The impact of comorbid anxiety and depression on alcohol treatment outcomes (original) (raw)
Related papers
Alcohol use disorders comorbid with anxiety, depression and drug use disorders
Drug and Alcohol Dependence, 2002
The aim of this paper is to report the prevalence of 12-month comorbidity between DSM-IV alcohol use disorders (abuse or dependence) and anxiety, affective and drug use disorders in the adult Australian general population and to examine the disability and health service utilisation associated with this comorbidity. The study uses data from the National Survey of Mental Health and Well Being (NSMH&WB). The NSMH&WB is a cross-sectional survey of 10,641 Australian adults conducted in 1997 that measured the prevalence of DSM-IV mental disorders in the previous 12 months and associated disability and health service utilisation. Results show approximately one-third of respondents with an alcohol use disorder (abuse or dependence) met criteria for at least one comorbid mental disorder in the previous 12 months. They were 10 times more likely to have a drug use disorder, four times more likely to have an affective disorder and three times more likely to have an anxiety disorder. Respondents with an alcohol use disorder and a comorbid mental disorder were significantly more disabled and higher users of health services than respondents with an alcohol disorder and no comorbid mental disorders. These results reinforce the need for both mental health and drug and alcohol professionals to be provided with education to assist with appropriate identification, management and referral of clients presenting with this complex range of disorders. #
Addiction Science & Clinical Practice, 2013
Background: A major barrier to successful treatment in alcohol dependence is psychiatric comorbidity. During treatment, the time to relapse is shorter, the drop-out rate is increased, and long-term alcohol consumption is greater for those with comorbid major depression or anxiety disorder than those with an alcohol use disorder with no comorbid mental disorder. The treatment of alcohol dependence and psychological disorders is often the responsibility of different services, and this can hinder the treatment process. Accordingly, there is a need for an effective integrated treatment for alcohol dependence and comorbid anxiety and/or depression. Methods/Design: We aim to assess the effectiveness of a specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting. Following a three-week stabilization period (abstinence or significantly reduced consumption), participants will undergo complete formal assessment for anxiety and depression. Those patients with a diagnosis of an anxiety and/or depressive disorder will be randomized to either 1) integrated intervention (cognitive behavioral therapy) for alcohol, anxiety, and/or depression; or 2) usual counseling care for alcohol problems. Patients will then be followed up at weeks 12, 16, and 24. The primary outcome measure is alcohol consumption (total abstinence, time to lapse, and time to relapse). Secondary outcome measures include changes in alcohol dependence severity, depression, or anxiety symptoms and changes in clinician-rated severity of anxiety and depression. Discussion: The study findings will have potential implications for clinical practice by evaluating the implementation of specialized integrated treatment for comorbid anxiety and/or depression in an alcohol outpatient service. Trial registration: ClinicalTrials.gov Identifier: NCT01941693
Journal of Affective Disorders, 2011
This study examines comorbidity of alcohol abuse and alcohol dependence as well as its risk indicators among anxious and/or depressed persons, also considering temporal sequencing of disorders. Methods: Baseline data from the Netherlands Study of Depression and Anxiety (NESDA) were used, including 2329 persons with lifetime DSM-IV anxiety (social phobia, generalized anxiety disorder, panic disorder, and agoraphobia) and/or depressive (major depressive disorder and dysthymia) disorders and 652 controls. Lifetime diagnoses of DSM-IV alcohol abuse and dependence were established, as well as information about socio-demographic, vulnerability, addiction-related and anxiety/depression-related characteristics. Temporal sequencing of disorders was established retrospectively, using age of onset. Results: Of persons with combined anxiety/depression 20.3% showed alcohol dependence versus 5.5% of controls. Prevalence of alcohol abuse was similar across groups (± 12%). Independent risk indicators for alcohol dependence among anxious and/or depressed persons were male gender, vulnerability factors (family history of alcohol dependence, family history of anxiety/depression, openness to experience, low conscientiousness, being single, and childhood trauma), addiction-related factors (smoking and illicit drug use) and early anxiety/depression onset. Persons with secondary alcohol dependence were more neurotic, more often single and lonelier, while persons with primary alcohol dependence were more often male and more extravert. Discussion: Alcohol dependence, but not abuse, is more prevalent in anxious and/or depressed persons. Persons with comorbid alcohol dependence constitute a distinct subgroup of anxious and/or depressed persons, characterized by addiction-related habits and vulnerability. However, considerable variation in characteristics exists depending on temporal sequencing of disorders. This knowledge may improve identification and treatment of those anxious and/or depressed patients who are additionally suffering from alcohol dependence.
