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Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 54: 313-321
Abstract
Objective:
To study patterns of co-occurrence of lifetime DSM-III-R alcohol disorders in a household sample.
Methods:
Data came from the National Comorbidity Survey (NCS), a nationally representative household survey. Diagnoses were based on a modified version of the Composite International Diagnostic Interview.
Results:
Respondents with lifetime NCS/DSM-III-R alcohol abuse or dependence had a high probability of carrying at least 1 other lifetimeNCS/DSM-III-R diagnosis. Retrospective reports have suggested that most lifetime co-occurring alcohol disorders begin at a later age than at least 1 other NCS/DSM-III-R disorder. Earlier disorders are generally stronger predictors of alcohol dependence than alcohol abuse and stronger among women than men. Lifetime co-occurrence is positively, but weakly, associated with the persistence of alcohol abuse among men and of alcohol dependence among both men and women.
Conclusions:
Caution is needed in interpreting the results due to the fact that diagnoses were made by nonclinicians and results are based on retrospective reports of the age at onset. Within the context of these limitations, though, these results show that alcohol abuse and dependence are often associated with other lifetime DSM-III-R disorders and suggest that, at least in recent cohorts, the alcohol use disorders are usually temporally secondary. Prospective data and data based on clinically confirmed diagnoses are needed to verify these findings.
... Depression and alcoholism are linked to significant morbidity, disability, and mortality. Several epidemiological studies [43][44][45][46] have demonstrated the extent of comorbidity between these disorders. In 2003, Sher et al. compared depressed patients with and without a previous history of alcoholism and found that depressed subjects with a history of alcoholism had lower cerebrospinal fluid monoamine metabolites [47]. ...
... Furthermore, the dopaminergic system in patients with comorbid depression and alcohol dependence is likely to be more impaired than in patients with each diagnosis alone. Moreover, individuals with a history of alcoholism exhibit additional biological abnormalities, including alterations in the ɤ-aminobutyric acid, N-methyl-D-aspartate, endogenous opioid, and serotonergic systems in the brain [44][45][46]. In certain studies conducted with alcohol-dependent patients, the results showed a higher incidence of the rs1386493 GG TPH2 gene [8,48,49]. ...
... Regarding our results about the rs4570625 TT TPH2 gene in PWH, we found that 15.3 and 11.9% from TDF/FTC + EFV group EFV and TDF/FTC + ATVr, respectively, carried this SNP. This SNP may be a biological factor and a potential risk factor for emotional regu--aminobutyric acid, N-methyl-D-aspartate, endogenous opioid, and serotonergic systems in the brain [44][45][46]. In certain studies conducted with alcohol-dependent patients, the results showed a higher incidence of the rs1386493 GG TPH2 gene [8,48,49]. ...
Efavirenz (EFV) causes neuropsychiatric effects such as anxiety, depression, and suicidal thoughts in people with HIV (PWH). Depressive disorders have been associated with the Tryptophan hydroxylase type 2 (TPH2) gene. Objectives: This study determines the genotypes and allelic frequencies of three TPH2 single nucleotide polymorphisms (SNPs) in a Mexican cohort of HIV-1 treatment-naïve-patients and the severity of depressive symptoms at baseline and after a four-week clinical follow-up of antiretroviral treatment. Methods: In a pilot prospective study, eighty-one antiretroviral treatment-naïve patients were recruited from the Infectious Disease Hospital, National Medical Center “La Raza”, in Mexico City. Of these, 39 were treated using a set-dose combination regimen of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) plus EFV and 42 were treated with TDF/FTC plus atazanavir/ritonavir (ATV/r), and fifty-nine control volunteers. Genomic DNA was obtained from peripheral blood mononuclear cells. All DNA samples underwent qPCR utilizing TaqMan probes for the three TPH2 SNPs studied. All participants underwent evaluation utilizing the Beck Depression Inventory. Results: Of the three SNPs examined, none exhibited any notable differences in the distribution of the alleles between the groups; nevertheless, rs4570625 TT and rs1386493 GG presented a twofold and fivefold greater risk of severe depression in PWH, respectively, independently of the treatment. Among PWH, those treated with EFV experienced severe depression at a higher rate of 90.4% after four weeks, compared to 87.5% in those treated with ATV/r. Conclusions: High rates of severe depression were identified in PWH, who presented the rs4570625 TT and rs1386493 GG polymorphic variants. Depression increased after four weeks of treatment and was higher with EFV than ATV/r. It is crucial to emphasize the necessity of conducting psychiatric monitoring for every patient with HIV and administering prompt antidepressant treatment.
... One-in-four adults in the U.S. engage in alcohol binge drinking weekly, making it the predominant form of alcohol misuse in the United States [1]. While several risk factors can influence alcohol misuse, exposure to adverse experiences (e.g., psychological stress) is associated with an increased risk of regularly misusing alcohol [2][3][4]. Indeed, the risk of engaging in binge drinking can increase nearly three-fold following a traumatic event [5,6]. Both binge drinking and stress exposure are well-characterized as negatively affecting the cardiovascular and hepatic systems while also leading to hyperlipidemia and atherosclerosis [7][8][9][10]. ...
... Exposure to adverse experiences can precipitate periods of alcohol misuse [2][3][4]. The impact of adverse experiences coupled with binge-pa erned alcohol drinking on signaling pathways involved in muscle proteostasis remains unexplored despite evidence supporting that each of these factors independently is detrimental to skeletal muscle health. ...
... Exposure to adverse experiences can precipitate periods of alcohol misuse [2][3][4]. The impact of adverse experiences coupled with binge-patterned alcohol drinking on signaling pathways involved in muscle proteostasis remains unexplored despite evidence supporting that each of these factors independently is detrimental to skeletal muscle health. ...
