In an October column, I responded to a letter from a woman concerned about her brother, who apparently suffered a severe anxiety disorder. He lived alone and frequently missed work for fear of being around people. To cope with the anxiety, he began drinking excessively. As a result of the alcohol abuse, he developed a variety of other problems, including multiple hospitalizations.
I spoke with John Grayson, a psychologist in Bala Cynwyd who specializes in anxiety disorders. He recommended that this man be detoxified from alcohol before being treated for anxiety. I also recommended that the sister attend Al-Anon meetings, which are designed to help friends and loved ones of alcoholics.
Several readers have also offered their insights. Here are two of those letters:
I am a psychiatrist who specializes in “dual diagnostic” conditions. I agree with John Grayson that hospitalization and detoxification is the place to start, but I would go further and state that a full inpatient rehabilitation treatment is essential for this patient to succeed and get well. The only way that his denial and other defense mechanisms can be addressed is through the extensive treatment still available at a quality treatment program that also offers co-management of his anxiety disorder(s). The overwhelming likelihood is that anything less than a minimum of a 28-day inpatient program will fail for this patient with the history described in your column. The concerned family should be advised that an intervention is an excellent idea, but the initial goal should be to get this patient into a rehab program for several weeks. It is a dated concept to state that one condition should be treated before the other; rather they need to be treated concurrently and in an integrated manner.
Michael W. Shore, M.D.
Dr. Shore is correct when he suggests a lengthier inpatient stay in a quality treatment program. But in the world of restrictive managed-care carriers, it can be quite difficult to get approval for a lengthy inpatient program. In addition, there have been dramatic cutbacks in staff and services at most of these programs, leaving fewer quality programs with longer waiting lists. And to pay out of pocket is extraordinarily expensive. It’s too bad, because we have the skills to provide quality care for both substance abuse and mental illness, which could improve the lives of countless thousands. But between government cutbacks and managed-care organizations, most of which would prefer medication to hospitalization, these advances in science don’t readily get to the people who most need them. But there are other options, as this reader suggests:
Dear Dr. Gottlieb,
I can attest to the truth and accuracy in the answer to that woman’s letter. After suffering lifelong anxiety/panic disorder and depression, no amount of therapy was any help until I stopped drinking and drugging. People (friends, family, therapists) told me I wouldn’t get any better until I stopped my attempts to “self-medicate,” but I was very stubborn and wouldn’t listen until my dual addictions led to a near-fatal suicide attempt. I am only clean and sober for one year and four months, but what a change! I have hooked up with a fantastic therapist, and once I accepted the first of the 12 steps (powerless over alcohol) and began to practice the principles of both AA and NA, wonderful things began to occur. I am actually in a position now to help others who suffer from the same sort of debilitating conditions from which I suffered. I have a wonderful support group, and when I feel strange or uncomfortable I know I can call someone and talk about it and maybe begin to understand what’s happening instead of trying to alleviate my discomfort by “using.” I lost everything I worked very hard for and am quite poor right now but I have what I need: wonderful people surrounding me. I had the privilege of speaking before a group of addicted teens at a recovery center in Quakertown last month, and when I told the story of my suicide attempt and resulting coma (eight days on life support) a 17-year-old boy made the comment that “maybe God had to put you in a coma before you would wake up.” Such wisdom from so young a person.