Clinical Depression During Addiction Recovery (Process, Diagnosis, & Treatment)

478 Pages·1996·1.36 MB·English

by  Kantor

Cover

Clinical Depression During Addiction
title: Recovery : Process, Diagnosis, and
Treatment
author: Kantor, Jerry S.
publisher: Informa Healthcare
isbn10 | asin: 0824796225
print isbn13: 9780824796228
ebook isbn13: 9780585376561
language: English
Depression, Mental--Treatment, Recovering
addicts--Mental health, Depressive
subject Disorder--diagnosis, Depressive Disorder--
therapy, Substance Dependence--
rehabilitation.
publication date: 1996
lcc: RC537.C558 1996eb
ddc: 616.85/27
Depression, Mental--Treatment, Recovering
addicts--Mental health, Depressive
subject:
Disorder--diagnosis, Depressive Disorder--
therapy, Substance Dependence--
rehabilitation.
Page i
Clinical Depression during Addiction Recovery
Process, Diagnosis, and Treatment
Edited by
Jerry S. Kantor
Addiction Recovery Centre
Fort Myers, Florida
Page ii
Library of Congress Cataloging-in-Publication Data
Clinical depression during addiction recovery: process, diagnosis,
and treatment / edited by Jerry S. Kantor.
p. cm.
Includes bibliographical references and index.
ISBN 0-8247-9622-5 (hardcover: alk. paper)
1. Depression, Mental—Treatment. 2. Recovering addicts—Mental
health. I. Kantor, Jerry S.
[DNLM: 1. Depressive Disorder—diagnosis. 2. Depressive Disorder—
therapy. 3. Substance Dependence—rehabilitation. WM 171 C6405
1996]
RC537.C558 1996
616.85’27—dc20
DNLM/DLC
for Library of Congress 95-45645
CIP
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This book is printed on acid-free paper.
Copyright © 1996 by MARCEL DEKKER, INC. All Rights Reserved.
Neither this book nor any part may be reproduced or transmitted in any
form or by any means, electronic or mechanical, including photocopying,
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system, without permission in writing from the publisher.
MARCEL DEKKER, INC.
270 Madison Avenue, New York, New York 10016
Current printing (last digit):
10 9 8 7 6 5 4 3 2 1
PRINTED IN THE UNITED STATES OF AMERICA
Page iii
To my two beautiful children,
Justin and Jessica
Page iv
Page v
Foreword
In addition to my other numerous acquaintances, I have one more
intimate confidant.… My depression is the most faithful mistress I have
known—no wonder, then, that I return the love.
Soren Kierkegaard (1843), Diapsalmata
Depression:
A Broad-Spectrum Disorder
Depressive disorders range from a relatively simple, time-limited
dysthymia to a more complicated and enduring bipolar illness with
intense depression. Depression, often characterized by strong feelings of
sadness, guilt, worthlessness, and malaise, also can include symptoms
that include sleep disorder, isolation, lack of sexual interest, loss of
appetite, suicidal ideation and suicidal behaviors. Bipolar affect disorder
is a more complex depression that can include psychosis and a wide
variety of other sequelae. There is no single entity that we can call
depression. Instead, depression is best thought of as a broad-spectrum
disorder. This disorder tends to shift perspective toward events past and
preclude interest in the future.
Some depressive episodes can be stimulated by the cessation of
psychoactive drug use. For example, stopping the regular and
immoderate use of cocaine can lead to a dysthymic reaction (i.e.,
anhedonia), on the one hand, and to acute suicidal behavior, on the
other. When patients first enter treatment for substance-abuse disorders,
they often
Page vi
appear depressed; however, as treatment continues, this depression
often begins to remit (e.g., Jaffe and Ciraulo, 1986). The waxing and
waning of depression during substance abuse and recovery led clinicians
to wonder whether depression causes substance abuse or substance
abuse stimulates depression? If substance abuse does stimulate
depression, does the depression reside latently, awakened only by the
trauma of addiction or, alternatively, can substance abuse give rise to
“original” depression? These important questions are rarely addressed.
Kantor and his contributors set out to remedy this situation as well as
other vexing issues in Clinical Depression During Addiction Recovery:
Processes, Diagnosis, and Treatment.
Depression and Substance Abuse—Cart or Horse?
Addiction is a very complex and unyielding phenomenon. Recovery from
addiction can be as perplexing as addiction. As I mentioned before, while
many patients who enter treatment reveal depression that meets
diagnostic levels, depression can also emerge after addiction wanes and
recovery emerges. This coincidence of depression and substance abuse
often led both casual and professional observers to conclude that these
patterns represent an enduring addiction motif. These confluent
conditions expose themselves regularly as a pattern of comorbidity that is
common among patients struggling with addictive disorders (e.g., Weiss
et al., 1988). Whenever a substance-abusing patient presents with
depression, clinicians must investigate antecedent and consequent
events. Is the depression antecedent to the substance-abusing pattern or
has the use of psychoactive substances insidiously stimulated
depression? When depression precedes substance abuse, a series of
possibilities exist to help both patient and provider to understand the
complex patterns of substance abuse. However, before discussing some
of these treatment considerations, it is very important to remember that
for many patients depression actually results from—rather than
engenders—the experience of protracted substance abuse. Furthermore,
and less well recognized, depression can be stimulated by (1) the
recession of addiction, (2) the onset of abstinence, and (3) ongoing tasks
of recovery.
This book offers clinicians essential information about recovery-
stimulated depression. For example, during recovery and without the