Adverse experiences (e.g., acute stress) and alcohol misuse can both impair skeletal muscle homeostasis, resulting in reduced protein synthesis and greater protein breakdown. Exposure to acute stress is a significant risk factor for engaging in alcohol misuse. However, little is known about how these factors together might further affect skeletal muscle health. To that end, this study investigated the effects of acute stress exposure followed by a period of binge-patterned alcohol drinking on signaling factors along mouse skeletal muscle protein synthesis (MPS) and degradation (MPD) pathways. Young adult male C57BL/6J mice participated in the Drinking in the Dark paradigm, where they received 2–4 h of access to 20% ethanol (alcohol group) or water (control group) for four days to establish baseline drinking levels. Three days later, half of the mice in each group were either exposed to a single episode of uncontrollable tail shocks (acute stress) or remained undisturbed in their home cages (no stress). Three days after stress exposure, mice received 4 h of access to 20% ethanol (alcohol) to model binge-patterned alcohol drinking or water for ten consecutive days. Immediately following the final episode of alcohol access, mouse gastrocnemius muscle was extracted to measure changes in relative protein levels along the Akt-mTOR MPS, as well as the ubiquitin-proteasome pathway (UPP) and autophagy MPD pathways via Western blotting. A single exposure to acute stress impaired Akt singling and reduced rates of MPS, independent of alcohol access. This observation was concurrent with a potent increase in heat shock protein seventy expression in the muscle of stressed mice. Alcohol drinking did not exacerbate stress-induced alterations in the MPS and MPD signaling pathways. Instead, changes in the MPS and MPD signaling factors due to alcohol access were primarily observed in non-stressed mice. Taken together, these data suggest that exposure to a stressor of sufficient intensity may cause prolonged disruptions to signaling factors that impact skeletal muscle health and function beyond what could be further induced by periods of alcohol misuse.
... The SNP rs9531855, has also been previously identified in a study that conducted a meta-analysis of genetic influences on initial alcohol sensitivity [43]. This is not surprising as a number of studies have reported a prevalence of comorbidity of depression and alcohol use disorders (AUD) [43,44]. ...
... The SNP rs9531855, has also been previously identified in a study that conducted a meta-analysis of genetic influences on initial alcohol sensitivity [43]. This is not surprising as a number of studies have reported a prevalence of comorbidity of depression and alcohol use disorders (AUD) [43,44]. Research indicates that higher alcohol consumption, influenced by genetics and environmental factors, increases the risk of developing major depression [45]. ...
Background
Major Depressive Disorder (MDD) has a heritable component, with estimates of heritability ranging from 30% to 40%. Depression is a significant comorbidity in people living with HIV (PLWHIV), increasing the risk of suicide-related behaviors. This study investigated the genetic risk loci associated with MDD among adults living with HIV in Uganda, where limited data exist on this relationship.
Methods
The case-control study analyzed 282 samples (139 MDD cases and 143 controls), assessed for MDD at baseline, six months, and one year using the Mini International Neuropsychiatric Interview. Blood samples were collected at these intervals, with DNA genotyping conducted in South Africa using the H3Africa array. Data were analyzed using PLINK2 and GEMMA for quality control and genome-wide association analysis respectively, followed by functional mapping with FUMA.
Results
While no significant single nucleotide polymorphisms (SNPs) were identified at the genome-wide threshold, six SNPs were found to be suggestively associated with MDD. These SNPs, which have been associated with other psychiatric conditions like Alzheimer's, alcohol use disorder, and bipolar disorder and have not previously been linked to MDD.
Conclusion
The study suggests the potential for novel MDD genetic risk loci discovery in PLWHIV and people of African ancestry, especially with larger sample sizes.
... Substance use disorders and addictive disorders have been shown to be accompanied by other co-ocurring mental disorders including depression, anxiety, attention-deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (Lai et al., 2015;Emmerik-van et al., 2012). Mood disorders are the most common psychiatric comorbidities among individuals with substance use disorders (Quello et al., 2005;Kessler et al., 1997). An epidemiological study showed that individuals with depression were approximately twice as likely to have a substance use disorder compared to individuals without any mood disorder (Kessler et al., 1997). ...
... Mood disorders are the most common psychiatric comorbidities among individuals with substance use disorders (Quello et al., 2005;Kessler et al., 1997). An epidemiological study showed that individuals with depression were approximately twice as likely to have a substance use disorder compared to individuals without any mood disorder (Kessler et al., 1997). Among individuals seeking treatment for any substance use disorder, an estimated 60% had experienced at least one mood disorder, and 42% an anxiety disorder (Grant et al., 2004). ...
Background
To date, there are no official diagnostic criteria for the frequently reported phenomenon of exercise addiction. Therefore, the aim of the present study was to investigate how mental disorders, specifically depression and attention-deficit hyperactivity disorder (ADHD), are related to exercise addiction (EA).
Methods
A total of 173 participants aged between 18 and 70 years, who reported exercising more than 10 h a week and continued to exercise despite injury or illness, answered questionnaires including the Exercise Dependence Scale, the Beck Depression Inventory, and the Homburger ADHD scale for adults. Multiple linear regression analyses were performed adjusting for relevant confounders (age, gender) and stepwise regression was used to identify which of the two mental disorders is the more influential predictor of EA.
Results
Pearson correlation analysis showed that depressive symptoms [r (171) = 0.422, p < 0.00] and ADHD symptoms [r (171) = 0.308, p < 0.001] were positively correlated with EA symptoms. The relation between depressive symptoms and EA remained after adjusting for confounders in the regression model (B = 20.531; t(170) = 5.950; 95% CI [13.719, 27.343]; p < 0.001). Similarly, the positive link between ADHD symptoms and EA persisted after controlling for confounders (B = 15.507; t(170) = 3.771; 95% CI [7.389, 23.625]; p < 0.001). Additionally, a stepwise regression model identified that depressive symptoms are a stronger predictor for EA than ADHD symptoms.
Conclusion
Depressive symptoms seem to be a stronger predictor for EA compared to ADHD symptoms in frequent exercisers. Although individuals with ADHD May exercise extensively, they might be less at risk for EA than individuals with depression. These results contribute to the complex characterization of the psychiatric profile of individuals with exercise addiction, and underline the need for further research elucidating the interplay between mental disorders and EA.
