itself.

Medication is the mainstay of schizophrenia treatment. Antipsychotic medications effectively reduce hallucinations, delusions, confusing thoughts and bizarre behaviors. These agents can have severe side effects and can be fatal, but this is rare. “Antipsychotic drugs, as a group, are one of the safest groups of drugs in common use and are the greatest advance in the treatment of schizophrenia that has occurred to date,” Dr. Torrey writes.

13. Individuals with schizophrenia can never regain normal functioning.

Unlike dementia, which worsens over time or doesn’t improve, schizophrenia seems to be a problem that’s reversible, Dr. Rose said. There’s no line that once it’s crossed signifies that there’s no hope for a person with schizophrenia, he added.

References

Drake, R.E., McHugo, G.J., Xie, H., Fox, M., Packard, J., & Helmstetter, B. (2006). Ten-Year Recovery Outcomes for Clients With Co-Occurring Schizophrenia and Substance Use Disorders>. Schizophrenia Bulletin, 32, 464-473.

Penn, D.L., Chamberlin, C., & Mueser, K.T. (2003). The effects of a documentary film about schizophrenia on psychiatric stigma. Schizophrenia Bulletin, 29, 383-391.

“Your daughter has schizophrenia,” I told the woman.

“Oh, my God, anything but that,” she replied. “Why couldn’t she have leukemia or some other disease instead?”

“But if she had leukemia she might die,” I pointed out. “Schizophrenia is a much more treatable disease.”

The woman looked sadly at me, then down at the floor. She spoke softly. “I would still prefer that my daughter had leukemia.”

“This book is a product of a thousand such conversations,” writes research psychiatrist and schizophrenia specialist E. Fuller Torrey, M.D., in Surviving Schizophrenia: A Manual for Families, Patients And Providers. Getting a diagnosis of schizophrenia can be devastating. Families and patients alike think there’s no hope. What follows may be shock, shame and confusion. But schizophrenia isn’t a death sentence or an inevitable descent into psychosis and violence, as some movies and shows would have you believe. Even though it may be terrifying, receiving a proper diagnosis is a good thing: It’s one step closer to the right treatment.

“Earlier treatment and shorter duration of untreated psychosis is associated with better treatment response, less likelihood of relapse and better clinical outcome,” said Sandra De Silva, Ph.D, psychosocial treatment co-director and outreach director at the Staglin Music Festival Center for the Assessment and Prevention of Prodromal States (CAPPS) at UCLA, departments of psychology and psychiatry.

Here’s a look at what effective treatment for schizophrenia entails, how you can manage the disorder and what to do if you notice early warning signs.

Early Diagnosis of Schizophrenia

Schizophrenia rarely occurs unexpectedly. Instead, it produces a gradual decline in functioning. There are usually early warning signs, referred to as the “prodrome,” which last one to three years, which provide the perfect place to intervene.

Early symptoms are the same as in psychotic illnesses, but “they are experienced at a milder, subthreshold level,” De Silva said. The key symptoms to look for are “suspiciousness, unusual thoughts, changes in sensory experience (hearing, seeing, feeling, tasting or smelling things that others don’t experience), disorganized communication (difficulty getting to the point, rambling, illogical reasoning) and grandiosity (unrealistic ideas of abilities or talents),” according to De Silva. Just one of these symptoms is the “greatest predictor of psychosis to date — greater than having a parent with schizophrenia,” she said. In fact, according to recent research, 35 percent of individuals who presented with one of these symptoms developed psychosis within 2.5 years. Substance use, such as alcohol and marijuana, also has been shown to boost risk.

Early Intervention for Schizophrenia

So what can you do if you think your loved one is showing these early signs? There are various prodromal clinics in the U.S. and some abroad that offer services — usually including regular evaluations and treatment — for at-risk youth and their families. At De Silva’s clinic, CAPPS, individuals from 12 to 25 years old get a diagnostic screening, assessments and case management at no charge. Early treatment aims to reduce the risk of developing schizophrenia, delay its onset (which research shows has a better prognosis), decrease severity after onset and improve outcomes in all areas, De Silva said.

