In response to the recent commentary by Drs. John J. Boronow and Steven S. Sharfstein on mental patients who do not realize they are ill, I would also like to point out that this same scenario is evident in substance use disorders ("Close the mental health revolving door," Dec. 29).
Alcohol use has been most clearly shown to increase aggression. Amphetamines, cocaine, LSD and PCP use may also precipitate violence in certain individuals.
The use of alcohol has also been linked to fatal injuries. A recent study by University of Maryland professor Gordon Smith and his colleagues found that alcohol is a significant factor in many fatal non-traffic injuries and that its importance varies by cause of injury. Alcohol was a major contributing factor in 32 percent of all homicide cases, 31 percent of unintentional injury deaths and 23 percent of suicide. Yet almost all the individuals involved are certain that nothing is wrong with them.
A percentage of these patients are still being treated in an outpatient setting when they need longer-term residential treatment. But unfortunately, this type of treatment is not covered by many insurance programs, including Medicaid.
Addicts often fake suicide attempts to get into psychiatric hospitals, where they hope to get the help they need. But they are discharged within three days when they are found not to have a mental illness.
The costs of this revolving door are huge as well. Nor can we overlook those who not only have a mental illness but also have a co-occurring substance abuse disorder as well as co-morbid conditions such as HIV/AIDS, hepatitis, etc.
Legislation must cover not only those with mental illnesses but also those with substance abuse disorders.
Patricia Bayly Miedusiewski, Monkon-
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