The American Journal on Addictions, 2016
Background and Objectives: Since significant differences have been reported, we estimated agreement between DSM-5 and DSM-IV criteria for alcohol use disorder (AUD). Methods: We assessed 327 outpatients (mean age: 45.2 AE 13.4) with depressive or anxiety disorders. Results: Absolute differences in prevalence rates between DSM-5 and DSM-IV AUD ranged from À1.1% (subjects with anxiety disorders) to þ1.8% (tobacco smokers). The agreement was excellent (k ¼ 0.88), also accounting for specific subgroups (relevant k coefficients >0.80). Discussion and Conclusions: DSM-5 criteria did not inflate AUD rates. Scientific Significance: Our results have epidemiological significance since, unlike previous reports, we found diagnostic stability between new and old AUD criteria in this clinical population.
Alcohol and Alcoholism, 2001
The goals of this study were to describe demographic variables, drinking history, and the 6-month prevalence of Axis I comorbidity among alcohol-dependent subjects in Germany. The variables: amount of alcohol consumption, age at onset of the first alcohol consumed, age at onset of daily alcohol consumption, age at onset of withdrawal symptoms and number of detoxifications were related to the different comorbid disorders and gender. In this study, 556 patients from 25 alcohol treatment centres were enrolled between 1 January 1999 and 30 April 1999. After a minimum of 10 days of sobriety patients who fulfilled ICD-10 and DSM-IV criteria of alcohol dependence were interviewed for data collection using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule) and a standardized psychosocial interview. The 6-month prevalence of comorbid Axis I disorders was 53.1%. Among the patients with comorbidity, affective and anxiety disorders were most frequent. Comorbid stress disorder was associated with an early start of drinking, an early beginning of withdrawal symptoms, highest number of detoxifications, and the highest amount of alcohol consumed. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid disorder. The data do not answer the question of the pathogenesis of comorbid disorders and alcoholism, but indicate that stress disorders in alcoholic patients and anxiety disorders in female alcoholics influence the course and severity of alcoholism.
A Study to Assess the Prevalence of Depression and Anxiety among Alcohol Use Disorder
IOSR Journals , 2019
Aim: Alcohol is the leading substance among the abused substances which is legitimate to use and causes significant burden than any other substances. Globally, alcohol consumption has escalated in recent decades, with all or most of that increase in developing countries. The present study was aimed to estimate the prevalence of depression and anxiety among individuals with alcohol use disorder in a tertiary care hospital . Methodology:A cross sectional based study .40 Subjects were recruited in the study after the approval from the institutional ethics committee. After obtaining the informed consent sociodemographic profile was collected using a Semi structured Proforma . Screening for alcohol consumption was done using CAGE questionnaire and Alcohol Use Disorder Identification Test (AUDIT).Patients were then screened for the presence of Depression and Anxiety , 10 days after the last consumption of alcohol . The severity of Depression and Anxiety were rated based on theHamilton Depression Rating Scale (HAM D) and Hamilton Anxiety Rating Scale respectively .The results were analysed using appropriate statistical methods. Results& Discussion:Evaluation of the study population revealed that 80 % had depression.The mean HAM D score was13.7 ± 6.35 in the study population . The mean HAM-D score for participants with psychosocial stressors was 17.4 which was significantly higher (P-value= 0.004) compared to participants without psychosocial stressors whose mean score was 11.52. Entire study population had symptoms of anxiety however the severity varied . 70% of them showed symptoms of mild anxiety while17.5% showed symptoms of mild to moderate anxiety . The mean HAM A score was 13.43 ± 9.03 in the study population. Conclusion: This study demonstrates the risk of depression and anxiety disorder to be significantly high in the adult population with Alcohol use disorder. When alcoholism and psychiatric disorder co-exist patients are more likely to have difficulty in maintaining abstinence and to avail mental health services. Meticulous evaluation of psychiatric complaints in alcoholic patients is important to reduce illness severity in these individuals and to improve their quality of life .
