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07 September 2010

Co-existing alcohol abuse seldom treated

Between 30 and 60% of alcohol abusers have underlying depression and anxiety disorders. Yet many doctors treat anxiety and depression but fail to treat alcohol dependence.

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Between 30 and 60% of alcohol abusers have underlying depression and anxiety disorders. Yet many doctors treat anxiety and depression but fail to treat alcohol dependence at the same time.

This is according to Prof Willie Pienaar of the Department of Psychiatry at the University of Stellenbosch.

“The problem is that one cannot treat depression and anxiety correctly if a person is abusing alcohol,” says Prof Pienaar.

In the long run alcohol worsens depression even though alcohol intoxication gives the sufferer an immediate escape from depression.

Self-medication
Many people abuse alcohol and/or other substances as a form of self-medication.

Dr Salduker, media spokesperson for the South African Society of Psychiatry says that self-medication is where a person unknowingly uses a drug/substance which alleviates symptoms of an underlying disorder temporarily without proper supervision and reason.

Self-medication goes hand-in-hand with denial. “Denial refers to the defence mechanism where people prefer to not acknowledge consciously something which causes them discomfort or pain. This refers specifically to the concept of stigma around psychiatric disorders where people are not willing to acknowledge that they may be battling with one and prefer to use a substance to gain temporary relief”, says Dr Salduker.

Types of substances
The commonest substance in self-medication is by far alcohol. Self-medication with alcohol is mostly a problem amongst males, however incidence amongst females is increasing at a faster rate than amongst males.

Cannabis is the second most common form of self-medication and is widely used in certain cultures as a symptomatic relief from insomnia, anxiety and depressive disorders. "The incidence of underlying disorders is not clear at this stage," says Dr Salduker. "But cannabis is much more insiduous in its effects and not as potent as alcohol in its effects on the physiology of the body. After long term use studies have demonstrated a chronic amotivation syndrome as seen in some regions in the Caribbean for example. Guys lying in their hammocks completely laid back, totally lacking in productivity is a very common occurrence."

The third most widely used substance often used in self-medication of psychiatric conditions is crack cocaine followed by the likes of over the counter preparations like analgesics, cough mixtures, cold and flu preparations. Analgesic abuse is often under rated and not seen as a form of self-medication for deeper psychopathology.

“Exercise in moderation is very good for the majority of people but exercising excessively, which releases endogenous endorphins in the brain and leads to a sense of well being, is sometimes an attempt to ward off depressive symptoms,” says Dr Salduker.

Interesting facts

  • 10 - 15% of all populations fall into the trap of alcohol dependence.
  • About 30 - 40% of persons with alcohol related disorders meet diagnostic criteria of major depression.
  • Depression is more common in alcohol dependent women than men.
  • Most successful suicides are carried out under the influence of alcohol.
  • 25 - 50% of alcoholics have anxiety disorders.
  • 70% of people who die unnaturally are intoxicated.
  • Addiction is a major dilemma in the mental health of the SA population.

- Ilse Pauw, health24

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