Which Develops First - Substance Abuse or the Emotional Problem?

It depends. Often the psychiatric problem develops first.  In an attempt to feel calmer, more peppy, or more cheerful, a person with emotional symptoms may drink or use drugs; doctors call this “self-medication.”  Frequent self-medication may eventually lead to physical or psychological dependency on alcohol or drugs.  If it does, the person then suffers from not just one problem, but two.

In other cases, alcohol or drug dependency is the primary condition.  A person whose substance abuse problem has become severe may develop symptoms of a psychiatric disorder:  perhaps episodes of depression, fits of rage, hallucinations, or suicide attempts.

What Treatment Options Exist?

Ideally, both problems should be treated simultaneously.  For any substance abuser, however, the first step in treatment must be detoxification - a period of time during which the body is allowed to cleanse itself of alcohol or drugs. It can take a few days to a week or more, depending on what substances the person abused and for how long. Once detoxification is completed, it’s time for dual treatment; rehabilitation for the alcohol or drug problem and treatment for the psychiatric problem. There are several different levels or intensities of care including full hospitalization or inpatient treatment, partial hospitalization, and outpatient treatment. Rehabilitation for a substance abuse problem usually involves individual and group psychotherapy. The idea is not just to stay off booze and drugs, but to learn to enjoy life without these “crutches.” Treatment for a psychiatric problem depends upon the diagnosis.  For most disorders, individual and group therapy as well as medications are recommended.