Patients with substance abuse disorders often have associated depression (Weissman et al., 1977; Rounsaville et al., 1982; Kamerow et al., 1986). Weissman and Myers (1980) identified 15 percent of alcoholics as having coexisting major depression. Of those patients, they identified approximately 40 percent as having depression secondary to the alcoholism. The prevalence of major depression in a study of 533 opiate addicts was 24 percent (Rounsaville et al., 1982). The data indicate clearly that these problems are interconnecteddepression and anxiety states, depression and drug dependency, substance abuse and depression, and all of these with chronic pain. However, the role of alcohol and other substance abuse in the genesis and maintenance of chronic pain is poorly understood. However there is help for depression

Treatment considerations regarding alcoholism or drug abuse and/or dependency in patients with chronic pain are similar to the considerations for the treatment of depression in these patients. Regardless of whether substance abuse is a cause, an effect, or merely a fortuitous concomitant feature of chronic pain, recognition and treatment of substance abuse disorders is likely to be an essential component of successful rehabilitation of the chronic pain patient. Depressive symptoms are likely to resolve spontaneously after relatively short (1 month) periods of abstinence from the abused substance (Jaffe and Ciraulo, 1986). Mutual help groups like Alcoholics Anonymous and family or group therapy may be helpful in treatment. Use of naltrexone (a pure opiate antagonist) in the treatment of formerly opiate addictions chronic pain patients is more controversial both because of the theoretical possibility that opioid blockade might exacerbate chronic pain (by disabling the endogenous mechanisms for pain modulation) and because of the practical difficulty in convincing some patients with chronic pain to accept complete abstinence from any use of opiate analgesics.

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