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Solomon:Alcohol, depression & anxiety

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from The Noonday Demon by Andrew Solomon

An Atlas of depression:


Of the significantly disabling substances of abuse, the most common is alcohol, which can do an excellent job of drowming out pain.While drinking during depression is not unusual, some people drink less when they are depressed, often because they recognise that alcohol is a depressant and that excessive drinking during a depression can severely exacerbate the depression. My experience is that alcohol is not partiularly tempting when you are experiencing pure depression, but that it is very tempting when you are experiencing anxiety. The problem is that the same alcohol that takes the edge off anxiety tends to exacerbate depression, so that you go from feeling tense and frightened to feeling desolate and worthless. This is not an improvement. I've gone for the bottle under these circumstances and have survived to tell the truth: it doesn't help...

There are many models for treating alcoholism apart from depression, but when the two conditions exist together, psychodynamic therapies appear to be most effective. Alcoholics Anonymous and other twelve-step programs provide supportive settings in which people can share both their experiences of alcoholism and their experiences of depression. Other group therapies and even short-term institutionalisation are also highly productive at addressing alcholism and depression as if they spring from a single cause. For many people, this works whether there is a single cause or not. Practitioners at Columbia University use an individual cognitive-behavioral therapy in the interests of relapse prevention. The program is written down and can be practised in the same way by any clinician. "It is very much a 'here and now' form of therapy," David McDowell explains. The typical treatment course begins with a week or two to address the person's cravings and then goes on to elucidate an individual's triggers for relapse and to figure out how to deal with them.

Published by Touchstone