Expert: Jan Edward Williams - 7/14/2009

Question
Okay - I know it's a toughie, but does one cause the other?  Is one an excuse for the other?  Where do you go first....AA or a therapist?

Answer
Hello Ann,
It IS a tough question, but here are my ideas on dual diagnosis, also called comorbidity. 85 to 90 percent of alcoholics, depending on the population, do NOT have a coexisting (or pre-existing) mental health disorder such as depression. Often any depression or anxiety is due to the CNS depressant effects of chronic excessive alcohol use, which will dissipate with a substantial period of abstinence. If an individual has both depression and alcoholism, obviously, if the depression is severe enough to endanger the person through suicide or self-harm, then the depression will need to be stabilized immediately. However, talk therapy or even antidepressant medications for the depression will often NOT be very effective if the alcoholic continues to drink. So, generally, absent danger-to-life issues, the alcoholism should be treated first, that is, the drinking stopped and alcoholism treatment completed. Usually, if the depression is related to the alcoholism, it will not be a problem after 30 days of sobriety and treatment. Check out my website for more information and professional help.
Jan Edward Williams, MS, JD, LCADC
www.alcoholdrugsos.com
jwilliams@alcoholdrugsos.com
443-610-3569