Environmental deprivation in alcoholic, medical and psychiatric patients.

Abstract

tion Score than did psychiatric outpatients and medical patients. Environmental and social support should accompany treatment o] their primary symptoms. There is philosophical and empirical substantiation for the hypothesis that adaptive behavior and a subjective sense of well-being are correlated positively with consistent environmental support. Cobb's (1) examination of the relevant literature emphasizes the importance of social support as a protective buffer against the negative consequences of crisis and change. For example, surgical patients given supportive care by an anesthetist needed significantly less medication for pain and were released an average of 2.7 days earlier than a control group without supportive care (2). Chambers and Reiser (3) observed that cardiac failure was associated with emotionally significant events and that emotional support from a physician tended to mollify or negate the stress. Related studies (4, 5) demonstrate the positive relationship of social support with reduced length of hospitalization, decreased reliance on medication and shortened convalescence. Incidence of influenza, syphilis, pneumonia and liver cirrhosis and even mortality are reported to be significantly higher among single than married people (6). Other stressful events which reduce social contacts (e.g., marital separation, loss of a job, moving to a different location, financial limitation) have been associated with the relative frequency of tuberculosis (6). The connection between affective disorder, especially depression, and loss is well established (4, 5, 7, 8). While the deprivation of vaguely defined environmental supports is more difficult to conceptualize than the loss of a limb, loved one or possession, reaction to this condition still involves the customary affective concomitance of loss. As in more tangible losses, the loser may be unaware of the relationship between maladaptive affect and environmental insufficiency. Individuals who are more predisposed to deviant social behavior (e.g., murder, theft, poor working habits, sexual promiscuity) than to affective expression of conflict or pain may further disguise the interface between their environment and their symptoms (9). In some patient populations, suicide is nine times more