Depression and Addictive Behavior Double

Depression and Addictive Behavior

Double Cruel Hand

Comobid Conditions

Contemporary, Challenging Concerns Worldwide

Derangement of the Volition 7 Contemporary Addictions

Addictions

VMAT2

Role of Cocaine Use in Depression

Clinical Techniques of Helping

Pharmacogenetics

Quit

Tried and True" Techniques

Medications

Points for Treatment Consideration

Clients' Reported Med Use When Admitted to Substance Abuse Clinics

Personal Growth and Maintenance (adapted from Daley, 2007)

"To Do" Recommendations

Physical and Lifestyle Areas Meriting Focus in Recovery

Emotional Areas Meriting Focus in Recovery from Addiction and Depression

DEPRESSION and ADDICTIVE BEHAVIOR

INTRODUCTION

Addiction and depression are common comorbid conditions." (Daley, 2007)

Double Cruel Hand

Comorbid," the term Daley (2007) purports in this study's introductory quote, denotes addiction and depression. According to Webster's New Millennium ™ Dictionary of English, comorbid, an adjective, pertains "to two diseases which occur together, such as ADHD and depression," (comorbid, n.d) or in the case of this research effort: addiction and depression. In the 1997 book, Terry, George McGovern, a former U.S. Senator, recounts details of his daughter Terry, who battled both the addiction of alcoholism and depression. McGovern wrote that Terry "was dealt a double cruel hand: the companion demons depression and alcoholism. They were demons that warred ceaselessly against the other aspects of her being -- a warm and sunny disposition." (Daley, 2007) According to McGovern, he and Terry's mother, along with numerous others who cared about Terry, repeatedly tried to help her recover. Late one December evening, however, despite attempted interventions by family and friends, a police officer and minister related details of Terry's death to the McGoverns. After consuming alcohol, Terry had gotten drunk and passed out in the cold, where she froze to death. Experiences McGovern (Daley, 2007) shares in Terry's story reveal that not only does the person suffering from common comorbid conditions such as an addiction, along with depression, his/her family simultaneously suffers.

In Terry's case, as common to individuals suffering a dual diagnosis, alcoholism combined with depression challenged the course of her recovery. Similarly, a person suffering from addictive behavior, coupled with depression, faces a challenging course to reach recovery. Samuel Taylor Coleridge, (1772-1834), a British poet and critic, who suffered from addiction to laudanum, in addition to depression, reportedly experienced difficulty completing numerous projects and, as a result berated himself for his "indolence."

Everett (2000) notes that whether Coleridge's increasing use of opium depicted a symptom or a cause of his growing depression is not clear. Even today, no model, as in Coleridge's time, completely explicates the addictive behaviors in a lucid, scientific manner. Nor does any definition propose a common cause for various "addictive" behaviors. (Campbell, 2002)

Significance of Study and Thesis Statement

Consequently, the thesis this researcher purports for this study proves significant, as it aims to enhance understanding regarding the relationship between addictive behavior and depression. Research indicates addictive behavior may evolve from depression, albeit depression may simultaneously stem from addictive behavior, as each "disorder" contributes to the other, this researcher contends. To confirm this particular proposed thesis, through the course of analyzing literature retrieved through the literature review, this study examines answers to the research question: How does addictive behavior relate to depression?

Problem Statement

Findings from a study conducted by Daley (2007), along with colleagues at Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, reveal that individuals with addiction and depression experience:

higher risk for suicidal and homicidal behaviors, poorer treatment adherence, higher relapse rates to either disorder, and higher re-hospitalization rates." (Cornelius et al., 1997; Salloum et al., 1996; Daley & Zuckoff, 1998 & 1999; cited by Daley, 2007)

Comobid Conditions

When individuals suffering from a dual diagnosis, also known as "comorbid conditions," professional treatment, as well as involvement in recovery can significantly, positively impact some clients and their family members, Daley (2007) stresses, while helping them manage the disorder s and improve quality of life for persons involved.

A number of treatments which may prove effective for depression include, but are not limited to:

interpersonal psychotherapy, cognitive behavioral therapy and supportive counseling; anti-depressant medications; and electroconvulsive therapy (ECT)." (Daley, 2007) few of the numerous effective treatments to treat addiction include "behavioral therapies and counseling, and sometimes, the use of medications." (Daley, 2007)

Treatment should be "integrated" and go beyond symptom reduction by helping the client engage in a recovery process (Daley & Thase, 2000). Recovery aims to help the client manage the disorders over the long-term by making changes in self and lifestyle and may occur in any of the major domains of functioning.... (Daley, 2000; cited by Daley, 2007)

The following figure (1) denotes 11 vital points for consideration in professional treatment and recovery of addiction and depression.

