Treating Alcohol Problems in the Context of Other Drug Abuse
Miller, William R., Bennett, Melanie E., Alcohol Health & Research World
People seeking treatment for alcohol problems frequently abuse other drugs as well, such as tobacco, cocaine, marijuana, methamphetamine, and opiates. The problem of polydrug use raises important issues for treatment providers. A person who abuses multiple drugs may have a more difficult time stopping drinking and a higher risk for relapse to alcohol use after treatment. Conversely, a person who successfully stops drinking may offset this achievement by substituting another drug for alcohol. Successful treatment must take into account both alcohol- and drug-related issues, with particular emphasis on assessment, motivation, treatment design, and outcome evaluation. KEY WORDS: AOD dependence; multiple drug use; illicit drug; AOD associated consequences; causes of AODU (alcohol and other drug use); patient assessment; motivation; treatment factors; treatment method; treatment outcome; AODD (alcohol and other drug use disorder) relapse
People who meet alcohol abuse or dependence criterial often use, abuse, or are dependent on other drugs as well. The "pure alcoholic" represents the minority in clinical settings, where the majority of patients engage in polydrug use. According to one recent study, more than 60 percent of men and women presenting for treatment of alcohol problems used another drug at least weekly (Caetano and Weisner 1995), and other studies have reported similarly high rates of multiple drug use (Weisner 1992a). Even in the general population, people who are alcohol dependent have been found to be five times more likely than other people ( 18 versus 3.5 percent) to meet the criteria for another drug-use disorder (Helzer and Pryzbeck 1988).
People with alcohol problems are more likely to use a variety of other drugs, including tobacco, cocaine, marijuana, methamphetamine, and opiates (for further details, see box, p. 120). Compared with individuals who experience only alcohol problems, polydrug users are likely to be younger and to have more severe alcohol and other drug (AOD)-related problems (Caetano and Weisner 1995; Hesselbrock et al. 1985). In an attempt to understand the high rate of comorbidity, some researchers have suggested that alcoholuse disorders and other drug-use disorders may share a common genetic (Jang et al. 1995) or psychological basis (Miller and Brown 1991) or that people using alcohol-drug combinations are attempting to self-medicate a psychological disorder (Jensen et al. 1990).
The problem of polydrug use raises important issues for both alcohol treatment programs and providers (Weisner 1992b). The use of other psychoactive drugs, such as tobacco or marijuana, may increase a person's risk for relapse to alcohol use following alcohol treatment. Outcome studies indicate that among people in treatment for alcoholrelated problems, those who use other drugs exhibit less change in their drinking habits (Brown et al. 1994; Rounsaville et al. 1987). One reason for this finding may be that polydrug use also tends to be linked to personalitybehavioral types that are more resistant to change. Another important issue for clinical consideration is the possibility of drug substitution. If a person's polydrug use is not addressed, a reduction in alcohol use may be offset by an increase in other drug use. Furthermore, treatment for polydrug use may require different emphases or approaches than does treatment for alcohol problems alone. That alcohol and other drug use can be considered a "dual diagnosis" reflects, in part, the fact that historically, both the treatment and research programs for these two problems developed separately and in relative isolation from each other. This separation has been reflected in treatment systems, in self-help groups (e.g., Alcoholics Anonymous versus Narcotics Anonymous and Cocaine Anonymous), and even in the scientific journals that publish clinical research findings. However, whether people initially seek treatment for alcohol or for other drug problems, they are likely to be polydrug users. …