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05/07/2010 - CO-OCCURRING DISORDERS
The occurrence of psychiatric symptoms as a result of legal and illicit drug use has been well documented. For example, high doses of caffeine can cause anxiety and panic attacks, whereas MDMA ( Ecstacy ) withdrawal can cause depression, memory impairment, and poor concentration. All hallucinogens ( marijuana, LSD, mescaline ) are associated with drug-induced panic reactions that may include paranoia and delusional states.
Depressive disorders, major depression, and dysthymia are among the most common psychiatric problems in the general population. Among drug and alcohol dependent patients, major depression has been associated with worse outcomes, including increased suicide risk. In these patients, the symptoms are not caused by the use of the substance, however the symptoms may be exacerbated by substance use. Mood symptoms such as sadness, anxiety, euphoria, and hopelessness are extremely common in patients with drug and alcohol problems, however may be associated with an independent mood disorder. Abstinence from mood-altering chemicals has always been the first step of treatment. Some symptoms will improve and others will persist.
The cardinal symptoms of social phobias, panic disorders, and post - traumatic stress disorders are distinctive, and are usually not attributable to substance intoxication or withdrawal.
These distinctions are important for development of a treatment plan, including the use of medication and/or behavioral therapy. Treatment for adolescents is significantly different from adult and elderly populations who abuse drugs or alcohol, yet the symptom presentation may be similar.
The astute clinician will always evaluate the patient for these co-occurring disorders. With the average stay in an inpatient treatment program of less than 3-5 days, it is important to know that some of the symptoms will emerge following detoxification and discharge. Follow up with experienced and credentialed clinicians cannot be overemphasized.