Discussion with CADC

[mpopovic]

At a social event, I had a discussion with a CADC about several issues. She works in the public sector/State level, and mentioned that the State sees "alcoholism and substance abuse "as a disease". Looking back, I should have just found someone else to talk to, but since I have a BS in Psychology and my Sister has a Masters Degree and works as a Substance Abuse counselor, I made the mistake of questioning some of her assumptions (she was pretty defensive and borderline hostile at times). My position, as I explained to her, was that "substance abuse as a disease" was an over simplified and inadequate approach to the issue. My premise was that Substance Abuse (SA from here on) was not a singular concept. Primarily it is a Comorbidity found in disorders such as Depression, PTSD, various Anxiety Disorders, and Narcissistic/Anti-Social (and other) Personality Disorders. I asserted that treating SA as the sole issue of a given individual's problems was a flawed approach. SA is indeed a serious issue, and does need to be addressed as a really dangerous and self destructive coping mechanism. However if the root cause(s) of SA comorbidity (Personality Disorders, etc.) are not also addressed, the probability of relapse is much greater, and perhaps inevitable. She responded that by treating SA the other psychological issues are diminished or somehow cured.

So what is the current most recommended approach recommended by the APA regarding treatment of SA - disease or comorbidity?

Somehow we also got into a discussion about Antidepressants and Alcohol. Her position was that Alcohol counteracts the effectiveness of Antidepressants. I'll issue a disclaimer now - I'm not endorsing the combination of Antidepressants and Alcohol. You shouldn't even combine Alcohol and Tylenol, or for that matter most drugs since most all are processed through the Liver. However I contested her position, since for nearly all of the current SSRI's, SNRI's and NDRI's the manufacturer data states that their studies have shown that Alcohol does not increase impairment, but in general is not recommended. Or in some cases, the recommendation is to "not consume alcohol in excess" (which in general is a given: 1-2 drinks per day, then Stop - Period.). Of course if MAOI, TCA's or Anti-anxiety drugs are used, do not drink at all. I explained to her that Alcohol is a short term CNS depressant, and Clinical Depression is an altogether different issue. Depression is a long term syndrome, and Antidepressant treatment is also a long term issue - it takes months to become effective and in most cases the type of Antidepressant is changed or combined with another. They are two different animals. At this point she became pretty outraged, and I managed to bail out of the discussion and escape. Keep in mind that Alcohol is indeed a toxin. Antifreeze in small amounts can produce similar effects - so would you try that too?