Treatment of Schizophrenia

“The longer an illness is left untreated, the greater the disruption to the person’s ability to study, work, make friends and interact comfortably with others,” De Silva said. A combination of treatments is best for individuals with schizophrenia. Medication is the mainstay of treatment, “used to minimize hallucinations, help the individual think more clearly, focus on reality and sleep better,” according to Dawn Velligan, Ph.D, professor and co-director of the Division of Schizophrenia and Related Disorders at the Department of Psychiatry, UT Health Science Center at San Antonio . However, “decades of research have shown that psychosocial treatments “are also important in improving symptoms and quality of life,” she added.

Here are some of the situations you typically see where people are having alcohol problems in their relationship:

“We just got home from a party. We had a few drinks and a great time. Now we’re bickering again over nothing!”

Or

“I know we’ve got problems, but it’s hard to cut back because all of our friends drink.”

Or

“We went out for a romantic dinner and shared a bottle of wine. We were relaxed and felt close. Then we went to a club and had a few more. Now she’s losing control again and flirting with a stranger. Why does this keep happening? Does she really love me?”

Or

“Things were great before we had kids. But I’m worried. We’ve had some bad fights. And I can’t seem to reach him anymore. Every night he drinks a few beers and just sits in front of the TV.”

How Do You Know if Alcohol Is the Problem?

Maybe you don’t know, because blaming only alcohol may be too simplistic. You may be surprised to read this, but usually relationship problems have several contributing causes. Many relationship issues can become much worse “under the influence” of alcohol. And alcohol affects relationships in several ways:

1. as a drug;
2. as cultural ritual; and
3. psychologically.

Alcohol’s Drug Effects

In my practice, I’m perplexed at how often people with obvious drinking problems push back when I suggest they may be self-medicating and might consider a psychiatric medication instead. If I suggest an antidepressant, for instance, they say they’re very uncomfortable with the idea of taking a drug! Alcohol is a drug, of course. By definition, a psychoactive drug chemically changes perception, thinking, and emotionality.

Alcohol also has more unwanted side effects that many prescription medications. Although its chemical effects include calming nervousness, when it starts to wear off, people get more anxious. This and its dehydrating side effect may cause insomnia or make it worse, and make it harder to sustain sleep. Sufficient doses of alcohol also prevent the dreaming sleep that helps us process emotions at night. Even “happy drunks” who drink often find that over time they become more depressed. And although very moderate drinking can have positive health effects, heavy drinking gradually breaks down body and mind.

Here’s an effect most people don’t know: Steady or binge drinking affects brain chemistry long after alcohol has left your body. Psychological testing is distorted as much as two weeks after not drinking — one author advises against testing a “wet brain.” But quitting “cold turkey” can be very dangerous, causing potentially fatal seizures.

Immersion journalism, as it’s called, can be kind of fun on a limited basis. In my days as a reporter, in pursuit of stories I volunteered to get Tasered and learned how to snowshoe. (The Tasering was fun for the cops who got to watch a journalist get nailed; the snowshoeing – a 5K race my first time on the things – was fun mostly in retrospect.)

Then there are immersion journalists who do it up big. Stefan Fatsis, a former Wall Street Journal reporter, became a professional Scrabble player, then a placekicker for the Denver Broncos. AJ Jacobs, an Esquire magazine editor, read the Encyclopedia Brittanica all the way through from A to Z. He followed that by spending a year obeying as many of the 613 rules of the Torah as he reasonably could, given the limitations of 21st-century life. And Norah Vincent, a former print journalist and syndicated columnist, spent 18 months dressing, living and dating as a man. It led to three stays in psychiatric hospitals – one voluntary, as she dealt with her own severe depression following her first book, and two where she felt more or less well, but played the part in the name of research.

The three hospitals Vincent admits herself to are located along the economic spectrum — a ward in an urban hospital with largely indigent, largely heavily-medicated patients; a private substance abuse rehabilitation clinic in the rural Midwest with a small psychiatric component; and an ultra-expensive “alternative therapy” private clinic that goes against most currently accepted psychiatric treatment protocols.