... Feelings Trigger Action has exhibited a stronger association with externalizing symptoms compared to other impulsivity factors (Johnson et al., 2013(Johnson et al., , 2017. This is consistent with findings that Positive and negative urgency show correlations with problematic alcohol use (for meta-analysis; Stautz & Cooper, 2013), which is the most common externalizing symptom (Kessler, 1997). On the other hand, Pervasive ...
... A smaller but still significant association was also observed between increased levels of Lack of Follow-Through, the non-ERI factor, and increased global internalizing symptoms severity. Also consistent with hypotheses, increased levels of Feelings Trigger Action, which reflect rash and regrettable behavior and speech when responding to emotions (Carver et al., 2011), were uniquely associated with increased alcohol use behavior (indexed by high AUDIT scores), the most common externalizing symptoms (Kessler, 1997). While those findings align with our hypotheses, future research should aim to expand upon them by (1) assessing these associations within the context of a longitudinal study design that incorporates therapeutic interventions for ERI psychopathologies and (2) Employing additional measures of externalizing symptoms (e.g., aggression, rule-breaking behavior, drug use, suicide attempt). ...
Background
Researchers have increasingly differentiated trait-like tendencies toward impulsivity occurring during emotional states (emotion-related impulsivity [ERI]) from impulsivity not tied to emotion (non-ERI). Relative to non-ERI, ERI has shown robust correlations with psychopathology and mild to moderate associations with physical health parameters (e.g., physical activity, poor sleep quality, body mass index [BMI]). Therefore, we first aimed to investigate the unique contributions of ERI and non-ERI to psychopathology symptoms while controlling for neuroticism. Second, we sought to explore the combined associations of physical health parameters with several impulsivity forms.
Methods
German-speaking adults (N = 350, 35.9 ± 14.6 years, 69.1% female, BMI: 24.0 ± 4.8 kg/m2, mostly students or employees) completed measures of impulsivity, psychopathology symptoms, neuroticism, and physical health. We gathered measures of two ERI forms: Feelings Trigger Action and Pervasive Influence of Feelings. As a control comparison, we gathered a measure of non-ERI, the Lack of Follow-Through scale. We conducted separate path models for Aims 1 and 2.
Results
For Aim 1, Pervasive Influence of Feelings showed strong links with internalizing symptoms. Feelings Trigger Action and Lack of Follow-Through showed small links with alcohol use. For Aim 2, poor sleep quality was related to all three impulsivity factors, while physical activity was only related to Pervasive Influence of Feelings and Lack of Follow-Through. BMI showed a curvilinear association with impulsivity.
Conclusions
ERI is more directly relevant than non-ERI for psychopathology symptoms, emphasizing the need to differentiate between the two ERI types. The association of ERI and non-ERI with physical activity and poor sleep quality may serve as potential treatment targets for impulsivity-related problems.
... et al. 2008). According to prospective research, anxiety and depression are also risk factors for the development and persistence of alcohol dependence, as well as the likelihood of relapse (Kessler et al., 1997). In a similar line, research indicates that exposure to alcohol stimuli and stress leads to substantial increases in alcohol craving, anxiety, and negative emotions, as well as decreases in positive emotions (Fox .et ...
Background: Psychological capital is a person's good mental growth state. It is made up of four parts: self-efficacy, optimism, hope, and resilience (Luthans et al., 2007). Previous study has also shown that all aspects of psychological capital are strongly connected to drug abuse. People who are addicted to drugs are known to think and act on impulse and have low tolerance levels. Few resourceful studies have been done on how to help people deal with problems and keep them from relapsing. The purpose of this research is to examine the impact of mindfulness-based cognitive therapy on psychological capital, specifically how it cultivates increased awareness of one's own thoughts, feelings, and emotions in the here and now via the practice of non-reaction and non-judgment modes of attention. This research investigates the efficacy of mindfulness-based therapy in assisting alcoholics in establishing psychological capital and so reducing the likelihood of relapse. Materials & Methods: Forty participants between the age range of 20-40 years diagnosed with alcohol dependence that fulfilled inclusion and exclusion criteria were selected from inpatient wards of hospital was assessed using socio demographic data sheet, five facet mindfulness questionnaire and psychological capital questionnaire on pre-post phase of the study. A pre-post experimental group with control group design was used. 20 participants were assigned in experimental group and 20 participants in the control group. Results: There was significant difference in the psychological capital in post intervention among experimental group as compared to control group.
... 47 The prevalence of anxiety, depression, and other psychiatric conditions is markedly elevated among individuals with alcohol dependance in comparison to the general population. 48,49 The most common mental health conditions that co-occur with Alcohol Use Disorder (AUD) include depressive disorders, 50 anxiety disorders, 51 trauma and stress-related disorders, 52 and sleep-related disorders. 53 The mood disorders most frequently observed in conjunction with alcohol dependance are major depressive disorder (affecting 27% to 40% of individuals) 54 and bipolar disorder (67%). ...
... A small but growing number of high-quality studies have demonstrated the feasibility of translating highly structured therapist-delivered programs (eg, CBT) to computer-delivered platforms for a variety of specific conditions [18][19][20][21][22][23][24][25][26]. Still, few studies of digital therapeutics aimed at addiction have addressed common comorbid psychiatric conditions [27][28][29], such as anxiety disorder [30]. This is an important omission since rank-in-file addiction counselors who are less well trained to address common comorbidities in addiction might view a fully autonomous digital program such as ours as more valuable than digital programs that deliver therapies counselors are already using in their standard practice. ...
Background
Anxiety disorders are common in alcohol use disorder (AUD) treatment patients. Such co-occurring conditions (“comorbidity”) have negative prognostic implications for AUD treatment outcomes, yet they commonly go unaddressed in standard AUD care. Over a decade ago, we developed and validated a cognitive behavioral therapy intervention to supplement standard AUD care that, when delivered by trained therapists, improves outcomes in comorbid patients. However, this validated intervention, like many others in addiction care, has not been taken up in community-based AUD treatment programs. This phenomenon—empirically validated treatments that fail to be widely adopted in community care—has been termed the “research-to-practice gap.” Researchers have suggested that the availability of fully autonomous digital equivalents of validated therapist-delivered therapies could reduce some barriers underlying the research-to-practice gap, especially by eliminating the need for costly and intensive therapist training and supervision.
