Alcohol Abuse

Since we've recently been covering topics involving the effects of substance use on psychiatric conditions, I thought I would complete the series this week by touching on alcohol abuse as it relates to mental health.

As with other mind altering or inhibition lowering drugs, the use of alcohol makes an initial psychiatric diagnosis very difficult. When people are intoxicated, they often exhibit signs that can resemble many psychiatric conditions. They can become moody, loud, violent, suicidal, paranoid, or behave as though they are manic. Any of these symptoms could also be attributed to a psychiatric condition.

With this in mind, it is crucial for a person to be sober in order for a proper diagnosis to be made by a physician.

Intoxication is not the only problem. Fluctuating levels of alcohol in the blood stream can also cause complications. Alcohol withdrawal often triggers anxiety and in extreme cases also causes psychotic symptoms. Delirium Tremens, the most serious manifestation of alcohol withdrawal, can also be a life threatening situation.

Similar to cigarette smoking, it seems that people with psychiatric conditions are more likely than the general population to abuse alcohol. For example, it is estimated that 10-30% of alcoholics also suffer from depression. Anxiety is another commonly co-existing problem among alcoholics as well as depressed individuals. Often, people believe they will 'feel better' if they use alcohol, but this is a mistake as alcohol has adverse effects on these and other psychiatric conditions.

Also, alcohol abuse lowers inhibitions and often results in impulsive suicide attempts by depressed individuals that never would have happened without alcohol. When the person wakes up in the hospital, he or she is usually remorseful and glad to be alive. Suicide attempts that happen while a person is intoxicated are very often impulsive, unplanned and poorly thought out. Unfortunately, these attempts can be fatal or permanently disfiguring and are a particularly tragic effect of alcohol abuse.

Violence against other people also occurs much more often when alcohol is a factor. The circumstances are similar to unplanned or impulsive suicide attempts - the person committing the violent act never would have done it without the influence of alcohol.

Alcohol can also have dangerous effects if used while a person is also taking some psychiatric medications. The most common effect of mixing alcohol and medication is that the individual becomes impaired more quickly or with a smaller amount of alcohol. This can result in motor vehicle accidents or dangerous or embarrassing behaviour. Alcohol use may also eliminate the benefits of medication - particularly antidepressants.

Getting treatment for co-existing alcohol abuse and psychiatric conditions can be difficult. Sadly, treatment programs for substance use and psychiatric disorders are often separate. In BC, until recently, the two were funded by different government ministries, involved different professional groups and were not integrated or even cooperative.

Patients with chemical addictions are still commonly told they have to be clean and sober before they are able to access any other psychiatric treatment. Similarly, many rehab programs still insist that patients stop all medications before entering. Unfortunately, this is often a recipe for failure as it can result in a person with a serious mood disorder being removed from effective medication at a time when it is most needed.

Ideally, people with co-existing problems should receive treatment by professionals who are well trained in both chemical dependency and psychiatry and who work in teams where both conditions are treated simultaneously and collaboratively. Such integrated treatment is long overdue and should be mandated by funding authorities. To date, not only is there a lack of vision in this area, but also a shortage of professionals who are adequately trained to make this possible.

 

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