Of the urban hospital experience, where a nurse confiscated the pen Vincent was using to take notes, she said:

Madness is a disease of the will, of judgment. That is what is impaired. And so, in there, along with so much else, your will was taken away, like a pen, because you could not be trusted with it. Yet your will is the thing that makes you feel human. Without it you cannot be well, which is why no one in there really got well, or, arguably, much better.

This is the paradox of asylums, and their fatal flaw. Put a person in a cage and you cannot help him. But leave him to his devices and he cannot help himself, or will not. Freedom is a prerequisite for healing a broken mind. It cannot be fixed against its will. Yet a broken mind is a broken will, a freedom that does harm, even potentially serious physical harm to itself and possibly others, a freedom that can attack or maim. So, how else to heal but by force? (p. 24)

Along the way, Vincent meets a cast of characters who would be comical if they weren’t so – depressing, actually. The pseudonyms she gives them are wonderfully evocative: “Mr. Clean” is a 6-foot-3 psychotic diabetic perpetually begging Vincent to ask her visitors to bring candy. “Mother T,” a delusional 42-year-old Puerto Rican woman, had seen Jesus flying to the part of the city the hospital was in and claimed Jesus had asked her to follow. Twenty-nine-year-old alcoholic “Bunny Wags (…)looked like a hundred and fifty pounds of chewed suet, sitting there pasty, slumped, defeated. … (p.123)”

At the “alternative therapy” clinic, where clients were housed in upscale apartments, did their own grocery shopping and had nearly unlimited access to therapists, Vincent finally was able to recognize life events she’d been repressing and deal with them. But before she gets that far, she still is accurately able to describe life with debilitating depression:

People say that depression is tears and lassitude and fears and self-loathing. But they do not say it is a brain made of tacks, that it is a relentless passing of sentence.

Guilty. I am guilty.

And an equally relentless rumination and breaking down in response to it. Perhaps like autism, depression is a protective reaction to too much information. Too many thoughts.

In this context, it’s interesting to ask: Why can’t a depressive get out of bed? Because if the minute you woke up, you thought of all the ways you could die or be injured or fail or cause death or failure or harm to others in any given day, you wouldn’t get out of bed either. If you thought too long and hard about all the people who die in crosswalks, you would never cross the street. If you thought of all the people who die in car accidents, you would never get in a car. And those are only the simplest considerations.

Life is lived on ignorance, on not thinking about all the possibilities, about ignoring the most basic fact, that you are mortal and that it is unreasonable to expect a sentient, self-conscious creature to live with the idea that she is going to die. (p. 122)

Once opposed to medication, Vincent eventually decides she will take it in the lowest possible dose to help herself stay out of the abyss. But it’s not just the combination of medication and self-care that the therapists always prescribe that is the biggest takeaway from this book:

It’s all of a piece. Together, the pieces bring about the whole, and the sense of wholeness that is essential to staving off depression. … It is up to me to tend to my wholeness. I do it or I don’t. That’s it. … The success or failure is my own.

…as for cure, that’s a fantasy. You don’t finish. You continue. And you don’t do it – you are not forced to do it – because you are mentally ill. You do it because that’s how living works. Maybe depressives like me have to work a little harder at happiness. Maybe psychotics … have to work a lot harder. But everyone has to work at it.

I’m not saying that eating right and exercising, nurturing your heart and challenging your brain, will save you. It won’t. There is no saving, of course. You never “arrive.” You move. You get on with it. That’s the prescription. (pp. 282-283)

I heartily recommend this book for families, friends and caregivers of the mentally ill. It provides an unflinching look at reality. While the subject matter can be difficult, Vincent’s combination of spare language and detailed description keep the reader engaged from start to finish.

In 1983, Robert Fletcher, DSW, ACSW founded an organization to serve that often-overlooked population. The result is the National Association for the Dually Diagnosed (NADD).

