The intensity of emotional experience and appropriate expression of emotion are strongly associated with the quality of psychological adjustment. Conflicts over anger and guilt, and the display of intense emotional reactions commonly accompany substance use. These disruptive emotions may either presage substance use or emerge following drug use onset. Not uncommonly, consumption of psychoactive substances is motivated by a need to ameliorate negative affective states such as anger, depression, and fear. The inability to express emotions effectively in the social context, particularly negative feelings, is also frequently associated with drug abuse.
Emotional disturbance is often encompassed within psychopathology. From the psychometric perspective, clinically significant psychopathology is present when severity exceeds two standard deviations from the population mean. In effect, the severity score ranks in excess of the 95th percentile in the population on a trait (e.g., anxiety). Whether the magnitude of severity of psy-chopathological disturbance points to the need for treatment can only be determined by integrating the findings obtained from a diagnostic psychiatric interview and psychometric assessments. For example, anxiety or depression may foster substance abuse in an individual even if the severity is subthreshold for diagnosis. Notably, subthreshold negative affective states predispose to drug seeking (Khantzian, 1985). As pointed out by Dodes (1990), psychoactive drugs modulate affect in part by ameliorating negative feelings concomitant to helplessness and powerlessness.
It is important to be cognizant of the possibility that a psychiatric disorder may remit following effective treatment of substance abuse. It is not uncommon for psychopathological symptoms to dissipate in conjunction with abstinence from alcohol and drugs following the initial period of detoxification and withdrawal. Furthermore, it is essential to recognize that emotional distress can both precipitate and sustain a psychopathological disorder. Characterizing the client's emotional status therefore enables the clinician to determine the relation of psychopathology to substance abuse either as a predisposing condition, a correlate of the disorder, or a consequence of the disorder.
In contrast to diagnostic psychiatric assessment, psychological tests measure traits. The evaluation is thus concerned with quantifying the person on particular dimensions, whereas the psychiatric evaluation categorizes the person according to presence or absence of a disorder. Hence, commonly used psychiatric interviews such as the Schedule for Affective Disorders and Schizophrenia, Diagnostic Interview Schedule, and Structured Clinical Interview for DSM-III-R are concerned primarily with dichotomous classification. Whether a categorical or dimensional approach is utilized, the most frequently observed psychopathological disturbances comorbid to alcohol or drug abuse are anxiety and depression. However, virtually every Axis I and Axis II disturbance has been observed concomitant to substance use disorder (Dackis, Gold, Pottash, & Sweeney, 1985; Daley, Moss, & Campbell, 1987; Helzer & Pryzbeck, 1988; Peace & Mellsop, 1987; Weissman, 1988).
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