We’ve all heard the phrase “dry drunk, ” referring to a person who is alcoholic and who has stopped drinking, but who has not done anything to address the underlying emotional and psychological issues, which his or her drinking medicated. Recent experience suggests there may also be something similar for the person who suffers from depression. The “dry depressive” is the lawyer who is depressed, often taking anti-depression medication, but who has not addressed the underlying emotional issues, which the depression is serving to repress.
The general structure of the reward circuitry in the brain in which addicted behavior flourishes is becoming well-known. This reward structure can be impacted negatively across a wide spectrum. At one end of that spectrum is the cocaine addict whose addiction drives his compulsive behavior almost without restraint. At the other end of the spectrum are most of us who have certain addictive habits that to some degree interfere with fully living. These habits may be as seemingly innocuous as having ice cream every night at 10 o’clock even when one is not hungry, in order to have the emotionally comforting feeling the texture and sugar in the ice cream provides. In other words, a particular habit is being used in an addictive way in order to ameliorate underlying emotional dis-ease. The reward circuitry of the brain known as the mesolimbic dopamine system is central to the addictive process. It involves a set of nerves that originate near the base of the brain and in an area called the ventral tegmental area, which reach out to regions in the front of the brain, most notably in an area beneath the frontal cortex called the nucleus accumbens. The nerves along this pathway communicate by dispatching the chemical neuro-transmitter dopamine.
This dopamine pathway “tells” the other brain areas how rewarding an activity is. The more rewarding the activity, the more likely the person is to repeat it. Alcohol and other drugs of abuse and various processes (such as sex, gambling, etc.) can hijack this natural reward pathway so that destructive conduct is reinforced. Addictive chemicals and processes thus create immediate pleasure sensations which allow a person not to feel negative emotional states. Failure to work through negative emotional trauma caused by growing up in alcoholic homes or other types of dysfunction, if it does not lead to addiction, often leads to depression by suppression of the feelings that are triggered in present time and relate to the old wound. Pharmacological treatment for depression seeks to stabilize certain of the neuro-transmitters in the brain like dopamine and serotonin. However, the brain is an organic changing structure and the attempt to bring some neuro-chemical stability via pharmacological treatment does not in any way address the underlying issues that may be causing the depression. Similarly, taking the pharmacological treatment to try to stabilize certain neuro-chemical transmitters in the pleasure pathway does not prevent the desire of a person to use addictive processes in order to try to repress the feelings of discomfort that continue to push the person toward depression. A cycle can be set in place in which a person needs his or her depression in order to continue an addictive process that offers illusory relief.
For example, it is not unusual to see lawyers who are suffering from depression, and taking a pharmacological treatment for depression, to also abuse alcohol. This could be for two reasons. First, the lawyer could have a separate primary condition of alcoholism, which is untreated. Or, the depressed person could simply be abusing alcohol as a way to try to also feel better and avoid addressing the underlying causal issue. Either way, this type of behavior is counter-productive. Alcohol is a central nervous system depressant and should not be used by depressed individuals seeking to feel less depressed. While the depressed person can still get some initial euphoric response in the first 30 to 60 minutes of using alcohol, the long-term effect of this depressant is to make the person feel more depressed, which in turn may set up a craving for more alcohol.
There is also the complicating tendency of two co-occurring disorders – addiction and depression – to create a greater barrier to a person’s perception of a problem. A recent study finds that 61% of persons with both a serious mental illness and a substance use disorder who had not received treatment for either illness, perceived no unmet need for treatment.
Another expression of the “dry depressive” acting out is too engage in sexual promiscuity. One of the most powerful neuro-chemicals in the brain comes from the neuro-chemicals involved in romance and sex. If one is depressed, promiscuity is a way to trigger these neuro-chemicals to provide “internal medication” which can mask the underlying feelings of depression and help the lawyer to avoid addressing those. This process is particularly unfortunate because it may harm not only the person engaging in it but another person also. Other patterns which may be used to attempt to comfort ourselves and relieve internal anxiety range from alcohol, drugs, sex, food, to excessive TV watching, inappropriate use of the internet, compulsive overwork and gambling. All of these addictive chemicals and addictive processes can range in a spectrum from harmless to life-threatening. In each case, it seems the addictive process supports a false posture of independence, an illusion that the lawyer is self-sufficient and has no need of other people. The reason it is so difficult to break these patterns is because the anxiety that is alleviated by the use of the substance, or the process addiction, always comes back to the surface and creates a state of greater depression (withdrawal) and leaves the lawyer in a state of even greater anxiety and need to repent the dysfunctional behavior for relief.
The good news is that it is possible to relinquish use of the addictive substances, or addictive processes, that keep a person trapped. However, this is not likely to happen unless the lawyer finds a supportive, trusting place in which to experience the normal living problems of life and practicing law. Once that support is in place, the lawyer understands how to face the frustrations of their wants and desires so that their emotions do not get repressed or negatively acted out. Learning to do this, like learning to do anything new, may seem frustrating initially. But once one learns how to overcome the emotional frustrations to unlock the grip on psyche energy of old wounds, then it is possible for the brain’s pleasure pathway system to be restored to the functioning for which it was designed. Lawyers who are depressed, and not addressing their underlying depression through therapy and/or self-help support groups, but are relying on just pharmacological treatment, may find that after their pharmacological treatment has stabilized them for a period of time that there may be a tendency to engage in addictive disorders or processes in order to try to feel better. This is a clarion call that more work needs to be done and that help should be sought.
– by Don CarrollPosted by