Figure 1: Points for Treatment Consideration (adapted from Daley, 2007)

High Rates of Combined Disorders

Studies of clinical populations also reveal high rates of numerous combined disorders. (Salloum, Daley & Thase, 2000; Daley & Moss, 2002; cited Daley, 2007) Many clients have to contend with recurrent major depression, and/or dysthymia (a chronic form of depression) or potentially both major depression and dysthymia, identified as, "double depression." Clients contending with addiction and depression frequently have additional DSM IV diagnoses including anxiety, bipolar, personality or other addictive disorders. In one study reported in 2007, conducted with 153 new clients seeking to secure treatment at six different substance abuse clinics, participants revealed "a mean Beck Depression Inventory of 18.8 (sd=13.0), which is in the moderate range, and a mean Beck Anxiety Inventory score of 23.3 (sd=21.8), which is in the moderate to severe range." (Daley, 2007)

The following figure (2) portrays percentages of clients' reported meds, when newly admitted to substance abuse clinics.

Figure 2: Clients' Reported Med Use When Admitted to Substance Abuse Clinics (Daley, 2007)

Contemporary, Challenging Concerns Worldwide

Drug addiction reflects a contemporary, challenging concern worldwide, reportedly linked with powerful genetic and environmental influences. Research reveals a variety of genes and biological processes underlie addiction, albeit, individual or a minute number of genes constitutes surveying one pieces of a jigsaw puzzle. Consequently, "individual technology can be biased and render only an incomplete picture." (Public Library of Science, 2008) Accessing and studying a majority of the addiction puzzle pieces from various regions and arranging them together in an orderly manner still may not reveal a complete picture of an addition. It will most likely, however, as this paper, present a semblance of fascinating, emerging patterns that contribute to potential, effective treatment options.

Definitions

The following definitions denote considerations this paper examines.

A addict person who cannot stop doing or using something, especially something harmful (Cambridge, 2008) depression (Unhappiness)

[U] a feeling of unhappiness and lack of hope for the future:

was overwhelmed by feelings of depression.

[C or U] a mental illness in which a person is very unhappy and anxious for long periods and cannot have a normal life during these periods:

Tiredness, loss of appetite and sleeping problems are all classic symptoms of depression. (Cambridge, 2008) clinical depression mental illness which causes feelings of sadness and loss of hope, changes in sleeping and eating habits, loss of interest in...usual activities, and pains which have no physical explanation...,(Cambridge, 2008) manic depression mental illness causing someone to change from being extremely happy and excited to being extremely sad...,(Cambridge, 2008)

During this paper's next segment, the review of literature, this researcher presents more specific information relating to, as well as, exploring the relationship between addiction and depression, which constitute, as Daley (2007) notes: "common comorbid conditions."

REVIEW of the LITERATURE

My case is a species of madness, only that it is a derangement of the Volition, & not of the intellectual faculties."

Samuel Taylor Coleridge (1772-1834) (Columbia, 1996)

Derangement of the Volition

In a letter dated April 26, 1814, regarding his addiction to laudanum, Coleridge, purports that his addiction adversely affected his "Volition" (the power to make his own decisions); however, it did not negatively impact his intellectual faculties. During the winter of 1801-1802, Coleridge's despair deepened due to two causes reportedly attributing to Coleridge's unhappiness: "opium and domestic discord." ("Coleridge's Conversation Poems, 1999) His plight and battle with depression addiction, similar to many individuals suffering "common comorbid conditions" throughout history may be attributed to a myriad of causes. Literature presented in this study's segment, however, claims that no concrete, credible causes for depression and/or addiction yet exist.

Contemporary Addictions

Caffeine Dependence/Addiction in addition to drug and alcohol addictions, addiction to caffeine, a contemporary addiction to a potent, addictive stimulant (caffeine), also "in non-herbal teas (bancha, green and black), chocolate, carbonated sodas, coffee-flavored dairy products and over-the-counter cold medications," (Hunt, 1999) does not present life-threatening health risks, Neal Barnard, M.D., president of the Physicians Committee for Responsible Medicine and author of Foods That Fight Pain, reports, are not life threatening, however, they possess the potential to become a problem. As caffeine stimulates a person's brain, increases his/her heart rate and relaxes kidney muscles, as well as the digestive system, it affects an individual's central nervous system. Excessive caffeine may contribute birth defects, infertility, miscarriage, as well as a decrease in the absorption of vital iron and/or calcium.

Caffeine dependency/addiction may contribute to "insomnia, digestive disorders, gastric irritation, headaches, as well as exacerbated PMS symptoms and emotional irritability," (Hunt, 1999) each potential components of depression. To counter the need for a caffeine "fix," gradually introduction decaf as substitute, albeit decaf also has between 2 and 33 milligrams (mg.) caffeine per 8-ounce serving.

