_________________________________________________________________ VOLUME 5, ISSUE 1 PSYCHNEWS INTERNATIONAL July 2000 -- AN ONLINE PUBLICATION -- _________________________________________________________________ SECTION F: DISCUSSION CORNER -------------------------------------------------------- Note: This section is a continuation of essays by Fred Cutter, Ph.D. (Licensed Psychologist; San Luis Obispo CA 93401). It is explicitly named "Discussion Corner", because the author invites others to submit their thoughts, experiences, data, and of course new topics. Dr. Cutter will collect these and publish them in subsequent issues. Please send comments to the PsychNews Int'l mailbox: psychnews@psychologie.de -------------------------------------------------------- ADDICTIVE BEHAVIOR Fred Cutter, Ph.D. This is usually divided into abuse versus dependence with the line between them quite porous. Users can be described as situational, symptomatic, or syntonic. This refers to a description of usage. Thus soldiers in VietNam were exposed to a situational temptation to use substances. Most returned home with no addiction. Symp- tomatic refers to the effort to self medicate for a mental disor- der. Syntonic is the life style user of weekend cocaine or daily marijuana or alcohol intake. The situational is self correcting. The symptomatic needs psychotropic medications (anti-anxiety, mood stabilizers or antipsychotic), the syntonic users only suffer distress when caught, and are relatively untreatable until their life becomes unmanageable. Obtaining substances varies with each one: a) obtaining street drugs requires cash and breaking the law to use, and to steal for money; b) Prescription renewals requires a visit to a physician who may not notice the addictive pattern and is usually paid by health insurance; c) purchasing alcohol requires a visit to an available market with the cost usually affordable without the need for stealing Cross addiction between alcohol dependence and other substances is often ignored. Heroin, cocaine, prescription anxiolytics often replace alcohol addiction; more commonly addictive substances can be supplemented or replaced by alcohol. Thus severe alcoholism can be treated by prescribing benzodiazepines. Withdrawal from Valium can induce return to substances or clinical depression if abstinence continues. Familial history of alcohol dependence is a highly relevant item in predisposing children to become adult addicts, and to marry other adult children of alcoholics or ACA. These are fellow victims. There is an emotional division of labor in such couples that allows one to use and the other to facilitate; when addic- tive partners separate, the sober ones find other addictive partners or become overt users themselves. Among severe alcoholics, there are stages of mental age recovery following cessation of intake. Attitude changes can be detected as the interval increases since last ingestion. Their are separate describable syndromes for each period following detoxification from severe addiction (2-7 days), recovery (5-30 days) family changes (30-180 day), rehabilitation (12 to 18 months). These changes are suggestive of increasing social maturity such as seen in preteen, teen, early adult behavior. Relapses and return to substance dependence can occur any time and are a constant threat. Dual diagnosis has been recognized for many years now, in which mental illness syndromes such as mood or psychotic disorders can be diagnosed in patients who are also dependent on alcohol, street drugs or other prescriptions. These self-mediators tend to seem to take anything that is available. In AA circles, "hitting bottom" is recognized as the start of recovery. Professionals can contribute by helping to raise the bottom, e.g. advising spouses to stop supporting addictive be- havior, making medication decisions contingent on AA or Rehabili- tation participation, other services require continuing ab- stinence, etc. In clients with dual diagnoses, treatment for one syndrome tends to aggravate the other in a socially downward spiral where for example anti-psychotic medications are stopped or taken with alcohol, cocaine, heroin etc. until failing health or the law creates a "bottom". Abstinence is absolutely necessary in the first year of recovery. There are many exceptions to this, but there is too much cost to taking a chance. Abstinence usually requires an external duress from health, family, debts or law enforcement. Self driven desires to seek improvement do occur despite the above, and are to be supported when observed. Suicide is a risk especially when abstinence is successful as with the use of disulfiram (antabuse). Psychotropics are not specific for addictions, except that anxio- lytics, alcohol, or street drugs can ease the distress of recovery, but then so can AA meetings prn. Three times daily can be helpful in the acute phases and is not uncommon in successful recoveries. _________________________________________________________________