oholics can abstain, they miss it. Their efforts to abstain, which include intense willpower (white knuckle approach), making great sacrifices, irritability, constant complaints, or dry drunks give evidence of their compulsion.Another of alcoholism’s powerful dynamics, which reinforces its obsessive ness and compulsiveness, is the relative certainty and immediacy of its rewards. Unlike the risk and uncertainty of interpersonal fulfillment, alcoholics can safely count on the effects of drinking. Drinking seldom lets them down; it usually gives them what they ask for. Alcoholic effects are easy to come by and occur quickly. There is little waiting; the rewards are immediate. Compounding the certainty and immediacy of gratification is the easy availability of alcohol. Alcohol is legal and easily acquired.One of the biggest problems in improving treatment for alcoholics in mental health care is that of assessment and diagnosis. More than half of the veterans admitted to the acute psychiatric care ward (2P) of the Boise VA Medical Center (VAMC) are substance abusers, yet they are not dually diagnosed. These patients most often exhibit symptoms of an apparent mood disorder that can range from dysthymia to a major depressive episode. Symptoms of anxiety are also a common feature, often mixed with symptoms of depression. Disorders that involve disturbances in thinking, such as mania and schizophrenia also occur.The traditional view that psychiatric disorders are unrelated to alcohol and other drug use problems has hampered effective treatment of patients who exhibit both types of disorders (Woody, 1996). Psychiatric and substance abuse disorders can produce many similar symptoms and often coexist in the same patient, where one disorder can influence the course and treatment outcome of the other. This makes me question which may have come first – substance abuse disorder or the psychiatric disorder. And did one cause the other? Or is...