Full-strength coffee has 145 to 272 mg.. A person may also substitute herbal drinks or drink peppermint tea.

As excessive caffeine consumption may impair sleep, a necessary practice to counter depression, re-establishing normal sleep patterns after withdrawal from caffeine may prove difficult as a person's body, frequently artificially stimulated " forgets" how to shut down when he/she becomes tired. Capsules of valerian with kava before going to bed may help, however, tinctures with an alcohol base introduce the herb into a person's system more quickly. Herbs, albeit, are to help support a person through the healing process, not to be deemed as a cure for addiction.

Sweet Addictions Sugar craving often masks a nutritional imbalance, so consequently, individuals experiencing an excessive desire for sugar need to evaluate their diets and make healthy changes.

In 1999, Hunt reported the average American roughly consumes his/her weight in sugar each year. Mood swings, weight gain, and increased risks for diabetes (insulin levels raised), potential kidney stones, lower immunity and pain threshold, as well as vital minerals' loss, including calcium and magnesium, which may contribute to osteoporosis, evolving from excessive sugar consumption may serve as factors' contributing to depression, due to sugar's accompanying "side affects."

New" Addictions

Research documents that serious consequences evolve from utilizing some of the world's "new" addictions, particularly the use of the Internet in an addictive manner, including gambling obsessively online, shopping excessively or gaming excessively. As with other addictions, "social isolation, depression, marital discord, divorce, job loss, and financial debt" (Young, 2005) constitute "side effects" which may also contribute to depression.

Internet addiction may not yet be widespread, however, Louise Nadeau, a professor at the Universite de Montreal's Department of Psychology, reports serious cases have been noted where teenagers do not leave their house, "don't have interpersonal relationships, and have been isolated in front of their computer screen for the past two or three years, and only speak in the language of the characters they play with in network video games." (University of Montreal, 2008)

Young (2005) purports that research reveals individuals benefit from prevention and education programs relating to in Internet use and that "specialized training can educate employees about the warning signs of online addiction to assist in early detection." Warning signs of Internet addiction include, but may not be limited to the following:

Staying online longer than intended;

Feeling preoccupied with online use, often to the point of daydreaming and anticipating the next online session;

Inability to control online use;

Feeling restless, moody, depressed, or irritable when attempting to restrict or stop Internet use;

Jeopardizing relationships or career endeavors because of excessive Internet use;

Lying to family members or friends to conceal the extent of involvement with the Internet; and Using the Internet as a way of escaping from problems. (Young, 2005)

Addiction theorists purport that addictions achieve something for the addicted individual, despite the fact the benefits or "fix" may be illusory or momentary. In turn, the resulting mental pleasure contributes to more intense feelings about the "substance." Because addictions "serve a useful purpose to the addict, the attachment or sensation may grow to such proportions that it damages a person's life."

Training can help combat the stigma accompanying addiction in the workplace, and in turn engender support and help for addicted individuals. (Young, 2005)

VMAT2 (May not fit and if so, needs reference to depression)

The brain vesicular monoamine transporter () constitutes a component of the re-uptake mechanism regulating monoaminergic neurotransmission, Schwartz, Weizman and Rehavi (2005) explain. In their study, "Decreased platelet vesicular monoamine transporter density in habitual smokers," these researchers note they previously demonstrated an elevated degree of similarity "between the pharmacodynamic characteristics of platelet and brain VMAT2." Findings from this current study, albeit reveals that the VMAT2's decreased density in smokers' platelets may mirror nicotine induced desensitization of VMAT2. When Schwartz, Weizman and Rehavi (2005) "measured the VMAT2 pharmacodynamic characteristics using high-affinity [3H]dihydrotetrabenazine (TBZOH) binding to platelets of smokers (n=15) compared to sex and age matched healthy nonsmokers controls (n=14)," they noted that in contrast to nonsmokers, smokers presented a considerable decrease (17%, P=0.02) in VMAT2 density (Bmax) in their platelets. These researchers note, albeit, that no significant difference existed in the affinity of [3H]TBZOH to its platelet binding site. In addition, the VMAT2 density did not link with the amount an individual smoked. This phenomenon, the researchers purport, may prove germane to the nicotine's addictive properties.

Role of Cocaine Use in Depression

In "Cocaine Use May Alter Brain Cells, Play Role in Depression," the NIH/National Institute on Drug Abuse (2003) reports results of another study relating to VMAT2. Researchers found that cocaine users exhibited lower concentrations of dopamine and VMAT2 than displayed in non-users' brains. In addition, cocaine users who suffered from depression presented lower levels of VMAT2 than individual cocaine users, not experiencing depression. Researchers did not confirm, albeit, whether cocaine use destroyed dopamine cells, or simply dysregulated them. They also did not know whether treatment, time or any other factor could reverse changes. Findings from this study indicate chronic cocaine use may foster changes in a person's brain, potentially contributing to a person potentially experiencing difficulty feeling a sense of pleasure. "Further efforts at clarifying the detrimental effects of cocaine on brain cells," the NIH/National Institute on Drug Abuse (2003) contends, "may help in the development of effective treatment interventions and pharmacotherapies."

