Influence of psychiatric comorbidity in alcohol-dependent subjects in a representative population survey on treatment utilization and natural recovery (original) (raw)
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Alcoholism: Clinical and Experimental Research, 1999
Objective: The primary purpose of this research was to compare the service use of patients diagnosed with alcohol dependence to the service use of patients diagnosed with other chronic illnesses. The secondary purpose was to determine the impact of comorbid alcoholism on the service use of patients with chronic illnesses. Methods: The sample included 67,878 veterans diagnosed with alcohol dependence, depression, or diabetes who were treated by the Department of Veterans Affairs in 1993. The number of inpatient days and outpatient visits over a 4-year period (1991 to 1995) were compared using regression models to control for differences in casemix. Results: Controlling for casemix, patients treated for alcohol dependence had significantly fewer outpatient visits than patients treated for either depression or diabetes. Patients treated for alcohol dependence also had significantly fewer inpatient days than patients treated for depression, but significantly more inpatient days than patients treated for diabetes. Comorbid alcoholism was prevalent among patients treated for depression and diabetes. Comorbid alcoholism increased the number of inpatient days for patients treated for depression or diabetes and increased the number outpatient visits for patients with depression. However, comorbid alcoholism decreased the number of outpatient visits for patients treated for diabetes. Conclusions: Results suggest that patients with alcohol use disorders should not be singled out as being more costly to treat than patients with other chronic illnesses. These findings are in stark contrast to those from studies comparing individuals with alcohol use disorders to relatively healthy individuals sampled from at-risk populations.
Drug and Alcohol Dependence, 2007
Background: Epidemiological studies consistently show low rates of alcohol treatment utilization among individuals with an alcohol use disorder (AUD). However, there is not as great consistency in the characteristics that predict alcohol treatment utilization. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we examined attributes associated with treatment utilization among individuals with an AUD. We used stepwise backward selection logistic regression analysis to examine demographic and clinical predictors of treatment utilization, in order to identify opportunities to improve the delivery of services to this population. Results: Only 14.6% of individuals who met lifetime criteria for an AUD reported ever having received alcohol treatment (including self-help group participation). A greater proportion of respondents with both alcohol abuse and dependence (27.9%) reported having received treatment, compared with 7.5% of those with alcohol abuse only and 4.8% of those with alcohol dependence only. Older individuals, men, and those who were divorced, had less education or more lifetime comorbid mood, personality, and drug use disorders were also more likely to have received treatment. Conclusions: The majority of individuals with an AUD never receive formal alcohol treatment, nor do they participate in self-help groups. Although natural recovery from an AUD is well documented, participation in alcohol treatment is associated with improved outcomes. The data presented here should be taken into account when efforts are made to enhance alcohol treatment utilization.
Alcohol and Alcoholism, 2006
Aims: To study the factors relating to remission from alcohol dependence in the general population. Methods: Within a representative, cross-sectional general population sample aged 30 years or more, the characteristics of subjects remitted from alcohol dependence were examined by comparisons with actively alcohol-dependent subjects. Results: The overall lifetime prevalence of alcohol dependence was 7.9%. Comorbid depressive and anxiety disorders were diagnosed in 22% of the actively alcohol-dependent and in 19% of the remitted subjects. There were few sociodemographic, clinical or childhood-related factors differentiating the two groups of subjects. Of comorbid mental disorders, social phobia (6% vs 1%) and dysthymia (7% vs 3%) were more common among the actively alcohol-dependent, whereas other common disorders were equally common for both active and remitted alcohol dependence. Health care or other service use for alcohol problems within the previous 12 months was more frequent among the actively dependent (16% vs 4%), and the same was true for health care use for mental health problems (17% vs 8%). Any service use in the previous year for either type of problem was more common among the actively dependent than the remitted (26% vs 13%). Conclusions: In an unselected setting, only comorbid social phobia and dysthymia differentiated active alcohol dependence from a remitted state, suggesting either that they are obstacles to remission from an active state, explaining why some alcohol-dependent individuals are unable to recover, or that their symptoms are maintained by excessive alcohol use. The actively alcohol-dependent used both substance use services and mental health services more often than the remitted subjects, possibly due to needs generated by their alcohol problem. Comorbid psychopathology should be considered when developing treatment options for alcohol dependence.
A study of psychiatric comorbidity in alcohol dependence
Indian journal of psychiatry, 2003
The diagnosis of comorbid psychiatric conditions have important clinical ramifications as the outcome is poorer with multiple disorders. Various studies have shown that alcohol abuse has severe adverse effects on the course of metal illness and vice versa. Only a little data on the subject are available from our country. We interviewed 30 patients suffering from alcohol dependence using SCID - I & SCID - II. Seventy six percent of the sample had axis - I comorbid diagnosis and 40% had an axis -II diagnoses. Depressive disorder and cluster B personality disorders were the most common comorbid diagnosis.
Comorbidity of alcoholism and psychiatric disorders: an overview
Alcohol Research and …, 2002
Alcohol abuse and dependence frequently occur with other psychiatric conditions; this dual diagnosis is called comorbidity. Professionals working with comorbid patients face unique and challenging dilemmas about how to provide the best treatment to address both conditions. Despite ...
Journal of studies on alcohol, 1996
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
The impact of comorbid anxiety and depression on alcohol treatment outcomes
Addiction, 2005
Aims This study examines the impact of comorbid Diagnostic and Statistical Manual version IV (DSM-IV) anxiety and/or depression on out-patient treatment for alcohol problems. Design A prospective correlational design. Participants and settings Seventy-one clients seeking alcohol out-patient treatment at two treatment sites were interviewed at commencement of a treatment episode for alcohol problems and reinterviewed using the same measures 3 months later. Comorbid DSM-IV anxiety and/or depression were measured by the Composite International Diagnostic Interview (CIDI), a comprehensive interview developed by the World Health Organization to assess current and life-time prevalence of mental disorders. Outcome measures included standardized measures of disability [the short form (SF)-12 Mental Health Summary Score and the number of days taken out of role] and the average amount of alcohol consumed. Clients were also asked to rate their satisfaction with the services received. Findings Participants with comorbid DSM-IV anxiety and/or depressive disorders were more disabled and drank more heavily than those without these comorbid disorders at entry to treatment. At 3-month follow-up both groups of participants (i.e. those with and without DSM-IV comorbid anxiety and/or depression) were significantly less disabled and also drank significantly less alcohol on an average drinking occasion than at baseline. Despite this, the comorbid group remained more disabled and drank more heavily than the noncomorbid group at follow-up. Conclusions Further research is needed to determine the most appropriate model of care for alcohol treatment seekers with comorbid DSM-IV anxiety and/ or depression.
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.