International Journal of Methods in Psychiatric Research, 2008
Aims: To examine, if the utilization of help for problematic drinking after brief intervention (BI) differs between general practice (GP) patients with and without comorbid depression or anxiety disorders. Methods: Longitudinal data of 374 GP patients, who met the diagnostic criteria of alcohol dependence or abuse according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and criteria of at-risk drinking or binge drinking, were drawn from a randomized controlled BI study. Participants were randomly allocated to either a control or one of two intervention groups, receiving a series of alcohol related BI. Of the sample, 88 participants were diagnosed with comorbid anxiety and/or depressive disorders. At 12-months follow-up, differences in utilization of formal help for drinking problems were assessed between comorbid and non-comorbid individuals. Results: BI were significantly related to an increase in utilization of formal help in non-comorbid patients (χ2 = 4.54; df = 1; p < 0.05) but not in comorbid individuals (χ2 = 0.40; df = 1; p = 0.60). In a logistic regression analysis, comorbidity [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.14–2.88; p = 0.01) and previous help seeking (OR = 15.98; CI = 6.10–41.85; p < 0.001) were found to be positive predictors for utilization of formal help. Conclusion: BIs do not seem to significantly support help-seeking in the comorbid. As comorbid anxiety and depression constitute a positive predictor for help-seeking, individuals with problematic drinking and comorbid anxiety or depressive disorders might benefit from more specialized support exceeding the low level of BI. Copyright © 2008 John Wiley & Sons, Ltd.
Drug and Alcohol Dependence, 2008
Background: Brief interventions (BIs) are effective methods to reduce problematic drinking. It is not known, if the effectiveness of BI differs between patients with or without comorbid depression or anxiety disorders. Methods: In a randomized controlled BI study with two intervention groups and one control condition, data were collected from 408 general practice (GP) patients with alcohol use disorders, at-risk drinking or binge drinking. 88 participants were diagnosed with comorbid anxiety and/or depressive disorders. The effectiveness of BI was assessed at a 12-month follow-up in relation to the presence and absence of comorbidity. Reduction of drinking in six ordered categories (g/alcohol) between baseline and follow-up served as the outcome variable. Results: BI were significantly related to reduction of drinking in the non-comorbid (−2.64 g/alcohol vs. −8.61 g/alcohol; p = .03) but not in the comorbid subsample (−22.06 g/alcohol vs. −22.09 g/alcohol; p = .76). Compared to non-comorbid participants, a significantly higher reduction of drinking was found for comorbid individuals (−6.55 g/alcohol vs. −22.08 g/alcohol; p = .01). An ordinal regression analysis revealed comorbidity to be a positive predictor for reduction of drinking (estimator = .594; CI = .175-1.013; p < .01). When entering the variables amount of drinking at baseline, intervention and classification of problematic drinking, these became significant predictors, whereas comorbidity showed only a tendency. Conclusion: BI did not significantly effect a reduction of drinking in comorbid patients. As BI are known to be less effective for dependent drinkers, a larger proportion of dependents among the comorbid might have limited the effectiveness of BI. Future studies with larger sample sizes of comorbid problem drinkers are necessary to confirm the results. (J.M. Grothues). and Rollnick, 1991) poses an effective technique to enhance motivation to change problematic drinking behavior. As the majority of problem drinkers do not seek help , primary care settings provide a suitable channel to reach a large number of the target group. A recent Cochrane review provided strong evidence that BI in primary care settings are effective to reduce problematic alcohol consumption . However, also describe "a clear need to characterise the types of drinkers for whom BI have a positive impact and any subgroups that have not been represented in the trials to date" (p. 3). While high rates of anxiety and depression have been found in various samples of individuals with alcohol 0376-8716/$ -see front matter
Does a U-shaped relationship exist between alcohol use and DSM-III-R mood and anxiety disorders?
Journal of Affective Disorders, 2004
Background: In recent community surveys, abstainers and heavy drinkers of alcohol have reported more mood and anxiety symptoms than moderate drinkers (U-shaped relationship). The present study was aimed at extending this finding by investigating this potential U-shaped relationship using structured diagnostic interviews to assess mood and anxiety disorders. Methods: Data came from two contemporaneous surveys, the National Comorbidity Survey (NCS; N = 6780) and the Mental Health Supplement of the Ontario Health Survey (OHS-MHS; N = 7001). The University of Michigan Revision of the Composite International Diagnostic Interview (UM-CIDI) was used to make DSM-III-R psychiatric diagnoses in both surveys. Three mutually exclusive lifetime alcohol use categories were compared: (1) Alcohol abstainers-individuals reporting no alcohol use or less than 12 drinks in any year throughout their life. (2) Moderate drinkers-individuals that did not meet criteria for alcohol abstainers or problem drinkers. (3) Problem drinkers-DSM-III-R lifetime alcohol abuse, dependence or hazardous levels of alcohol use. Results: After controlling for demographic variables, alcohol abstainers were not found to have significantly higher rates of mood and anxiety disorders in comparison with moderate drinkers. However, problem drinking was significantly associated with mood and anxiety disorders. Conclusions: Across both surveys, there was no evidence of a Ushaped relationship between lifetime alcohol consumption and lifetime mood and anxiety disorders. D