At the time of NADD’s founding, it seemed that neither the mental health system nor the mental retardation system wanted to take responsibility for individuals who were dealing with both sets of challenges. At that time, people with intellectual disability (ID) were routinely either misdiagnosed or misunderstood. Individual distress and challenging behaviors were often seen as a function of their intellectual disability rather than symptoms of mental illness. Dr. Fletcher and his colleagues created NADD to help bridge the gap by advocating for services and providing professional development to improve the system of available care. In the years since its inception, the organization has been at the forefront of advances in assessment, treatment, and policy for this under-recognized and underserved population.

25th Anniversary Celebration

NADD celebrated its 25th anniversary at its annual conference from Nov. 12 – 15 in Niagara Falls, Ontario. Over 500 people from eight countries including Israel, Australia, the UK, and Italy, as well as the U.S. and Canada met to exchange information and network with one another.

Keynote speaker David Hingsberger, an internationally known expert in the rights of people with developmental disabilities, spoke eloquently about the long-term effects of violence on people with ID. He called on all conference participants to become actively involved in erasing the language of hate that so often separates people with ID from their community. “Re-tard” is hate language. It stereotypes and diminishes people. Insistence on respectful speech, says Hingsberger, will go a long way toward helping people with ID feel they have a rightful place in their world.

He went on to talk about how people with disabilities are frequently told to “just ignore it” when others put them down or hurt them. Saying that is, in essence, telling a person who has been hurt to shut up. It compounds the original insult by demanding the person’s silence. This is how social brutality is reinforced and groups of people are marginalized. Equality comes from standing up instead of shutting up. Hingsberger urges us to stand up and be part of a movement that asserts the right of all people to be treated with respect. Every contact we make with people with ID, he maintains, can either continue trauma or promote healing.

Two days of seminars, symposia, and presentations followed. The conference offered over 60 different educational sessions and 22 poster sessions. Topics included cutting-edge information about psychopharmacology, best practices in interventions, family support needs, staff training programs and research.

One of the many things that makes NADD special is its encouragement of eclecticism. There is much yet to learn about the dually diagnosed population. Active inquiry and exchange of ideas among the professional disciplines as well as interested laypeople continue to bring the field forward.

Consistent with its educational mission, NADD publishes a large library of training materials, CDs and DVDs to disseminate research and support staff training. The publication of the Diagnostic Manual – Intellectual Disabilities (DM-ID) last October was the culmination of years of work and is a major step forward in providing a consistent framework for diagnosis of mental illness in those with intellectual disability (see Psych Central’s review). The NADD Bulletin started out as a two-page newsletter and is now a respected journal in the field of intellectual disabilities. The debut of a new journal, The Journal of Mental Health Research in Intellectual Disabilities, was a highlight of the conference.

Happy 25th Birthday, NADD! I’m looking forward to your 26th in New Orleans.

To learn more about NADD, please visit the theNADD.org website.

However, Al-Anon and Alateen focus on alcoholism and alcohol issues, not other substance abuse problems. Only concerns related to the impact of a relative or friend’s drinking and application of the Al-Anon/Alateen principles are discussed at Al-Anon/Alateen meetings and appear in Al-Anon/Alateen literature.

Al-Anon meetings are usually listed in print and online meeting schedules as “open” or “closed.” Anyone interested in Al-Anon may attend an open Al-Anon meeting. Closed Al-Anon meetings are for people who can identify that they are being or have been affected by a relative or friend’s drinking, or are already members of Al-Anon. All Alateen meetings are closed to adults so that younger family members can conduct their own meetings with only one or two adult Alateen Group Sponsors available for guidance.

It is appropriate to refer a patient, consumer, or client to Al-Anon when:

1. They are being or have been affected by a problem drinker or alcoholic. It is possible that the relative or friend of the alcoholic or person abusing alcohol has a different relationship to the potential Al-Anon newcomer than the individual who is dependent upon drugs or other substances. However, person is still welcome to attend Al-Anon in instances such as this because someone else’s drinking has impacted his or her life.

