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 The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the address below. 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, micro-filming, and recording, or by any information storage and retrieval 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