Clinical Techniques of Helping

Pharmacogenetics

Pharmacogenetics, Jancin (2005) reports, according to Sean P. David, M.D., director of research in family medicine at Brown University, Providence, R.I., may help combat tobacco addiction as tobacco-related illness currently constitute the world's primary public health problem. According to Dr. David, twin studies suggest that approximately half the variation in smoking behavior may evolve from genetic factors. Although accompanied by concerns and a bevy of question, pharmacogenetics possesses the capability to customize individuals' treatment/s for addictions, as well as avert adverse events by genotype. In 2005, the World Health Organization (WHO) projected estimated that by 2020, tobacco use will contribute to roughly 10 million deaths each year.

In addition, WHO estimates that approximately 500 million people living in 2005, including approximately one-third of Chinese males will ultimately die prematurely, from illnesses related to tobacco. (Jancin, 2005) Numerous epidemiologists argue that tobacco use prevalence could be cut in half during the next 25 years, contributing to 150-200 million saved lives. They noted this task, in fact, has been done in the past in the U.S., as between the 1950s and the 1980s, U.S. tobacco consumption decreased by half.

The choice is ours....," Dr. David stressed to his audience of physicians at Wonca 2004, the conference of the World Organization of Family Doctors regarding the war against tobacco addiction. He concluded "...if we so choose," he contends, physicians with the help of pharmacogenetics, can win the war on tobacco addiction. (Jancin, 2005)

Quit

In the 1999 article "Quit," Hunt shares strategies to help a person overcome sugar, tobacco and caffeine addictions. Hunt stresses that "no single pill, powder, tea, tincture or trick to 'cure' addictions" exist, however a myriad of treatments, currently available, can increase a person's understanding of addictions' psychological roots, as well as educate individuals as how to overcome addictions. According to Hunt (1999), the most successful treatments utilize a combination of "nutritional guidance, acupuncture, hypnosis, homeopathy or herbs with behavior modification and social support." Two vital factors, desire and commitment, according to Joseph Parisi, Ph.D., a clinical psychologist in Charlotte, North Carolina, albeit prove vital to a person overcoming his/her addiction.

A are desire and commitment. Beyond that, "you should only attempt to quit during a low-stress period in your life. Gather support from friends and family by telling them your intentions and asking them to help keep you on track. Finally, recognize the role addiction plays in your life by identifying the situations, people, places and emotions that trigger your addictive behavior." (Hunt, 1999)

Tried and True" Techniques

Homeopathy Homeopathy reportedly proves most effective when a trained practitioner personalizes and prescribes treatment. In Homeopathy a-Z, Dana Ullman, M.P.H., recommends Tabacum, a veg-safe microdose derived from tobacco, as a remedy to counter tobacco addiction.

When a person experiences the desire to smoke, Ullman contends that four pellets of the 6, 12 or 30C potency will help him. Incense serves as a substitute for the burning smell cigarettes emit. Tim Blakley, herb educator for Frontier Natural Products Co-op in Norway, Iowa, suggests that chewing sweet, woody licorice root also helps smokers overcome their cravings, as the long, narrow licorice root, similar to a cigarette, will helps quench a person's "need for an oral fix," while giving their hands something to hold on to. (Hunt, 1999)

Hypnosis and Acupuncture Two other "tried and true" techniques, hypnosis and acupuncture possess positive track records.

In hypnosis, a therapist induces a highly relaxed state and makes suggestions to a client's subconscious mind designed to change his/her attitude regarding smoking. In the practice of acupuncture, a practitioner inserts tiny pins or staples into various points in a client's ears, nose and wrists, regions reportedly associated (in Chinese medicine) with a person's urge to smoke.

Repeated treatments allegedly increase the probability of quitting. (Hunt, 1999) Contemporary treatment for individuals suffering with addictions and depression, dissimilar to treatment available for Coleridge during his time, proffers a variety of clinical techniques to them. The following two tables (1; 2) depict areas for focus in treating individuals suffering from addiction and depression.

Table 1: Physical and Lifestyle Areas Meriting Focus in Recovery from Addiction and Depression (adapted from Daley, 2007)

Physical and Lifestyle

Exercise

Follow a healthy diet

Get sufficient rest, sleep & relaxation

Control cravings for substances

Take medications (if needed)

Take care of medical problem

Learn to structure time

Engage in pleasant activities

Achieve balance in life

Behavioral and Cognitive