The Impact of Psychiatric Problems

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I have stated many times that the key in maintaining long term sobriety is to feel good  If one is feeling bad most of the time , it is only a matter of time before they relapse.  If some one is angry, jealous, lonely. they will relapse.  It does not make a difference if we are justified in our feeling bad; feeling bad causes relapse.

If one is suffering from a psychological disorder, they will be also be feeling bad.  The psychological disorders that are most common are depression, anxiety, bipolar disorder as well as ADHD.  I will save ADHD to another article.


I do not claim to be hugely expert is these problems and I am aware that there are a lot of other sites that review these problems more comprehensively.  I only want to review these concepts quickly.


Depression is most common. Up to 50% of woman will be clinically depressed at some point in their lives and a large fraction of men are also afflicted.  It is normal to get depressed for a few days at a time, it becomes more relevant when the period lasts for  weeks and especially when it last several months. 

Most people feel that sad mood is essential for depression.  While this is a common symptom, it is not necessary to feel sad when you’re depressed.  I feel the most important element is isolation.  Things do not interest us; we withdraw from people and activities that use to cause us pleasure.    Another common problem is lack of concentration making it harder to perform at work and school.  People often report memory problems; this is a result of the lack of concentration. (These symptoms are also seen in withdrawal during the first few months.  The persistence of theses symptoms may be the only way to differentiate between depression and withdrawal).

Sleep disturbance (especially early awakening), weight loss or weight gain, fatigue are also common.  People tend to be irritable and, if they are not too withdrawn, tend to bite off your head.

Many different types of medications are available to treat this and many are quite effective. It is interesting that both marijuana and opiates act as anti-depressants; perhaps these are being used by people to treat depression they are unaware they have.

Anxiety comes in many different forms but all involve fearfulness.  Often anxiety is mistaken with irritability.  If I say hello to an irritable person, they’ll snap at me.  If I say hello to an anxious person, they’ll try to run away.  The following are subtypes of anxiety:

Generalized Anxiety Disorder        chronic level of mild or moderate anxiety

Panic Disorder                             OK most of the time but episodes of panic and impending doom.  People often isolate because they are afraid of losing control

Social Anxiety Disorder                 Fear of certain situations.  It is normal to fear certain situations (such as getting up to speak in a large room) but not getting on a bus.  I once had a person who could not urinate except at home or work.

Post Traumatic Stress Disorder      This occurs after a scare.  It may take months to develop.  It is characterized by intrusive thoughts, nightmares and anxiety brought on by various triggers.

Obsessive/Compulsive Disorder     Some may not consider this a subset of anxiety.  Certain people have highly-structured and ritualistic behavior.  They become very anxious if they are forced to stray from their routine.

Traditionally, people are treated with sedatives such as Xanax and Valium but the use of these medications is problematic in an addicted population.  Luckily a variety of non-habit forming medications are available for use.

Another common problem is bipolar disorder.  Patients get depressed at times but also get “manic” at times.  Mania can be difficult to discern from addiction since many of the characteristics of this disease is seen at various time related to intoxication or drug-seeking behavior.  I try to focus on a time when my patients may have been free of drug use to look for typical behavior. 

A manic person feels good; has lots of energy and can often get a lot of things accomplished.  Every one wants to be a little manic.  However, they may or may not be inefficient at their tasks and are often unable to follow through on what they are trying to accomplish.  They are often intense and dismissive of others.  They exhibit bad judgment and are more likely to spend too much money, act out, commit inappropriate acts or get into a fight.  Concerned friends will often notice the change.  One clue is the periodicity of these symptoms: they last from days to weeks or longer and in between they do well.

The problem is two-fold.  A manic episode is often followed by a period of depression.  Also, relapse often occurs; since bad behavior is not perceived as having consequences, returning to drug use also has no consequences. 

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