-- AN  ONLINE  PUBLICATION --


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:

                        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

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