Objective
With this in mind, we obtained a Program Development Grant (R34) to conduct formative work in the development of a fully autonomous digital version of our previously validated therapist-delivered intervention for AUD treatment patients with a comorbid anxiety disorder.
Methods
In the first phase of the project, we developed the digital intervention. This process included: (1) identifying appropriate collaborators and vendors; (2) consultation with an e-learning expert to develop a storyboard and accompanying graphics and narrative; (3) video production and editing; and (4) interactive programming. The second phase of the project was functional testing of the newly developed digital intervention conducted in 52 residential AUD treatment patients with a comorbid anxiety disorder. Patients underwent the 3 one-hour segments of the newly developed intervention and completed user surveys, knowledge quizzes, and behavioral competence tests.
Results
While the development of the digital intervention was successful, the timeline was approximately double that projected (1 vs 2 years) due to false starts and inefficiencies that we describe, including lessons learned. Functional testing of the newly developed digital intervention showed that, on average, patients rated the user experience in the upper (favorable) 20% of the response scales. Knowledge quizzes and behavioral demonstrations showed that over 80% of participants gained functional mastery of the key skills and information taught in the program.
Conclusions
Functional testing results in this study justify a randomized controlled trial of the digital intervention’s efficacy, which is currently ongoing. In sharing the details of our challenges and solutions in developing the digital intervention, we hope to inform others developing digital tools. The extent to which the availability of empirically validated, fully autonomous digital interventions achieves their potential to reduce the research-to-practice gap remains an open but important empirical question. The present work stands as a necessary first step toward that end.
... There are several risk factors for the occurrence or development of mental disorders, including genetic factors (Kendler & Prescott, 2006), personal characteristics (Caspi et al., 1996), chronic stress (McEwen, 2004), biochemical factors in the brain (Nestler & Hyman, 2010), substance use (Kessler et al., 1997), brain injuries (Perry et al., 2016), chronic illnesses (Verhaak et al., 2005), and trauma experiences (Rothschild, 2000(Rothschild, , 2017Van der Kolk, 2014). The latter can lead to acute or post-traumatic stress disorder but whether this happens depends on numerous factors related to the individual's psychosocial context before, during, and after the traumatic event (Sayedet al., 2015). ...
The effectiveness of psychotherapeutic treatment represents an important topic in modern psychotherapeutic science. Client factors, in fact, play the most significant role in predicting potential positive changes, while other factors are common to all modalities. To understand the psychodynamics and critical unstable periods of an individual, the practice has adopted the method of the synergetic-navigation system and informed treatment which involves the supervisor, the psychotherapist, and the client. This article presents a case study of applying the synergetic-navigation system and informed treatment in the supervision process: it explains the daily monitoring of the client and the feedback given to the psychotherapist and supervisor, which was based on the analysis of the client’s daily entries. The results are shown in diagrams of complex resonations and repetition graphs of time series. The article demonstrates the potential for understanding the complex psychodynamics of the client, for planning and conducting treatment based on the data obtained from the synergetic-navigation system, and for potentially predicting future critical unstable periods of the client, including possible problematic behaviors. The application of the aforementioned client monitoring and feedback can also be extended to other disciplines.
... Another commonly cited RF is trauma (pre-or post-displacement), especially in the context of forced displacement because of armed conflict, the loss of associated property, social relationships, livelihoods, and identity [46,[65][66][67]. It has been suggested that harmful substance use may act as a coping strategy in response to these stressors and that alcohol consumption may constitute an attempt at behavioral self-medication [67][68][69][70][71][72]. ...
Non-communicable diseases, previously thought of as a problem of high-income countries, now coexist in low- and middle-income countries, including the countries of origin for many refugees traveling to Europe. We aimed to describe the prevalence of risk factors for non-communicable diseases among refugees, asylum seekers, and subsidiary protection beneficiaries resettled or relocated in Portugal between 2015 and 2020 and compare these to the prevalence of risk factors in the 12 months before they left their country of origin. A cross-sectional study was conducted between 2019 and 2020 of all refugees, asylum seekers, and subsidiary protection beneficiaries attending a Lisbon, Portugal refugee center. Behavioral and biological risk factors were assessed using the WHO STEPwise modified questionnaire. A descriptive statistical analysis was conducted, which included 80 respondents, mainly men, with an average age of of 30.3 ± 9.8 years. The prevalence of several behavioral risk factors for non-communicable diseases among refugees, asylum seekers, and subsidiary protection beneficiaries was higher at the time of the study than in the 12 months before leaving the country of origin. Differences between men and women were noted in tobacco (49.1% vs. 25.9%) and alcohol use (43.4% vs. 18.5%) in the receiving country. Overweight and obesity also showed differences by gender (7.5% vs. 11.1% and 39.6% vs. 48.1%). The prevalence of suicidal ideation and suicidalplanning was high, and varied from 6.3% and 20% in the country of origin to 16.3% and 38.5% respectively in the receiving country, however the prevalence of suicide attempts was lower in the receiving country (66.7%) compared to the country of origin (100.0%). Information on health and social determinants is critical to identify priorities and increase access to access to gender-specific health and community level interventions, including mental health, to reduce risk factors associated with refugee relocation and resettlement.
... Several epidemiological and clinical studies have identified sociodemographic factors associated with the co-occurrence of SAD and AUD. Specifically, individuals with co-occurring SAD and AUD tend to be younger (Bakken et al., 2005), female (Kessler et al., 1997;Kushner et al., 2005), less well educated (Terra et al., 2006b;Thevos et al., 1999;Yoshimi et al., 2016), have a family history of alcohol dependence (Terra et al., 2006a), and have a lower occupational status and income Yoshimi et al., 2016) in comparison to those with an AUD but no SAD. Moreover, a recent systematic review identified several risk factors related to the association between SAD and alcohol use among adolescents, including being female, seeking approval from peers, affective problems linked to alcohol use, and having secondary comorbidities such as depression and generalized anxiety (Cruz et al., 2017). ...
