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Atlanta Medical Psychology
The clinical practice of Dr. David B. Adams is located in The Medical Quarters in the northside of Atlanta at the junction of Scottish Rite, Northside and Saint Joseph's Hospitals. Dr. Adams consults to occupational medicine, surgeons, nurse case managers, insurers and employers regarding the psychological impact of work-related injury and the role of psychological factors in short- and long-term disability. 

October 4, 1999

Q "I have back spasm and my family doctor put me on Valium 5mg three times a day for two weeks as part of the treatment. I understand that Valium is highly addictive and have not taken the medication. Can you provide me with some thoughts on this or similar drugs?"

A The benzodiazepines, and their derivatives, are use mainly in the treatment of anxiety, insomnia and panic disorder. They are also used for acute stress (an emotional upheaval) and often pre-surgically. They are safe and effective, and their likelihood of causing dependence is based upon dosage and length of time for treatment. Those with past histories of other drug or alcohol dependence may be more vulnerable to dependence upon the benzodiazepines. Some studies indicate that patients have taken the benzodiazepines for months or years, usually maintaining or actually reducing intake.

When dependence occurs it is due to the action of the drug at nerve receptors alongside receptors for the inhibitory neurotransmitter called gamma-aminobutyric acid (GABA). With repeated use, the benzodiazepines receptors can adapt to the drug's presence, and the sensitivity of the receptors change. Then if the drug is abruptly withdrawn, the patient can become anxious, agitated or have difficulty sleeping. This is uncomfortable but not life threatening. There are, however, rare instances of withdrawal seizures, depression or psychotic states.

There is no proof, but some clinicians believe that potent benzodiazepines with short half lives (Xanax or Ativan) create faster dependence (in comparison to Valium, Librium or Serax which have longer half-lives in the system).

Patients hear these tales, become fearful of what the patient calls "addiction" and those prescribing often become equally concerned about long term use. Interestingly, abuse of these drugs is uncommon, most are prescribed for short term treatment, but, as noted, there are data to indicate that even long term monitored use can be entirely safe. It is always best to discuss these fears, beliefs and concerns with who is prescribing the benzodiazepines.

October 11, 1999

Q "I have never been entirely clear on whether addiction is psychological or physical or both, and frankly, some of my friends use drugs and/or alcohol to such an extent that I would think of them as having a problem. In general can you give me an overview of this problem?"

A Substance-Related Disorders refer to not only the chemical upon which abuse or dependence has occurred, but also the nature of the impact of the substance use has had upon the individual. This can vary from abuse to dependence and from hallucinations to delusions to delirium. Substance abuse or dependence can result in mood, anxiety, sleep and sexual disorders as well as problems arising from withdrawal. Agents ranging from alcohol to cocaine to cannabis, hallucinogens, inhalants, opioids, phencyclidine, inhalants and sedatives can be of concern.

November 1, 1999

Q "We have no alcoholism in the family, and frankly all I know about it is that it is a terrible problem and results in DUIs, deaths and family violence. Are there mental disorders that arise from alcoholism or just problems in behavior?"

A When considering substance related disorders like alcohol abuse or dependence, you need to think in terms of the moods and behaviors that arise from intoxication as well as the physical problems which arise from withdrawal from the substance. The morbidity and mortality from alcohol, the most frequently used brain depressant, with 60% of males and 30% of females having at least one alcohol related adverse life event. There are psychological disorders that arise from the dependence upon alcohol and its abuse. These include dementia, amnesia, delusions, hallucinations, mood disorder, sleep disorder, anxiety disorder and sexual disorder. Not surprisingly, alcohol, the most commonly abused substance, is often an attempt at self-medicating the very problems that it creates.

November 8, 1999

Q "I typically use hydrocodone for my post-surgical patients. I feel that this is an effective drug although it can be habituating. But I wonder if I should combine it with antidepressants or some other form of therapy since many of these patients have the symptoms of depression including sleep problems and anxiety. Care to comment?"

A Opioid-Related Disorder (including syntheric opiates) can be associated with abuse and dependence. The discontinuation of the medication can be related to withdrawal and overuse can be associated with intoxication, and dependent upon patient and dosage, psychotic symptoms with hallucinations and/or delusions. The medications themselves can create their own clinical manifestation of mood disorder. Sleep disorder due to changes in sleep architecture and sexual dysfunction may occur.

November 15, 1999

Q "I read all of these psychological articles about "addiction to the internet", and I have some doubts. I do know that I personally am drawn to the auction sites and even considered getting one of those pagers that tell me when bids are exceeded, etc. Is this internet thing really addictive?"

