Substance Abuse in the Mentally and Physically Disabled

331 Pages·2001·1.87 MB·English

by  Hubbard Martin

Substance Abuse in the
Mentally and Physically Disabled
edited by
John R. Hubbard and Peter R. Martin
Vanderbilt University Medical Center
Nashville, Tennessee
• W BYAOSRE KLEN MARCEL DEKKER, IN C.
D E K K E R
Library of Congress Cataloging-in-Publication Data
Substance abuse in the mentally and physically disabled / edited by John R. Hubbard,
Peter R. Martin.
p. cm.
Includes index.
ISBN 0-8247-0587-4 (alk. paper)
1. Dual diagnosis. 2. Chronically ill—Substance use. I. Hubbard, J. R. (John R.)
II. Martin, Peter R.
RC564.68 .S83 2001
616.86—dc21
2001032419
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In Memoriam
This book is dedicated to Pietro Castelnuovo-Tedesco, M.D., a dear
friend who passed away on January 16, 1998. His contribution to this vol-
ume—retrieved from his briefcase by his wife, Lisbeth—represents the last
contribution to psychiatry from this compassionate and fertile mind. He brings
to us an erudite essay on how psychoanalytical theory may inform our
approach to treatment of individuals who suffer from drug and alcohol
dependence. He draws on a long career devoted to explorations in psychother-
apy, psychoanalysis, and psychosomatic medicine. His contribution is all the
more valuable as he addresses the issues of the alcohol- and drug-dependent
patient, at our request, in what was for him a new area, elucidated by his
extensive experience in delivering the highest quality of psychiatric care
throughout a lifetime.
Before his death, Pietro Castelnuovo-Tedesco was the James D. Black-
more Professor of Psychiatry at Vanderbilt University School of Medicine and
a supervising analyst in the St. Louis Psychoanalytic Institute. Prior to his
arrival at Vanderbilt in 1975, he was Chairman of Psychiatry at Harbor General
Hospital in Los Angeles and Professor of Psychiatry at UCLA School of
Medicine. In addition to his leadership role in American psychoanalysis, he is
perhaps best known for two seminal books: The Twenty Minute Hour: A Guide
to Brief Psychotherapy for the Physician and Psychiatric Aspects of Organ
Transplantation.

Preface
Preface
The important interrelationship between substance abuse and psychiatric or
general medical illness has become increasingly clear from both clinical and
scientific sources. Growing attention to this issue is evidenced by the estab-
lishment of subspecialties in addiction psychiatry and addiction medicine. This
book provides current clinical, scientific and epidemiological information on
the etiology, detection, pathology, and treatment of substance abuse patients
who have a comorbid psychiatric or general medical disorder.
Substance Abuse in the Mentally and Physically Disabled is divided into
there parts. Part 1 provides an overview. Assessment instruments, laboratory
data, and major comorbidity epidemiological studies are discussed, in addition
to general information on comorbidity. Part 2 is composed of six chapters on
specific psychiatric illnesses (including anxiety, depression, bipolar disorder,
schizophrenia, personality disorders, and mental disorders of childhood.) It
also includes a chapter by Dr. Castelnuovo-Tedesco (now deceased) on psy-
choanalytically informed treatment of alcoholism. Part 3 comprises four
chapters on substance abuse in special subpopulations of general medicine
(including cardiovascular disease, HIV-related illnesses, chronic pain, and
neurological disorders). In addition, a chapter on substance abuse in the elderly
has been provided in light of the ever-increasing age of our population and in
recognition of their special problems.
We wish to thank the many excellent chapter authors who contributed to
this book. Distinguished scientists were recruited from numerous leading
v
vi Preface
universities in the United States. It is our hope that the information and
analysis contained in this text will be helpful to substance abuse clinicians,
general medical doctors, medical specialists, clinical researchers, and basic
scientists who are interested in this exciting and rapidly expanding field.
In addition, we are very grateful to the many administrative assistants
who have helped make this book possible. Our deepest appreciation is also
extended to our families, including Suzanne Hubbard, Tara Hubbard and
Erin Hubbard, Barbara Martin, and Alec Martin for their inspiration, love,
and support.
John R. Hubbard
Peter R. Martin
Contents
Contents
In Memoriam iii
Preface v
Contributors ix
INTRODUCTION
1. Substance Abuse in the Mentally and Physically Disabled:
An Overview 1
John R. Hubbard and Peter R. Martin
SUBSTANCE ABUSE AND MENTAL HEALTH
2. Comorbidity of Anxiety Disorders in Substance Abuse 11
Robert R. Swift and Timothy Mueller
3. Substance Abuse and Depression 33
Lauren P. Lehmann, John R. Hubbard, and Peter R. Martin
4. Bipolar Disorder and Comorbid Substance Use Disorders 59
Carlos A. Zarate, Jr., and Mauricio F. Tohen
vii
viii Contents
5. Substance Abuse in Schizophrenia: Biological Factors Mediating
Comorbidity and the Potential Role of Atypical Antipsychotic
Drugs 77
Myung A. Lee and Herbert Y. Meltzer
6. Substance Abuse and Personality Disorders: The Impact of
Three Personality Clusters on Prevalence, Course,
and Treatment 103
Lisa A. Ottomanelli and Bryon Adinoff
7. Comorbid Mental Disorders in Adolescents with Substance
Use Disorders 133
Duncan B. Clark and Jeanette Scheid
8. Comments on the Psychoanalytically Informed Treatment
of Alcoholism 169
Pietro Castelnuovo-Tedesco
SUBSTANCE ABUSE AND PHYSICAL DISABILITIES
9. Cardiovascular Disease and Substance Use Disorders 179
Robert P. Albanese, Jr., W. Blake Haren, and John R. Hubbard
10. The Relationship of Substance Abuse to the Human
Immunodeficiency Virus: Background and Management 203
Stephen A. Wyatt and Richard S. Schottenfeld
11. Chronic Pain and Substance-Related Disorders 241
John R. Hubbard and Edward A. Workman
12. Substance Dependence in the Elderly 265
Richard R. Irons and Donald E. Rosen
13. Neurological Disorders and Head Injuries 277
David D. Weinstein and Peter R. Martin
Index 307
Contributors
Contributors
Bryon Adinoff, M.D. Department of Psychiatry, University of Texas South-
western Medical Center, and VA North Texas Health Care System, Dallas, Texas
Robert P. Albanese, Jr., M.D. Departments of Psychiatry and Internal
Medicine, Medical University of South Carolina, and Ralph H. Johnson VA
Medical Center, Charleston, South Carolina
Pietro Castelnuovo-Tedesco, M.D.† Department of Psychiatry, Vanderbilt
University School of Medicine, Nashville, Tennessee
Duncan B. Clark, M.D., Ph.D. Department of Psychiatry, Pittsburgh Ado-
lescent Alcohol Research Center, and University of Pittsburgh, Pittsburgh,
Pennsylvania
W. Blake Haren, M.D. Departments of Psychiatry and Internal Medicine,
Medical University of South Carolina, and Ralph H. Johnson VA Medical
Center, Charleston, South Carolina
†Deceased.
ix