Social anxiety disorder (SAD) and alcohol use disorder (AUD) are prevalent disorders that often co-occur. SAD onset typically precedes that of AUD, and co-occurrence of the two disorders is associated with greater symptom severity than either condition alone. This chapter reviews current evidence about psychological treatment of co-occurring SAD and AUD. While people with co-occurring SAD-AUD can benefit from single-disorder cognitive behavioral therapy (CBT) approaches (either AUD-focused or SAD-focused), treatment efficacy and long-term outcomes are negatively impacted by the co-occurring disorders. Two alternate treatment models have been tested for co-occurring SAD-AUD: (i) dual-focused treatment, and (ii) integrated treatment. In one of two trials, dual-focused CBT for SAD and AUD resulted in worse outcomes, potentially due to the demands of engaging in two separate treatments. By contrast, integrated SAD-AUD treatment involves a synthesized therapeutic protocol (delivered by one therapist) to address SAD, AUD and the inter-connection between these disorders. To date, two trials have found that integrated CBT for co-occurring SAD-AUD improved outcomes compared to AUD-focused treatment. The remainder of the chapter provides a comprehensive overview of the therapeutic strategies and clinical application of integrated CBT for co-occurring SAD and AUD. A clinical vignette illustrates the treatment, common challenges, and provides example worksheets and therapeutic dialogue.
... Over the past 40 years, research based on DSM-III (1980), DSM-IV (1994) and DSM-5 (2013) has shown consistently high levels of psychiatric comorbidity among large clinical populations and community samples (Bourdon et al., 1992;Kessler et al., 1997;Kessler et al., 2005;Hasin et al., 2007;Grant et al., 2015). Individuals receiving treatment for a psychiatric illness usually have higher levels of psychiatric comorbidity than individuals recruited for community samples. ...
Objective: The influence of gender on the number and pattern of co-morbid psychiatric illness was archivally compared between patients with and without an Alcohol Use Disorder (AUD) among psychiatrically treated individuals drawn from a large Danish birth cohort. Method: By age 45, fifteen percent of the Copenhagen Perinatal Birth Cohort (N=8,109) had been treated in a Danish psychiatric facility. Of those 1,247 patients, 368 were assigned an AUD diagnosis (29.5%). All psychiatric diagnoses assigned to these patients, over all admissions, were classified into one of 14 broad ICD-10 F categories for comparative purposes. Results: More of the patients with an AUD diagnosis were male. Patients with an AUD diagnosis were significantly more likely to receive two or more non-AUD psychiatric diagnoses than patients without an AUD diagnosis. The number of psychiatric diagnoses was greater for female than male AUD patients, a difference not found among male and female patients without an AUD diagnosis. For patients with no AUD diagnosis, the influence of gender on the pattern of psychiatric disorders was similar to that commonly reported. In contrast, the influence of gender on the number and pattern of psychiatric disorders for patients with an AUD diagnosis indicated fewer gender differences. Several diagnostic categories that discriminated male from female patients without an AUD-related diagnosis, no longer discriminated male from female patients with an AUD-related diagnosis. Conclusions: Our findings suggest that gender differences associated with psychiatric comorbidity that have been reported in large heterogenous study, should not be generalized to specific diagnostic groups without further study.
... Rates of hazardous drinking, or patterns of alcohol consumption that increase risk for harmful consequences, are substantially higher among people with symptoms of post-traumatic stress disorder (PTSD), relative to the general population (Kessler et al., 1997). Conversely, among people with alcohol use disorders, 7.7% have a diagnosis of PTSD (Petrakis et al., 2002). ...
... Our data suggest that almost 7% of ED patients came for a mental disorder, which is more frequent than the average of other countries (4%) (40), and that 45% of them had an AUDIT-C score in favor of unhealthy alcohol use. This high rate of unhealthy alcohol use is not surprising as AUD is highly associated with many mental disorders (41)(42)(43)(44). This study was designed to provide an overview of alcohol use associated with the general reason for ED admission and does not allow us to discern which mental disorder(s) are most closely associated with unhealthy alcohol use. ...
Background
Many patients admitted to general emergency departments (EDs) have a pattern of drinking that could lead to future alcohol-related complications. However, it is often difficult to screen these patients in the context of emergency. The aim of this study is to analyze whether reasons for admission could help to screen patients who have an unhealthy alcohol use.
Method
Patients were recruited among six public hospital ED in France, between 2012 and 2014. During a one-month period in each hospital, anonymous questionnaires including sociodemographic questions, AUDIT-C and RAPS4-QF were administered to each patients visiting the ED. The reason for admission of each patient was noted at the end of their questionnaire by the ED practitioner.
Results
Ten thousand Four hundred twenty-one patients were included in the analysis. Patients who came to the ED for injuries and mental disorders were more likely to report unhealthy alcohol use than non-harmful use or no use. Among male patients under 65 years old admitted to the ED for a mental disorder, 24.2% drank more than four drinks (40 g ethanol) in typical day at least four time a week in the last 12 months. Among these patients, 79.7% reported daily or almost daily heavy episodic drinking (HED, 60 g ethanol), and all were positive on the RAPS4-QF.
Conclusion
This study highlights that unhealthy alcohol use is frequent among ED patients and particularly among those who come for injuries or mental disorders. Men under 65 years old with a mental disorder require special attention because of their increased prevalence of daily or almost daily HED.
... So far, many studies proved clear tendencies to abusing alcohol in a group of patients with depression or anxiety disorder, which are much than in a control group. [3,5,34] According to the National Co-morbidity Study, lifetime prevalence rates of AUD among patients with social anxiety disorder were 24% compared to a group without anxiety disorder where it rated 14,19% [35]. It means, that alcohol abuse is a consequence of anxiety disorder. ...
