We need to come to the point where it is more fashionable to go to the gym than to happy hour. Dependence is a neurological state and involves the concept of tolerance, where more and more of the substance is needed for the desired effect. While many people may think of alcohol abusers or people dependent on alcohol as skid-row types, staggering in the street or sleeping it off every morning, most alcoholics are functioning alcoholics. In truth they function with their illness just as diabetics function with their disease and people with heart disease function with theirs. But we know that life is not as functional as it should and could be, and there are sure to be health consequences from the drinking.
Substance abuse can make an already-severe mental illness much more difficult to treat.
Called dual-diagnosis, because the patient has both a mental health and substance abuse problem, this is a disorder that is growing in numbers each year. People suffering from psychoses have a rate of substance abuse 5-10 times that of the general population. Sixty percent of people with bi-polar, or manic depression, abuse either alcohol or drugs. Half of people with depression do also, and about half of people with generalized anxiety do. The man has to go to work five days a week, and that is somewhat of a control on his drinking.