Comorbid psychiatric diagnosis predicts three-year outcomes in alcoholics: a posttreatment natural history study (original) (raw)

1996, Journal of studies on alcohol

To examine the impact of three common comorbid disorders on a variety of outcomes 3 years after inpatient alcoholism treatment. Method: Using a prospective cohort design, we examined the frequency and intensity of drinking, the severity of alcohol-related symptoms, global alcohol-related outcome and severity of psychiatric symptoms in a group of 225 (74% male) alcoholics. At the index admission, patients were categorized as to the lifetime presence of major depression, antisocial personality disorder (ASP) and drag abuse/dependence. Multiple linear regression was used hierarchically to step in blocks of predictors in a logical sequence: (1) gender and age; (2) number of comorbid psychiatric diagnoses and the presence or absence of the three individual comorbid psychiatric disorders; and (3) the interaction between gender and each of the three diagnostic groups. Results: Men showed greater intensity of drinking, more alcohol-related symptoms and poorer global alcohol-related outcome. Younger patients also showed more alcohol-related symptoms. Although the number of comorbid diagnoses was correlated with both the intensity of drinking and the severity of psychopathology, each of the specific comorbid diagnoses accounted for unique variance in outcome. Comorbid drug abuse/dependence was associated with more drinking days and more alcohol-related symptoms. In contrast, the presence of comorbid major depression was associated with lower intensity of drinking. Finally, ASP was associated with poorer global alcohol-related outcome. Conclusions: Outcomes 3 years after alcoholism treatment are related to the presence of specific lifetime comorbid psychiatric diagnoses. Since such disorders may positively influence the course of alcoholism, trials of clinical interventions that target these disorders are warranted. (J. Stud. Alcohol 57: 619-626, 1996) IGH RATES of comorbid psychiatric disorders have been found in both clinical (Hesselbrock et al., 1985; Powell et al., 1982; Ross et al., 1988; Schuckit, 1985) and community samples of alcoholics (Helzer and Pryzbeck, 1988; Kessler et al., 1994). The most common comorbid disorders in many of these studies have been mood disorders (particularly depression), drug abuse and antisocial personality disorder (ASP). Although these comorbid psychiatric disorders are considered to be important both in the development of alcoholism and in its clinical course (Meyer, 1986; Pottenger et al., 1978), studies of their prognostic significance have not yielded consistent findings. In a 1-year follow-up study of alcoholics who had undergone extensive psychiatric assessment during their index treatment episode, Rounsaville and colleagues (1987) found that psychiatric diagnosis at intake predicted treatment outcome on a variety of measures. In addition, these investigators noted that them were a number of significant interactions between psychiatric diagnosis and gender. Among men, the presence of a comorbid lifetime diagnosis of major depres