A Weeks ago we discussed Impulse Control Disorders, one of which was Pathological Gambling. These disorders to not rise to the criteria of addiction, but they can represent a major disruption to occupational and interpersonal functioning. The individual who feels impelled to bid on auctions to the point of disruption of adaptive daily functioning becomes preoccupied, often increasing risk, and fails attempts unsuccessfully to stop the behavior. They become involved in "chasing their losses", returning repeatedly to the situation, feeling driven to engage in the behavior and may borrow from others to perpetuate the pattern. While such individuals appear more likely to develop stress related physical disorders, there is no evidence that they are more prone to substance related disorders.

November 21, 1999

Q "I take Xanax for my anxiety disorder. I take it according to schedule and in recent weeks this has been decreased because my symptoms have been reduced. I am on a small maintenance amount and hope to be off the drug soon. When the drug is stopped, I am concerned that I will be left with an addiction or addictive personality."

A There are several sedative, hypnotic and anxiolytic disorders. Hypnotics are used for treatment of sleep disorders, anxiolytics are used for the treatment of a range of anxiety disorders. All three groups of agents, if not properly regulated can result in dependence, and all three are open to abuse. In some cases intoxication, withdrawal, delirium, amnesia, mood, sleep, sexual and other symptom patterns may arise. In some cases hallucinations may occur even though the individual is aware that the hallucinations are caused by the medication (does not believe the hallucinations to be real). However, these medications, when dispensed and used appropriately, can be quite effective as an adjunct to the treatment of a range of disorders and should be taken according to guidelines and not avoided due to fear.

November 28, 1999

Q "My uncle is 67 and has high blood pressure. He denies the seriousness of his problem. We also suspect that he (a former commanding officer for three tours in Vietnam) has continued to use a variety of drugs. We think he has Alzheimer's Disease. His memory is very bad and becoming worse. When I asked the Veteran's Hospital if this were Alzheimer's, they only said `perhaps' as though there were other causes. Can you tell me of other possible causes?"

A Dementia comprises multiple cognitive (thinking) deficits including the inability to retain new information and recall previously learned information. It arises not only in Alzheimer's Disease, but in Vascular Dementia where the blood supply to the brain in interrupted or blocked. Dementia can result from the intake (intentionally or accidentally) of substances and can also be due to a variety of medical conditions that effect the central nervous system. There can be mood changes, behavioral disturbances, delusions and delirium (reduced clarity of awareness of the environment).

In toto, however, this is not something that you should, or can, personally diagnose. His symptoms, and your concern, should suggest to you that he be appropriately evaluated by someone who is, or can become, familiar with his history, including the drug abuse and problems with compliance with his anti-hypertensive regimen.

December 6, 1999

Q "If an individual has memory impairment, does this necessarily mean Alzheimer's Disorder?"

A Amnestic Disorder, the impairment in the ability to learn new information or recall previously learned material, can be transient or chronic. It can be substance induced or can be the result of a disease process. It is only one component of the dementia seen in Alzheimer's Disorder (in which there may be language disturbance, inability to carry out motor activities (apraxia), failure to recognize familiar objects (agnosia) and/or inability to organize, plan, etc (executive functioning). Amnestic Disorder is confined to memory difficulty and is not associated with the mood, delusional and behavioral complications of Alzheimer's Disorder.

December 13, 1999

Q "You talked about vascular dementia and Alzheimer's disease, but dementia also comes from other diseases as well, does it not?"

A Dementia presented as memory impairment (both inability to learn new material and to recall old material), along with cognitive problems such as language disturbance (aphasia), inability to carry out motor activities (apraxia) or inability to recognize objects (agnosia) can arise from HIV Disease, Head Trauma, Parkinson's Disease, Huntington's Disease, Pick's Disease, Creutzfeldt-Jakob Disease and others. Dementia can also be the longstanding and perhaps permanent impact of substances ingested. Obviously,dementia can, for some individuals, be the combined result of multiple factors. 

December 20, 1999

Q "I saw a movie recently about Tourette's Disorder. It was a comedy, and I did not learn a great deal. What is this disorder?" 

A Tourette's Disorder is a tic disorder in which there are multiple motor and one or more vocal tics present during the course of the disorder. The motor or vocal tic need not be present concurrently. The tics often occur in bouts almost every day and for a period of greater than one year. There are no tic-free periods exceeding three months in order to be diagnosed with Tourette's Disorder. The onset is before the age of 18.

December 27, 1999

Q "I went to school with a boy who would wince and shrug his shoulder as though flinching. He would do this several times a day. When I went to college, I sat next to a fellow who would give a series of verbal noises...much like saying "huh?" several times. What is this problem?"

A Chronic motor or vocal tic disorder are recurrent, involuntary movements or vocalizations over which the individual appears to have no control. It is usually diagnosed when the behavior has been present for at least a year and during which time there has been no period exceeding three months when the problem was not present. The onset is prior to adulthood and is not caused by another disease process or substance abuse. The person is most often distressed by the symptoms and social/occupational functioning can be impaired. There are psychological and medical approaches to treating a motor or vocal tic disorder.