2. The drinker is dependent both upon alcohol and other substances. Individuals with this type of experience need to know that they will only hear the principles of the Al-Anon/Alateen program and experiences of members related to the impact of someone else’s drinking discussed at the meetings. Someone concerned about a relative or friend’s use of drugs may hear other members share that their loved one’s use of both alcohol and drugs. In this case, the newcomer can speak with the Al-Anon member before or after the Al-Anon or Alateen meeting, or personally contact the member on their own.

3. Adults or younger family members who are uncertain whether or not they have been or are being impacted by someone else’s drinking. Newcomers or younger family members are encouraged to attend at least six Al-Anon or Alateen meetings before deciding whether or not Al-Anon or Alateen can be helpful to them because they are or have been affected by someone else’s drinking. It is also recommend to attend different Al-Anon or Alateen meetings because each group has its own characteristics and varied membership.

Local Al-Anon meeting information for most of the US and Canada is available on Al-Anon’s website, www.al-anon.alateen.org or by calling their toll free meeting information number, 888-4AL-ANON (888-425-2666), which is available from 8 am to 6 pm ET, Monday – Friday.

A major depressive episode involves a depression in mood with an accompanying loss of pleasure or indifference to most activities, most of the time for at least 2 weeks. These deviations from normal mood may include significant changes in energy, sleep patterns, concentration, and weight. Symptoms may include psychomotor agitation or retardation, persistent feelings of worthlessness or inappropriate guilt, or recurrent thoughts of death or suicide. The diagnosis of major depression requires evidence of one or more major depressive episodes occurring without clearly being related to another psychiatric, alcohol or other drug (AOD) use, or medical disorder. Major depression is subclassified as major depressive disorder, single episode and recurrent. There are nine symptoms of a major depressive episode listed in the DSM-IV draft, and diagnosis of this disorder requires at least five of them to be present for 2 weeks.

Dysthymia is a chronic mood disturbance characterized by a loss of interest or pleasure in most activities of daily life but not meeting the full criteria for a major depressive episode. The diagnosis of dysthymia requires mild to moderate mood depression most of the time for a duration of at least 2 years.

A manic episode is a discrete period (at least 1 week) of persistently elevated, euphoric, irritable, or expansive mood. Symptoms may include hyperactivity, grandiosity, flight of ideas, talkativeness, a decreased need for sleep, and distractibility. Manic episodes, often having a rapid onset and symptom progression over a few days, generally impair occupational or social functioning, and may require hospitalization to prevent harm to self or others. In an extreme form, people with mania frequently have psychotic hallucinations or delusions. This form of mania may be difficult to differentiate from schizophrenia or stimulant intoxication.

A hypomanic episode is a period (weeks or months) of pathologically elevated mood that resembles but is less severe than a manic episode. Hypomanic episodes are not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization.

Bipolar disorder is diagnosed upon evidence of one or more manic episodes, often in an individual with a history of one or more major depressive episodes. Bipolar disorder is subclassified as manic, depressed, or mixed, depending upon the clinical features of the current or most recent episodes. Major depressive or manic episodes may be followed by a brief episode of the other.

Cyclothymia can be described as a mild form of bipolar disorder, but with more frequent and chronic mood variability. Cyclothymia includes multiple hypomanic episodes and periods of depressed mood insufficient to meet the criteria for either a manic or a major depressive episode. The revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) states that for a diagnosis of cyclothymia to be made, there must be a 2-year period during which the patient is never without hypomanic or dysthymic symptoms for more than 2 months.

Substance-induced mood disorder is described in the DSM-IV according to the following criteria:

• A prominent and persistent disturbance in mood characterized by either (or both) of the following:
  1) depressed mood or markedly diminished interest or pleasure in all, or almost all, activities,
  2) elevated, expansive, or irritable mood.
• There is evidence from the history, physical examination, or laboratory findings of substance intoxication or withdrawal, and the symptoms in criterion A developed during, or within a month of, significant substance intoxication or withdrawal.
• The disturbance is not better accounted for by a mood disorder that is not substance induced. Evidence that the symptoms are better accounted for by a mood disorder that is not substance induced might include: the symptoms precede the onset of the substance abuse or dependence; they persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication; they are substantially in excess of what would be expected given the character, duration, or amount of the substance used; or there is other evidence suggesting the existence of an independent non-substance-induced mood disorder (e.g., a history of recurrent non-substance-related major depressive episodes) .
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance does not occur exclusively during the course of delirium.