Introduction Over past decades the number of patients suffering from psychiatric disorders all around the world is constantly increasing. Thank to general awareness and less stigmatization people seek for specialist’s help more willingly. Recently, one of the most common diagnoses has been anxiety disorder and many of them also tend to abuse alcohol. So far, scientists have focused mostly on alcoholism as a consequence of anxiety disorder, due to patients’ predilection to addictions. However, ethanol can also trigger anxiety itself. Aim of the study The aim of this study is to summarize the current state of knowledge on the role of alcohol in anxiety disorder development and its pathomechanisms. Material and methods This article is based on available publications in Pubmed and Google Scholar databases. Conclusions Excessive alcohol consumption may lead to the development of anxiety disorder in some patients, as well as, many other psychiatric disturbances. However, further research must be done to find out precise pathomechanism responsible for those states.
... Estimates of lifetime exposure to interpersonal violence among women in the United States exceed 36% for sexual assault (Smith et al., 2017) and 52% for physical assault (Tjaden & Thoennes, 1998). Interpersonal trauma serves as a transdiagnostic risk factor for various psychopathologies, particularly posttraumatic stress disorder (PTSD; e.g., Lilly et al., 2012;Schumm et al., 2006) and problematic alcohol use (Cole et al., 2019;Hien et al., 2005), which commonly co-occur in up to 26.2% of women (Kessler et al., 1997;Torchalla & Nosen, 2019). Problematic alcohol use can result in consequences that include functional or occupational impairment (e.g., job loss), involvement with the criminal justice system, and risky sexual behavior (e.g., engagement in unsafe sexual practices) which contribute to increased risk for subsequent revictimization (Livingston et al., 2021;Looby et al., 2019;Messman-Moore et al., 2009;White & Hingson, 2014). ...
College women face heightened risk of interpersonal trauma, which is associated with co-occurring posttraumatic stress disorder (PTSD) and alcohol use. As engagement in alcohol use can lead to negative repercussions, particularly for those using it to cope with psychological distress, it is important to further understand the variables that underlie this association. We aimed to identify emotional and cognitive processes that mediate the relation between PTSD symptom severity and alcohol use consequences among women interpersonal trauma survivors. Thus, we investigated the potential indirect effect of PTSD symptoms on alcohol use consequences via emotion dysregulation and alcohol use motives using structural equation modeling. A sample of 526 college women completed surveys; only those who reported lifetime interpersonal trauma and current alcohol use were included (n = 184). We found that PTSD severity had a significant indirect effect on alcohol use consequences via emotion dysregulation and alcohol use coping motives (β = 0.01, 95% CI [0.01, 0.02]). After accounting for the effects of the mediators of emotion dysregulation and alcohol use coping motives, there was no longer a significant direct effect of PTSD symptoms on the negative repercussions of alcohol use (β = 0.08, SE = 0.09, 95% CI [-0.02, 0.17]). Thus, PTSD symptoms predicted more emotion dysregulation, which predicted higher alcohol use to cope, which was associated with worse consequences, nullifying the direct effect of PTSD on alcohol use consequences. These findings could enhance evidence-based practices surrounding screening, assessment, and intervention for posttraumatic sequelae and improve quality of life for survivors of interpersonal violence.
... However, the gap in the prevalence of AUD between men and women has decreased over time, reinforcing the need to study AUD in females. Additionally, women have a higher co-occurrence of anxiety disorders (Kessler et al. 1997), and are more likely to cite stressful life experiences and negative emotions as reasons for substance use and relapse. This suggests that women may be more prone to rely on alcohol to reduce distress of negative affective states (Erol and Karpyak 2015;Smith and Randall 2012). ...
Alcohol use disorder (AUD) is characterized by loss of control over intake and drinking despite harmful consequences. At a molecular level, AUD is associated with long-term neuroadaptations in key brain regions that are involved in reward processing and decision-making. Over the last decades, a great effort has been made to understand the neurobiological basis underlying AUD. Epigenetic mechanisms have emerged as an important mechanism in the regulation of long-term alcohol-induced gene expression changes. Here, we review the literature supporting a role for epigenetic processes in AUD. We particularly focused on the three most studied epigenetic mechanisms: DNA methylation, Histone modification and non-coding RNAs. Clinical studies indicate an association between AUD and DNA methylation both at the gene and global levels. Using behavioral paradigms that mimic some of the characteristics of AUD, preclinical studies demonstrate that changes in epigenetic mechanisms can functionally impact alcohol-associated behaviors. While many studies support a therapeutic potential for targeting epigenetic enzymes, more research is needed to fully understand their role in AUD. Identification of brain circuits underlying alcohol-associated behaviors has made major advances in recent years. However, there are very few studies that investigate how epigenetic mechanisms can affect these circuits or impact the neuronal ensembles that promote alcohol-associated behaviors. Studies that focus on the role of circuit-specific and cell-specific epigenetic changes for clinically relevant alcohol behaviors may provide new insights on the functional role of epigenetic processes in AUD.
... The co-occurrence of alcohol consumption disorders with other mental disorders is well known (Kessler et al., 1997). When an individual begins to use alcohol to cope with psychiatric distress, the onset of the other disorder may be significantly influenced. ...
