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Substance abuse and behavioral pathology: A commentary

Article (PDF Available)  · January 1991with23 Reads
Robert O Pihl at McGill University
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  • McGill University
Sherry H Stewart at Dalhousie University
  • 44.77
  • Dalhousie University
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  • ... Deykin and Stephen (1997) investigated chemically dependent adolescents, whereas Helzer et al. (1987) studied a community sample. Several causal pathways may explain the co-occurrence of PTSD and alcoholism (Pihl and Stewart, 1991). Alcohol misuse might increase anxiety and arousal levels through psychological processes, such as stressful life events, causing heavy drinking (Kushner et al., 1990). ...
    ... There are several problems inherent to this point of view. Independent of aetiological factors, once abusive drinking has begun, the alcohol disorder may follow its own course (Pihl and Stewart, 1991). On the one hand, it seems difficult for individuals to discontinue drinking after PTSD symptom management. ...
  • ... Since ethanol possesses anxiolytic properties, likely due to its effects on the GABA-ergic benzodiazepine receptor (see Stewart, Pihl, & Padjen, 1992), the positive relationship between AS levels and the use of alcohol primarily to cope, is not surprising: individuals who fear their anxiety symptoms (i.e., high AS individuals) appear most likely to use this anxiolytic drug primarily to control the symptoms that they fear. The applicability of this finding to explaining the high overlap between alcohol abuse and anxiety disorders characterized by high levels of AS, such as panic disorder and post-traumatic stress disorder ( Kushner, Sher, & Beitman, 1990;Pihl & Stewart, 1991;Stewart, 1996), awaits empirical investigation. An unexpected finding was that the significant positive relationship between AS levels and substance use primarily to cope also held for females' use of cigarettes (a substance containing nicotine-a drug with a myriad of acute pharmacological effects including physiologic arousal-enhancement). ...
  • ... This article critically reviews the evidence for an important functional relationship between posttraumatic stress disorder (PTSD) and alcoholism. Although several reviewers have shown a significant overlap between certain anxiety disorders and alcohol abuse (e.g., B. J. Cox, Norton, Swinson, & Endler, 1990; Kushner, Sher, & Beitman, 1990; Pihl & Stewart, 1991 ), they did not consider the relationship between PTSD and alcoholism . One review examined the relationship between PTSD and substance abuse (i.e., Keane, Gerardi, Lyons, & Wolfe, 1988 ). ...
    ... Several causal pathways may explain the co-occurrence of PTSD and alcoholism (Pihl & Stewart, 1991 ). These possibilities are not necessarily mutually exclusive. ...
    ... There are several problems inherent in this viewpoint. Independent of etiological factors , once the abusive drinking has begun, the alcohol disorder may take on a life of its own (Brinson & Treanor, 1989; Hurley, 1991; Nace, 1988; Pihl & Stewart, 1991 ). Thus, discontinuing abusive drinking, even following PTSD symptom management, is difficult for these individuals. ...
  • ... This issue could be addressed using the stressinduced drinking methodology (e.g., Higgins & Marlatt, 1973, 1975), to examine the quantity of alcohol consumed following stress induction in MS vs LAS subjects. Finally, given that the present results were obtained with university students, the applicability of the present findings to clinical conditions such as the panic-related disorders, posttraumatic stress disorder, and alcohol abuse/dependence (conditions that are often overlapping in clinical settings; see reviews by Cox, Norton, Swinson, & Endler, 1990; Pihl & Stewart, 1991; Stewart & Zeitlin, in press) remains to be determined. ...
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