Substance-induced mood disorder can be specified as having 1) manic features, 2) depressive features, or 3) mixed features. Also, it can be described as having an onset during intoxication or withdrawal. For most of the major mental illnesses, the DSM-IV draft includes the alternative of a substance-induced disorder within that diagnosis.

Historically, when patients in alcohol and other drug (AOD) treatment exhibited vivid and acute psychiatric symptoms, the symptoms were either: 1) unrecognized, 2) observed but misdescribed as toxicity or “acting-out behavior,” or 3) accurately identified, prompting the patients to be discharged or referred to a mental health program. Virtually the same process occurred for patients in mental health treatment who exhibited vivid and acute symptoms of AOD use disorders.

Mislabeling, rejecting, failing to recognize, or automatically transferring patients with dual disorders can result in inadequate treatment, with patients falling between the cracks of treatment systems. The symptoms of psychiatric and AOD use disorders often fluctuate in intensity and frequency. Current symptom presentation may reflect a short-term change in the course of long-term dual disorders. Thus, even when patients receive traditional professional help, treatment may address only selected aspects of their overall problem unless treatment is coordinated among services including AOD, mental health, social, and medical programs.

As a result, the treatment system itself may be a stumbling block for some people attempting to receive ongoing, appropriate, and comprehensive treatment for combined psychiatric and AOD use disorders. Thus, treatment services for patients with dual disorders must be sensitive to both the individual’s and the treatment system’s impediments to the initiation and continuation of treatment.

Treatment Systems: Mental Health, Addiction, And Medical

People with dual disorders who want to engage in the treatment process (or who need to do so) frequently encounter not one but several treatment systems, each having its own strengths and weaknesses. These treatment systems have different clinical approaches.

The Mental Health System

Actually, there is no single mental health system, although most States have a set of public mental health centers. Rather, mental health services are provided by a variety of mental health professionals including psychiatrists; psychologists; clinical social workers; clinical nurse specialists; other therapists and counselors including marriage, family, and child counselors (MFCCs); and paraprofessionals.

These mental health personnel work in a variety of settings, using a variety of theories about the treatment of specific psychiatric disorders. Different types of mental health professionals (for example, social workers and MFCCs) have differing perspectives; moreover, practitioners within a given group often use different approaches.

A major strength of the mental health system is the comprehensive array of services offered, including counseling, case management, partial hospitalization, inpatient treatment, vocational rehabilitation, and a variety of residential programs. The mental health system has a relatively large variety of treatment settings. These settings are designed to provide treatment services for patients with acute, subacute, and long-term symptoms. Acute services are provided by personnel in emergency rooms and hospital units of several types and by crisis-line personnel, outreach teams, and mental health law commitment specialists. Subacute services are provided by hospitals, day treatment programs, mental health center programs, and several types of individual practitioners. Long-term settings include mental health centers, residential units, and practitioners’ offices. Clinicians vary with regard to academic degrees, styles, expertise, and training. Another strength of the mental health system is the growing recognition at all system levels of the role of case management as a means to individualize and coordinate services and secure entitlements.

Medication is more often used in psychiatric treatment than in addiction treatment, especially for severe disorders. Medications used to treat psychiatric symptoms include psychoactive and nonpsychoactive medications. Psychoactive medications cause an acute change in mood, thinking, or behavior, such as sedation, stimulation, or euphoria.

Psychoactive medications (such as benzodiazepines) prescribed to the average patient with psychiatric problems are generally taken in an appropriate fashion and pose little or no risk of abuse or addiction. In contrast, the use of psychoactive medications by patients with a personal or family history of an AOD use disorder is associated with a high risk of abuse or addiction.

Some medications used in psychiatry that have mild psychoactive effects (such as some tricyclic antidepressants with mild sedative effects) appear to be misused more by patients with an AOD disorder than by others. Thus, a potential pitfall is prescribing psychoactive medications to a patient with psychiatric problems without first determining whether the individual also has an AOD use disorder.