Introduction: According to the studies, a quarter of people who drink alcohol suffer at least one depressive episode in their lifetime. It has also been found that one-third of people who suffer from depression, abusively consume psychoactive substances, such as alcohol, as a form of self-healing. Aim: In this retrospective study, we propose to statistically quantify the relationship between alcohol-related mental and behavioural illnesses and depression spectrum disorders. Method: The retrospective study was conducted on a group of hospitalized patients, between January 1st and June 30th, 2018, at "Elisabeta Doamna" Psychiatric Hospital, in Galati, Romania. For diagnosis we used the ICD-10 (The ICD-10 Classification of Mental and Behavioral Disorders. (Clinical description, diagnostic guidelines and psychometric tests, such as HAM-D (Hamilton Depression Rating Scale)), AUDIT (Alcohol Use Disorders Identification Test). Patients were selected among those who had a combination of mental and behavioural disorders due to alcohol and depressive spectrum disorders. Results: Between January 1st and June 30th, 2018, a quarter of total 6316 hospitalized patients, or 24.79% (1566 patients) were diagnosed with alcohol-related disorders, and 5.4% (341 cases) had a dual diagnosis, with alcohol-related disorders associated with depressive elements. During this 6-month period, of all cases of alcohol-related disorders, it was found that approximately 22% had a dual diagnosis, respectively, the combination of alcohol-related disorders with depressive spectrum disorders or depressive elements. Conclusions: Unfortunately, it is estimated that depression will become a secondary cause of disability worldwide after cardiovascular disease. According to the WHO (World Health Organization), this disease affects more than 320 million people worldwide, and its combination with alcohol abuse is alarming. Therefore, patients with dual diagnosis require a multidisciplinary therapeutic approach to reduce or even neutralize the adverse consequences that may occur in the psycho-social, medical, family, economic, or behavioural context.
Depression and substance use disorders (SUDs) pose a substantial global health burden, impacting both individual's well-being and societal functioning, as well as economic stability. The co-occurrence of these conditions within rehabilitation centres further complicates treatment outcomes and recovery trajectories. The objective of this study was to identify the prevalence and factors associated with depression among patients undergoing substance abuse treatment in rehabilitation centres located in Pokhara Metropolitan City of Nepal. An institution-based cross-sectional study was done to conduct the research among rehabilitation centre patients in Pokhara Metropolitan. A multistage probability sampling approach was used to select 212 patients who were admitted to rehabilitation centres. Data collection utilized a semistructured questionnaire administered through face-to-face interviews. The collected data were entered into EpiData software and analysed using SPSS. Binary logistic regression using odds ratios with a 95% confidence interval was performed. In total, 212 participants were interviewed, with more than half (58%) of the patients in the rehabilitation centre experiencing depression. Among them, 47.2% exhibited mild depression, 9.9% had moderate depression, and 1.4% experienced severe depression. Factors significantly associated with depression (p < 0 05) were financial capabilities (UOR = 2 71), sleep duration (UOR = 2 16), problematic sleep (UOR = 3 19), violence exposure (UOR = 3 12), and self-esteem (UOR = 2 06). The study identified a high prevalence of depression among patients undergoing substance abuse treatment in rehabilitation centres. The findings highlight the importance of implementing comprehensive measures within rehabilitation centres, including the introduction of financial support programs, sleep hygiene education, violence prevention strategies, and self-esteem enhancement approaches.
Background
While men have been found to drink more alcohol and have higher rates of alcohol‐related mortality, women tend to experience higher rates of alcohol‐related consequences, including psychological comorbidities and worse alcohol use disorder (AUD) outcomes. However, gender differences in comorbid psychopathology and associations with AUD outcomes among veterans are less well understood.
Methods
Veterans (N = 126; 32 women) receiving inpatient treatment for AUD completed baseline clinical measures including the Beck Depression Inventory‐II, Beck Anxiety Inventory, Early Life Stress Questionnaire, and PTSD Checklist for DSM‐5. Alcohol use was assessed with the Timeline Followback for the 90 days prior to the baseline assessment and again at 1‐, 3‐, and 6‐month follow‐ups. Gender differences in baseline alcohol and psychopathology measures were examined using Fisher's exact test and Mann–Whitney U test. Linear/logistic regression was used to examine associations between comorbid psychopathology and alcohol relapse/use severity post‐study.
Results
Consistent with prior literature, statistically significant gender differences in psychopathology were observed, with women reporting higher anxiety (p < 0.001), depression (p = 0.001), early life stress (p < 0.001), and PTSD (p < 0.001) at baseline. Higher early life stress was also associated with higher anxiety, depression, and PTSD. Statistically significant gender differences were not observed for alcohol use in the 90 days prior to the study. Similarly, gender was not associated with relapse or severity of use at 1‐, 3‐, or 6‐month follow ups (ps > 0.05). Psychopathology measures were not associated with relapse or severity of use at any time point (ps > 0.05).
Conclusion
Our study highlights that women veterans are drinking similar quantities of alcohol to men, supporting emerging evidence of a narrowing gender gap in alcohol use. Women also have a higher psychiatric burden than men; thus, identifying ways to mitigate comorbidity among women veterans should be a health priority.
Background: Persons with posttraumatic stress disorder (PTSD) compared to those without evince high rates of hazardous drinking, or patterns of alcohol consumption that increase the risk for harmful consequences. One potential marker of vulnerability for PTSD-hazardous drinking comorbidity may be smoking behavior. Individuals with PTSD have a higher prevalence of smoking and smoke at higher rates. Smokers, compared to nonsmokers, are more apt to engage in hazardous alcohol use. Notably, there is a need to expand research on smoking in the context of PTSD and hazardous drinking to inform treatment of these morbidities. Objective: The present cross-sectional investigation sought to examine smoking status as a marker of risk among persons with probable PTSD who engage in hazardous drinking (N = 647; Mage = 38.90 years, SD = 10.71; 51.2% female). Results: Results indicated that trauma-exposed smokers, compared to non-smokers, evinced greater severity of PTSD symptoms, depression, emotion regulation difficulties, hazardous drinking, and substance use problems, with small effect sizes. No statistically significant group differences were found for anxiety symptom severity. Secondary analyses among only smokers supported an interrelation between cigarette dependence and each of the criterion variables that demonstrated statistically significant group differences. Specifically, cigarette dependence was statistically significantly and incrementally related to PTSD symptom severity, depression, emotion regulation difficulties, more severe hazardous drinking, and a greater degree of substance use problems. Conclusions: Overall, the current investigation found that smoking status among persons with probable PTSD who engaged in hazardous drinking was associated with numerous indicators of mental health and substance use vulnerability.
