Cory F Newman

Depressed individuals who also have problems with alcohol and other drugs face an uphill climb in getting and adhering to the treatment they need to manage and overcome this formidable combination of clinical issues. From a treatment systems standpoint, there has been a historical division between mental health and substance abuse treatment services (Evans & Sullivan, 2001; Mueser, Noordsby, Drake, & Fox, 2003). Until recently, it was fairly common for patients with this comorbidity (often known as "dual diagnosis") to be denied an integrative treatment (Carroll, 2004). Instead, patients were instructed to receive treatment for either the mood disorder or the substance-related problem as a prerequisite to receiving care for the other. Anecdotally, patients have lamented that they tried to seek help, only to be told that their alcohol and drug use precluded them from involvement in the "depression program," or that their depression needed to be "resolved" before they could gain admission into the "drug and alcohol group." The result was that these patients too often fell through the cracks in the mental health care system, feeling shut out from treatment.

Additionally, patients themselves often posed challenges to their own prospects for remission and recovery from either the mood or the substance problems. For example, depressed patients who abused alcohol and other drugs were more apt to find that their trials on antidepressant medications

(ADMs) were unsatisfactory, inasmuch as their recreational and/or addictive use of substances interacted unfavorably with their prescription medications, hindered their cognizance of following directions for proper dosing and scheduling, and may have damaged the liver's ability to metabolize the ADM properly, to name but a few of the difficulties. Similarly, patients may have reasoned to themselves that they "needed" to continue drinking or engaging in related drug abuse to "cope" with their feelings of loneliness, ennui, and/or despair. This sort of maladaptive belief about the role of alcohol and illicit drugs in their lives interfered with these patients' ability to benefit from talk therapy for depression, in that they were poor attenders, were often neglectful in doing therapy homework, and contributed to the decline of the quality of their lives regardless of the quality of their therapy. The patients' faulty beliefs about their "relationship" with alcohol and illicit substances are extremely important targets for intervention in cognitive therapy (CT; Beck, Wright, Newman, & Liese, 1993).

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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