While most clinicians in the mental health system generally have expertise in a biopsychosocial approach to the identification, diagnosis, and treatment of psychiatric disorders, some lack similar skills and knowledge about the specific drugs of abuse, the biopsychosocial processes of abuse and addiction, and AOD treatment, recovery, and relapse. Similarly, AOD treatment professionals may have a thorough understanding of AOD abuse treatment but not psychiatric treatment.

Establishing an accurate diagnosis for patients in addiction and mental health settings is an important and multifaceted aspect of the treatment process. Clinicians must discriminate between acute primary psychiatric disorders and psychiatric symptoms caused by alcohol and other drugs (AODs). To do so, clinicians must obtain a thorough history of AOD use and psychiatric symptoms and disorders.

There are several possible relationships between AOD use and psychiatric symptoms and disorders. AODs may induce, worsen, or diminish psychiatric symptoms, complicating the diagnostic process.

The primary relationships between AOD use and psychiatric symptoms or disorders are described in the following classification model (Landry et al., 1991a; Lehman et al., 1989; Meyer, 1986). All of these possible relationships must be considered during the screening and assessment process.

• AOD use can cause psychiatric symptoms and mimic psychiatric disorders. Acute and chronic AOD use can cause symptoms associated with almost any psychiatric disorder. The type, duration, and severity of these symptoms are usually related to the type, dose, and chronicity of the AOD use.

• Acute and chronic AOD use can prompt the development, provoke the reemergence, or worsen the severity of psychiatric disorders.
• AOD use can mask psychiatric symptoms and disorders. Individuals may use AODs to purposely dampen unwanted psychiatric symptoms and to ameliorate the unwanted side effects of medications. AOD use may inadvertently hide or change the character of psychiatric symptoms and disorders.
• AOD withdrawal can cause psychiatric symptoms and mimic psychiatric syndromes. Cessation of AOD use following the development of tolerance and physical dependence causes an abstinence phenomenon with clusters of psychiatric symptoms that can also resemble psychiatric disorders.
• Psychiatric and AOD disorders can coexist. One disorder may prompt the emergence of the other, or the two disorders may exist independently. Determining whether the disorders are related may be difficult, and may not be of great significance, when a patient has long-standing, combined disorders. Consider a 32-year-old patient with bipolar disorder whose first symptoms of alcohol abuse and mania started at age 18, who continues to experience alcoholism in addition to manic and depressive episodes. At this point, the patient has two well-developed independent disorders that both require treatment.
• Psychiatric behaviors can mimic behaviors associated with AOD problems. Dysfunctional and maladaptive behaviors that are consistent with AOD abuse and addiction may have other causes, such as psychiatric, emotional, or social problems. Multidisciplinary assessment tools, drug testing, and information from family members are critical to confirm AOD disorders.

The symptoms of a coexisting psychiatric disorder may be misinterpreted as poor or incomplete “recovery” from AOD addiction. Psychiatric disorders may interfere with patients’ ability and motivation to participate in addiction treatment, as well as their compliance with treatment guidelines.

For example, patients with anxiety and phobias may fear and resist attending Alcoholics Anonymous or group meetings. Depressed people may be too unmotivated and lethargic to participate in treatment. Patients with psychotic or manic symptoms may exhibit bizarre behavior and poor interpersonal relations during treatment, especially during group-oriented activities. Such behaviors may be misinterpreted as signs of treatment resistance or symptoms of addiction relapse.

Alcohol and Other Drug Use and Psychiatric Symptoms

• Alcohol and other drug (AOD) use can cause psychiatric symptoms and mimic psychiatric syndromes.
• AOD use can initiate or exacerbate a psychiatric disorder.
• AOD use can mask psychiatric symptoms and syndromes.
• AOD withdrawal can cause psychiatric symptoms and mimic psychiatric syndromes.
• Psychiatric and AOD use disorders can independently coexist.
• Psychiatric behaviors can mimic AOD use problems.