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This study determines the substance use and abuse patterns among patients with comorbid substance-related disorder (SRD) and dysthymia in SRD-dysthymia as compared with patients with SRD only. Differences in use and abuse patterns could be useful for (a) understanding motivations for use, such as self-treatment, and (b) assisting clinicians to identify cases of dysthymia among SRD patients. Retrospective and current data were obtained regarding history of substance use and current SRD diagnoses. Two university medical centers with alcohol-drug programs located within departments of psychiatry were the settings. A total of 642 patients was assessed, of whom 39 had SRD-dysthymia and 308 had SRD only. Data on past use were collected by a research associate using a questionnaire. Current SRD and dysthymia diagnoses were made by psychiatrists specializing in addiction. The patients with SRD-dysthymia and SRD only did not differ with regard to use of alcohol, tobacco, and benzodiazepines. The patients with SRD-dysthymia started caffeine use at an earlier age, had shorter 'use careers' of cocaine, amphetamines, and opiates, and had fewer days of cocaine and cannabis use in the last year. They also had a lower rate of cannabis abuse/dependence. This study indicated that patients with dysthymia and SRD have exposure to most substances of abuse that is comparable to patients with SRD only. However, they selectively use certain substances less often than patients with SRD only. Early use of caffeine may reflect self-treatment for depressive symptoms among patients with SRD-dysthymia., INTRODUCTION We know little about substance use among patients with comorbid substance-related disorder (SRD) and dysthymia (1-3). This paucity of understanding probably stems from two issues: (a) the long duration [...]

The purpose of this paper is to describe an outpatient dual-diagnosis treatment program and 1-year clinical outcome and hospital utilization data. Subjects were 118 consecutive admissions to the Seattle Veterans Affairs (VA) Medical Center's Dual Disorders program over the period from June 1, 1992, to August 31, 1994. Program eligibility requirements included having a current substance use disorder and an active non-substance-related major Axis I disorder (typically major depression, post-traumatic stress disorder [PTSD], bipolar disorder, or schizoaffective disorder). The treatment frame involved group-based programming (including support, medications management, and psychoeducation), routine urine drug screening, and crisis interventions. Results showed that subjects averaged 1.5 non-substance-related Axis I psychiatric disorders (54% involving psychotic symptoms) and 1.8 active substance use disorders. Patients stayed engaged in treatment for a median of 217 days, with 60% of patients having no positive drug screens, and the overall sample having a 40% reduction in the number of inpatient bed days in the year after intake. Conclusions were that, for a number of patients with comorbid disorders, psychiatric stabilization and cessation of substance use can be accomplished within an outpatient treatment frame that averages two completed clinical contacts per week., INTRODUCTION Dual diagnosis, that is, comorbid substance use and psychiatric disorders, has received considerable attention in recent psychiatric literature. Estimates of the prevalence of substance abuse in psychiatric populations range [...]

The purpose of this paper is to evaluate two models of behavior change: cognitive theory and 12-step theory. Research subjects were drawn from three separate, but parallel, samples of adults. The first sample consisted of out-of-treatment chronic drug users, the second consisted of drug users who had applied for treatment at a publicly funded multiple-provider drug treatment facility, and the third consisted of drug users who had applied for treatment at an intensive outpatient program for crack cocaine users. Cognitive theory was supported. Study participants applying for drug abuse treatment reported a higher level of perceived problem severity and a higher level of cognitive functioning than out-of-treatment drug users. Two hypotheses drawn from 12-step theory were not supported. Treatment applicants had more positive emotional functioning than out-of-treatment drug users, and one treatment-seeking sample had higher self-esteem. Key Words. Cognitive functioning; Drug abuse; Emotional well-being: Hitting bottom; Psychological functioning; Treatment; 12-step theory, INTRODUCTION Drug abuse treatment is generally regarded as a voluntary process of counselor- or therapist-assisted self-change. In this way, drug abuse treatment resembles other therapist-assisted self-change processes. The voluntary aspect [...]

This article discusses 3 different strategies for dealing with the harmful consequences of drug use and other risky behaviors: We can discourage people from engaging in the behavior (prevalence reduction), we can encourage people to reduce the frequency or extent of the behavior (quantity reduction), or we can try to reduce the harmful consequences of the behavior when it occurs (harm reduction). These strategies are not mutually exclusive; this article offers a framework for integrating them. The framework is useful for examining frequent claims that harm reduction 'sends the wrong message.' Opposition to harm reduction is based in part on a recognition of potential trade-offs among the strategies, but it is also fueled by several more symbolic psychological factors. Strategies for successfully integrating prevalence reduction, quantity reduction, and harm reduction are explored.

Swiss adolescents, aged 16 to 17 years, were asked about their past drug use, their intended drug use, their optimism about their future health, their negative emotions, and their well-being. On the basis of their self-reports, they were divided into 3 types of drug users: nonusers, experimenters, and frequent users. Compared with nonusers, experimenters and frequent users reported low optimism and more negative feelings. Females reported more negative feelings and less psychological well-being than did males, but the genders did not differ regarding optimism. Logistic regression demonstrated that optimism about future health was a protective factor for the intention to use drugs. Students who perceived themselves as less vulnerable to harm had in the past not used drugs and intended not to accept drugs when given the occasion. The implications of the findings for prevention of drug use are discussed.

The correlates and consequences of parental psychopathology were studied in families with comorbidity of substance abuse and anxiety disorders. There was a strong rate of specificity of familial aggregation of both anxiety and substance disorders. Conduct disorder and depression rates were higher among offspring of all affected parents. The findings regarding the specificity of transmission of the anxiety disorders and links between parental substance abuse and antisocial personality with child conduct disorder were further strengthened with the inclusion of co-parent disorders.

Extreme sensations - thirst, pain - can focus attention on local consequences at the expense of the overall, perhaps for good evolutionary reasons. Maybe the same phenomenon evolves from prolonged use of addictive substances. The matching law explains mistaken choice, not how a person who has confronted personal catastrophe manages to ignore it in making a locally induced choice.

Heyman's target article is an analytical tour de force, but it makes too hard a distinction between voluntary and driven behavior. It is more fruitful to think about brain and behavior as shifting, interacting 'agents,' represented by multiple neural circuits. This has the virtue of better connecting behavioral analysis with wet neuroscience.

Heyman's two crucial theses are that people over-value immediate rewards, and that addictive substances 'subvert the value of competing commodities.' These perennial ideas were discussed by Plato. Whereas Heyman provides scientific clarification and support for the first, the second remains problematic. I outline how this deficiency might he remedied via evolutionary considerations.

Relapse - Issues and Answers Relapse is more than just using alcohol or drugs. It is a process of becoming so dysfunctional in recovery that use seems like a reasonable […]

A study recently completed by The Willough at Naples, a Florida-based psychiatric hospital that specializes in eating disorders, as well as chemical dependency, suggests a possible link between the two [...]