To summarize the support for the diagnosis, there have been three nationally known psychiatric experts in substance dependency who have supported further investigation of the diagnosis. The National Council on Alcohol and Drug Dependence (NCADD) added its support almost a year ago. Quite recently, the California Mental Health Dept. took the public-spirited, open-minded and even courageous action of informing all of its psychiatrists about the diagnosis. The "courageous" aspect of this action is that academic psychiatry "hasn’t liked" this diagnosis because it clashes with its "biological ideology." It has largely dealt with the diagnosis by simply "stonewalling it." Biological psychiatry greatly emphasizes the role of genetics and "biochemical imbalances" in the origin of serious psychiatric illness. In doing so it is often guilty of overly reductionistic and simplistic thinking. Its very name represents a distortion of the dictionary meaning of the legitimate term, "biological." Its influence has had the very unfortunate effect of eliminating any training in ("unbiological") psychotherapy at many psychiatric training programs. At my web site www.rust.net/~norman is a very worthwhile and critical essay on "Biological Psychiatry" by psychiatrist David Kaiser, which is entitled: "Not By Chemicals Alone: A Hard Look At Psychiatric Medicine."

The head of the addictive section of an eastern medical school psychiatric department was seriously planning to organize a clinical trial on the diagnosis two years ago. But this was largely prior to his assuming the post. Subsequently, he soon lost almost all of his interest and initiative regarding the diagnosis. I could only assume that he had underestimated the resistance of the psychiatric department to the diagnosis, and didn’t want to deal with the inevitable hassle it represented.

I recently learned with some difficulty from the University of Melbourne (only) that it is currently conducting a clinical trial on what captures much of the essence of the SDIP diagnosis. This knowledge came about because a father from Australia had emailed me after having accessed my web site on the diagnosis. His 15 year old son had became mentally ill after abusing drugs during his parent’s recent divorce, and was not doing well. He remarked that reading about the diagnosis was "like a breath of fresh air for him." I agreed with him that the diagnosis likely applied to his son. A few months, later I learned that his son was responding very well to treatment being offered at an outpatient treatment program, and that it was "much like I had recommended for SDIP patients." It was this knowledge that led me to learning that the son was a participant in a clinical trial. He was exceedingly fortunate to have such a concerned father, and to have lived near the only appropriate treatment program for him in the world. The father didn’t want to reveal where his son was being treated- but I later learned that it was at the EPPIC (Early Psychosis Prevention Intervention Centre) program in Melbourne- which is aimed at young people.

I will be candid about this article. It is intended to inform- but also to motivate its readers to do whatever they can to support adequate media exposure of this diagnosis. I am convinced that the public has a right to know about this diagnosis, and that enough exposure will inevitably result in some medical school organizing a critically-needed clinical trial. I live in Michigan and the medical writer for the Detroit Free Press expressed real interest in reporting on the diagnosis earlier this year. Then about a month later, she mysteriously lost all her interest- and never would explain herself. I am convinced she belatedly learned of the "politically incorrect status" of the diagnosis. It is absolutely inevitable that the SDIP diagnosis will eventually become officially established. I would like this to happen sooner than later to avoid the preventable and very considerable suffering on the part of so many SDIP-afflicted persons.

The diagnosis of a SDIP is predicated on the pre-existence of a substance dependency, for which a variety of evidences point to its crucial role in the genesis of the psychosis. These include the timing of the illness, the nature of its symptoms, and the response to treatment. (One patient suffered his last auditory hallucination when he finally fully admitted to himself that he was alcoholic. This occurred six weeks into an outpatient substance dependency treatment program. A "voice" then said to kill himself. It was his first "voice" in months, and the first ever involving any suicidal ideas.) My executive patient likely would never have suffered a psychosis if he hadn’t first become alcoholic. He also probably wouldn’t suffered a psychosis if his brother had died several months later, when his alcoholic recovery would likely have been better consolidated. The first psychotic symptoms often develop during regular practice of the dependency. But they also often occur during periods of reducing or attempting to cease use of the substance because of increasing problems with its use. Probably the strongest evidence for the diagnosis is when a person first experiences symptoms very shortly after a return to (usually moderate) substance use- following a significant period of abstinence.

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