Faculty Bibliography

The renewed public, governmental, and professional interest in addictive disorders should serve to encourage the interest of psychiatrists in this important and rapidly changing field. It is the view of the Group for the Advancement of Psychiatry (GAP) Committee on Alcoholism and the Addictions that all psychiatrists should possess expertise in the recognition, assessment, and treatment of substance use disorders. This position paper by the GAP committee reviews the role of the psychiatrist in the evaluation and treatment of patients with substance use disorders. It also notes some of the obstacles to full involvement in this field by medical practitioners in general and psychiatrists in particular. The psychiatrist has a critical role to play in the diagnosis and treatment of patients with substance use disorders. As biopsychosocial phenomena, substance abuse problems constitute a special and direct challenge to the psychiatrist, whose training, perspective, and competence should span all three domains. Psychiatrists must be willing to accept this challenge and fully participate in the development and application of treatment strategies adequate to cope with the enormous human suffering resulting from the abuse of alcohol and other psychoactive drugs

The authors studied 40 cocaine-dependent subjects admitted to psychiatric inpatient wards of a metropolitan hospital because of general psychiatric symptoms. The results indicate that the predominant form of cocaine administration (88%) was freebasing 'crack.' DSM-III-R cluster B personality disorders (N = 17) and schizophrenia (N = 13) constituted the diagnoses for 75% of the sample. Compared to the schizophrenic patients in this cohort, the patients with cluster B personality disorders used cocaine in greater quantities and more frequently and began abuse of the drug at an earlier age. The escalation in urban areas of psychiatric hospitalizations attributed to use of crack may be largely related to psychiatric symptoms in cocaine-dependent patients with personality disorders as well as cocaine-induced psychopathology in schizophrenic patients

In order to ascertain the relative impact of coercion by a welfare program on retention in an ambulatory alcoholism program, records of 178 consecutive admissions to an inner-city alcoholism clinic were reviewed. Patients who came to the clinic via coerced referral from a public assistance agency were as likely to remain in treatment for at least nine sessions as self-referred patients

The authors studied 100 impaired physicians who were successfully treated in a program that combined professionally directed psychotherapeutic treatment and peer-led self-help. An average of 33.4 months after admission they all reported being abstinent and rated Alcoholics Anonymous (AA) as more important to their recovery than professionally directed modalities. Feelings of affiliativeness to AA, which were very high, were strong predictors of the respondents' perceived support for their recovery. These feelings, and an identification with the role of care giver in addiction treatment, appeared to be central to their recovery process

Plasma levels of 3 methoxy, 4-hydroxy phenylethyl glycol (MHPG) of detoxified alcoholics were found to be positively correlated with age as previously found with normal subjects. The slope of the regression line of plasma MHPG and age of the alcoholics in remission was significantly steeper than that of normal controls, indicating a faster age-related increase of MHPG in alcoholics

Modern cults and zealous self-help movements exercise an intense group influence and can have a major impact on their members' psychiatric status. On the basis of research findings, the author describes the charismatic group, a generic model for such cohesive, intensely ideological movements. He examines the psychological forces they tap and the way they can both relieve and exacerbate psychopathology. The model is then used to explain the operation of zealous self-help programs that address psychiatric syndromes; these are directed at problems of the medically ill, substance abusers, and relatives of psychiatric patients