HAMS: Harm Reduction for Alcohol

Alcohol and Mental Health: A Harm Reduction Approach to Dual Diagnosis

Introduction

At HAMS we do not see people as having a lifetime disease of alcoholism which forces them to put some label like "alcoholic" on themselves--we see these labels as harmful and an impediment to change. Rather we see people who have problems with alcohol which they can solve by choosing to practice safer drinking, reduced drinking, or by quitting alcohol altogether.

Likewise at HAMS we do not see a value in people placing the label of "mentally ill" on themselves for the rest of their natural lives. We see this kind of labeling as both harmful and an impediment to getting better. We find it far more useful and therapeutic to talk about people having life issues with depression or anxiety or panic or social phobia or PTSD or what have you. These are issues which can be dealt with in varying ways according to the choice of the individual who has them. Some options are medication or talk therapy or a support group or a self help book. Or any combination of them.

Research by George Vaillant shows us that there are more than a few people who solve alcohol problems on their own without any outside help. Research by Hans Eysenck shows that the same is true of problems with mental health.

Here at HAMS we are supportive of whatever path individuals choose for dealing with their life issues just as we are supportive of whatever path they choose for dealing with their drinking issues. We find nothing unusual at all in people becoming depressed because they have had to deal with depressing life events. We also do not find it unusual that some people will choose to drink to deal with these depressing life events. HAMS does not care much for the term "Dual Diagnosis". We talk about life issues which co-occur with drinking issues and we believe that improvements can be made in both areas. We also believe that an improvement with a life issue can help make it easier to change a drinking issue and vice versa. We would never follow the a model which requires people to abstain from alcohol before they can benefit from psychotherapy; HAMS considers such attitudes cruel and inhuman and outdated and long ago demonstrated to be failures.

HAMS will always support you in working on a life issue or a drinking issue according to YOUR choice and YOUR priorities. We are here to be supportive when you want to try to get better and work to get over life issues which have been giving you problems or bad drinking habits which have been giving you problems.

Here at HAMS we like to focus on mental health and changes for the better with both life issues and drinking issues. The motto "Better is better" applies equally well to life issues and to drinking issues. We believe that everyone is capable of making positive changes in both their life issues and their drinking issues.

The paths to change are myriad! Choose one or more of these paths and we will support the hell out of you on it!!

The Chicken or the Egg?

There has been a great deal of debate over whether mental health issues such as depression or anxiety lead to alcohol use or whether excessive alcohol or drug can lead to mental health issues. The current state of the research suggests that there are both cases where the former is true and cases when the latter is true. Let us take a little closer look at the research here.

The Self Medication Hypothesis: The self medication hypothesis assumes that people use alcohol or other drugs to alleviate unpleasant symptoms of mental distress. As we shall see below this seems to be true of some forms of mental distress but not of others.

Depression: The current research suggests that there are both cases where heavy drinking can lead to depression (Raimo & Schuckit 1998; Swendsen, et al 2000) and cases where depression can lead to heavy drinking (Swendsen, et al 2000; Vengeliene et al 2005). Generally when heavy drinking leads to depression the depression tends to lift after an abstinence period. There are also cases where depression--situational or other-leads to heavy drinking to alleviate its symptoms. This follows the self medication hypothesis.

Please also see our page Drinking and Depression

Social Phobia: Social phobia and other phobias generally seem to precede alcohol use and conform to the self-medication hypothesis (Swendsen, et al 1998).

PTSD (Post Traumatic Stress Disorder): Chilcoat and Breslau followed 1,000 young adults enrolled in a health care program for a period of five years. Their results showed that subjects who had PTSD at the time of enrollment were four times as likely as others to develop substance use problems. On the other hand those with substance use problems at the time of enrollment were no more likely than others to develop PTSD. These facts lend support to the self medication hypothesis for PTSD and alcohol use.

Bipolar (Manic Depressive): There is no evidence that Manic Depressive Disorder is developed as a result of drinking alcohol. There is some evidence which suggests that Manic Depressives may use alcohol to accentuate the Manic Phase or to medicate the Depressive Phase.

Anxiety: Anxiety and Panic are generally considered to be Bidirectional with heavy drinking (Kushner et al, 2000). Alcohol can cause anxiety as a part of a hangover or part of withdrawal symptom. Alcohol also relieves anxiety during periods of intoxication. So people might use alcohol to relieve an underlying anxiety problem.

Borderline Personality Disorder: Borderline Personality Disorder and Alcohol Use Disorder seem to stem from common factors rather than one causing the other (Trull et al 2000). The common factors are hypothesized to be: inherited deficiencies in serotonergic functioning and deviant family environment.

Antisocial Personality Disorder (Psychopathy, Socipathy): Antisocial Personality Disorder is very commonly found to co-occur with drug or alcohol use disorders. It is uncertain what the relationship between the two is (Bennett et al 2007). It is very difficult to treat Antisocial Personality Disorder which co-occurs with Substance Use Disorder because these people do not care if they harm others.

Schizophrenia: Schizophrenia does not fit will with the self medication hypothesis. The jury is still out on the relation between substance use problems and schizophrenia (Bennett et al 2007).

See also our web page on The Prevalence of Co-Occurring Issues.
and our web page More on Dual Diagnosis
and our web page Antisocial Personality Disorder and Alcohol

REFERENCES:

Bennett, ME & Gjonbalaj-Morovic, S. (2007). The Problem of Dual Diagnosis. In Adult Psychopathology and Diagnosis, 5th Edition

Chilcoat HD, Breslau N. (1998). Investigations of causal pathways between PTSD and drug use disorders. Addict Behav. Nov-Dec;23(6):827-40.
PMID: 9801719 [PubMed - indexed for MEDLINE]

Eysenck, H. J. (1952). The effects of psychotherapy: An evaluation. Journal of Consulting Psychology, 16, 319324.
http://psychclassics.yorku.ca/Eysenck/psychotherapy.htm

Kushner MG, Abrams K, Borchardt C. (2000). The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings. Clin Psychol Rev. Mar;20(2):149-71.
PMID: 10721495 [PubMed - indexed for MEDLINE]

Raimo EB, Schuckit MA. (1998). Alcohol dependence and mood disorders. Addict Behav. Nov-Dec;23(6):933-46.

Stewart SH, Pihl RO, Conrod PJ, Dongier M. (1998). Functional associations among trauma, PTSD, and substance-related disorders. Addict Behav. Nov-Dec;23(6):797-812..
PMID: 9801717 [PubMed - indexed for MEDLINE]

Swendsen JD, Merikangas KR, Canino GJ, Kessler RC, Rubio-Stipec M, Angst J. (1998). The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities. Compr Psychiatry. Jul-Aug;39(4):176-84.
PMID: 9675501 [PubMed - indexed for MEDLINE]

Swendsen JD, Merikangas KR, (2000). The comorbidity of depression and substance use disorders. Clin Psychol Rev. Mar;20(2):173-89.

Trull TJ, Sher KJ, Minks-Brown C, Durbin J, Burr R. (2000). Borderline personality disorder and substance use disorders: a review and integration. Clin Psychol Rev. Mar;20(2):235-53. PMID: 10721499
[PubMed - indexed for MEDLINE]

Vaillant, George E. (1995).The natural history of alcoholism revisited Cambridge, Mass. Harvard University Press.

Vengeliene V, Vollmayr B, Henn FA, Spanagel R. (2005). Voluntary alcohol intake in two rat lines selectively bred for learned helpless and non-helpless behavior. Psychopharmacology (Berl). Mar;178(2-3):125-32.
PMID: 15719228 [PubMed - indexed for MEDLINE]

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