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Posts Tagged ‘depression’

Alcohol and Suicide

Thursday, July 4th, 2013

130704 suicide3

“It’s Larry,” said the nurse, handing me the phone.

No other introduction was needed.  Larry was a Viet Nam vet who was a frequent patient at the hospital where I worked. It was 8 p.m., I had a unit full of psychiatric patients and he wanted to be admitted. Larry was drunk, which he and I both knew would keep him from getting a bed here tonight.  I wasn’t entirely conscious of it at the time, but something was different.   “I feel lost,” he said.

Thirty minutes later Larry shot himself in the head with his military revolver.

This was almost twenty years ago, but it feels no less tragic  today than it did then.  Suicide is a therapist’s worst nightmare, perhaps because so little is really known about why people kill themselves.

One thing that we do know for sure is that alcohol plays a role in suicidal thought, ideation and attempt. In 2009, the Centers for Disease Control and Prevention measured blood alcohol levels post mortem and found that one in four suicide victims were legally drunk.

Dr. Alex Crosby, the author of the CDC report, described the nature of the connection.  “It leads to disinhibition, and it can enhance feelings of hopelessness and depression,” he said,  “Alcohol impairs judgment and can lead to much more impulsive behavior.  Any suicide prevention efforts must take that into account and address alcohol and substance abuse as well.”

So you can add this to the list of dangerous side effects of drinking to excess: Statistically, one in ten people in the U.S. abuse alcohol, yet alcohol is implicated in 40% of all suicides. If you abuse alcohol, you’re four times more likely to die from suicide.  

Depression is the culprit, but the chicken and the egg argument pops up here, and in my years of treating alcoholics I still can’t always figure it out, at least at first.   What’s clear is that depression is found at clinical levels in 30% to 50% of active alcoholics. (Anecdotally, I think it’s higher.)   Women are more likely to self-medicate with alcohol than men.

In some people, heavy drinking brings on depression: sober them up and the depression goes away.  Others – and this may be the majority – drink alcohol to excess to self-medicate an un- or undertreated depressive episode.

Either way, the danger can’t be overstated.  You’re more likely to commit suicide from heavy drinking than you are to die driving drunk.

There’s a brain chemistry feedback loop that keeps you trapped in the cycle of relief drinking, even when you want to stop.  How can you tell if your drinking has become a problem?  If you can’t stop when you want to.  If you’re in doubt, ask a social drinker if he or she has trouble stopping drinking.  They’ll look at you, like, “Do have trouble stopping hitting yourself on the head with a hammer?”

It’s not a willpower problem.  Willpower doesn’t work on the brain disease of alcoholism any better than it does on any other disease.  Try willing your blood sugar to go down.  Will away that pesky toenail fungus.

If you’re drinking too much and feeling like life’s not worth living, ask for help.

Now.  Your life may very well depend on it.



The Cuckoo’s Nest, 50 Years Later

Sunday, June 2nd, 2013

130601 Nicolson Cuckoos Nest

In the late 1950’s, a journalism student at Stanford University who worked as an aide in the Veteran’s Hospital participated in CIA-funded experiments on behavioral engineering of humans using psychoactive drugs.  The hallucinogenic experiences he enjoyed would change the young author’s outlook on life and inspire his writings.

A few years later, the man wrote an allegory on individual liberty and social conformity called One Flew Over the Cuckoo’s Nest, set in a mental hospital.  It made Ken Kesey somewhat of a rock star before there were rock stars.

About the time that Mr. Kesey was participating in the experiments at Stanford, the treatment of mental illness enjoyed a huge breakthrough, when the drug Thorazine was discovered.  Prior to Thorazine, persons with severe and persistent mental illness were relegated to mental hospitals, where they often spent decades.  With Thorazine, however, these persons could function in the community and live meaningful lives.  One of the hospitals in which patients were warehoused was the Oregon State Hospital, where One Flew Over The Cuckoo’s Nest was filmed in 1975.  The superintendent who authorized the use of the hospital, Dr. Dean Brooks, died this week at the age of 96.

Dr. Brooks was known in his field as an innovator. His approach, unusual for its day, included letting patients wear their own clothes rather than hospital uniforms and taking them on therapeutic trips into the wilderness.  Although he had no prior acting experience, Dr. Brooks played the psychiatrist who treated Jack Nicolson’s character, McMurphy.

As one who has worked in the field of mental health since the 1980’s, Dr. Brooks’s death gave me pause to reflect upon the state of mental health in 2013.  Mental Illness has come out of the closet, and May marked the annual recognition of Mental Health Month.

My feelings, frankly, are mixed.  On the positive side, our understanding of the medical aspects of mental illness has expanded dramatically.  We know that depression is more than “the blues” and that addiction is a brain disease rather than a moral weakness.   Treatments have improved as well:  today, people with anxiety, schizophrenia and bipolar disorder have sophisticated treatment options that didn’t exist even ten years ago.

In my field, we have yet to see a “magic pill” that will cure addiction, and we never may.  Yes, there are medications that deal with cravings and block the effects of harmful drugs.  Medications like Suboxone have saved the lives of countless addicts who had little hope of surviving.  But the “cure” for addiction will always require another component.  We in the field see addiction as threefold: physical, emotional and spiritual.  By addressing only the physical component of addiction, two-thirds of the disorder goes untreated.  The emotions and behavior of an addict have to change, and this seems to happen only through a rigorous course of psychotherapy, the instillation of religious belief, or the treatment of choice for addicts, Alcoholics and Narcotics Anonymous.

MH Awareness 4There are two discouraging factors related to the state of mental health.  First, mental illness continues to be the subject of ridicule in our culture and often has second-tier status in terms of availability.  A study performed ten years ago in Florida found that only one in four people who sought treatment for substance abuse were able to get it.

Sadly, the Florida Governor’s Office of Drug Control, which accomplished significant things under Jeb Bush and Charlie Crist, has been eliminated by Governor Rick Scott.  Funding for a statewide database on prescription drugs that can save lives runs out of money this month.  Imagine the outrage if, for instance, the Governor cut funding for children’s health care, or for developmental disabilities.  Oh. Never mind.  He did that.

The other troubling issue in our field is the formidable tail that wags the dog of our scientific understanding of mental illness: the medical, pharmaceutical and insurance industries. In another blog, I’ll address how these potent forces effect public opinion and access to treatment.