Aim
While considerable data on the alcohol drinking behavior of the general population are available for the United States and Europe, data from Asian countries are scarce. We attempted to estimate the social backgrounds and other factors associated with high Alcohol Use Disorders Identification Test (AUDIT) scores in Japan.
Methods
This web‐based survey was conducted in 2023. In order to ensure the representativeness of the sample, the population distribution by age and region was determined from the Statistics Bureau Census Basic Population Summary. The survey questionnaire items included AUDIT, educational background, occupation, income, marital status, body mass index (BMI), age at the time of the first alcoholic drink, age at the start of habitual drinking, Kessler Psychological Distress Scale (K6), and Link's Devaluation Discrimination Scale.
Results
A total of 40,720 responses were received from people aged between 20 and 75 years old. The proportion of potential alcohol use disorder based on AUDIT score ≥15 was 9.2% in men and 2.0% in women. The number of people with AUDIT scores ≥15 tended to be high in men in their 50s and women in their 20s and 40s. Among those with AUDIT scores ≥15, the age at the first drink and age at the start of habitual drinking were significantly lower, and the K6 score was significantly higher.
Conclusion
This web survey showed an association between AUDIT scores and age at first drinking and mental health condition. Since this survey was a web‐monitored survey, caution should be taken in generalizing the prevalence.
Rationale
Alcohol consumption despite negative consequences is a core symptom of Alcohol Use Disorder. In animal models, this is studied by pairing aversive stimuli with alcohol access, and continuation of drinking under these conditions is known as aversion resistance. Previously, we found that female mice are more aversion resistant than males. Corticotropin releasing hormone (Crh) and the Crh receptor 1 (Crhr1) regulate stress-induced reinstatement, alcohol dependence, and binge-like drinking. However, the role of the Crh system in aversion resistance has not been assessed.
Objectives
We aimed to identify sex differences in the Crh system during quinine-adulterated alcohol intake.
Methods
We used two-bottle choice and adulterated the alcohol solution with quinine. Next, we measured Crh and Crhr1 levels in brain tissue using real-time polymerase chain reaction (RT-qPCR) and RNAscope in situ hybridization. We then infused a Crhr1 antagonist into the medial prefrontal cortex (mPFC) prior to quinine-alcohol intake.
Results
After quinine-alcohol consumption, females exhibited increased mPFC Crhr1 mRNA levels as measured by RT-qPCR. This was confirmed with greater anatomical specificity using RNAscope, with females exhibiting an increased number of Crhr1 + cells in the dorsomedial PFC and the ventromedial PFC. mPFC Crhr1 antagonist treatment reduced quinine-alcohol consumption in females but did not impact consumption in males. Quinine-free alcohol intake was unaffected by Crhr1 antagonist treatment.
Conclusions
Our findings suggest that Crhr1 in mPFC plays a role in aversion resistant alcohol intake in females. Future experiments will examine the sources of Crh innervation to the mPFC and their distinct roles in alcohol seeking.
Acute exacerbations are sudden, severe worsening of respiratory symptoms, including dyspnea and cough, accompanied by rapid decline in lung function. Acute exacerbations are associated with high morbidity and mortality rates and may require hospitalization and intensive care management. Increased pulmonary vascular resistance leading to elevated pulmonary artery pressures and right heart strain. Pulmonary hypertension is a common complication of IPF and is associated with worse prognosis and reduced survival. Increased susceptibility to respiratory infections, including bacterial pneumonia, viral respiratory tract infections, and fungal infections, due to impaired lung function and compromised immune response may develop.
Gastroesophageal Reflux Disease (GERD) is a common comorbidity in idiopathic pulmonary fibrosis patients, with reflux of gastric contents into the esophagus potentially exacerbating pulmonary fibrosis through microaspiration and inflammation.
Increased risk of venous thromboembolism, including pulmonary embolism, in idiopathic pulmonary fibrosis patients may emerge due to impaired lung perfusion, immobility, and hypercoagulability. Reduced bone mineral density and increased risk of fractures due to chronic corticosteroid use, physical inactivity, and systemic inflammation. High prevalence of depression, anxiety, and psychological distress in idiopathic pulmonary fibrosis patients, attributed to chronic illness, physical limitations, functional decline, and uncertainty about prognosis.
Acute exacerbations are a significant predictor of poor prognosis, with increased risk of disease progression and mortality. Advanced age is a negative prognostic factor in idiopathic pulmonary fibrosis, with older patients generally experiencing more rapid disease progression and shorter survival compared to younger individuals. Presence of comorbid conditions, such as cardiovascular disease, diabetes mellitus, and chronic kidney disease, is associated with increased mortality risk in idiopathic pulmonary fibrosis patients. Various prognostic scoring systems, such as the GAP index (gender, age, physiology) and the ILD-GAP index (interstitial lung disease-GAP index), integrate clinical, radiological, and physiological parameters to stratify idiopathic pulmonary patients into risk categories and predict survival outcomes.
Acute exacerbations are sudden, severe worsening of respiratory symptoms, including dyspnea and cough, accompanied by rapid decline in lung function. Acute exacerbations are associated with high morbidity and mortality rates and may require hospitalization and intensive care management. Increased pulmonary vascular resistance leading to elevated pulmonary artery pressures and right heart strain. Pulmonary hypertension is a common complication of IPF and is associated with worse prognosis and reduced survival. Increased susceptibility to respiratory infections, including bacterial pneumonia, viral respiratory tract infections, and fungal infections, due to impaired lung function and compromised immune response may develop.
Gastroesophageal Reflux Disease (GERD) is a common comorbidity in idiopathic pulmonary fibrosis patients, with reflux of gastric contents into the esophagus potentially exacerbating pulmonary fibrosis through microaspiration and inflammation.
Increased risk of venous thromboembolism, including pulmonary embolism, in idiopathic pulmonary fibrosis patients may emerge due to impaired lung perfusion, immobility, and hypercoagulability. Reduced bone mineral density and increased risk of fractures due to chronic corticosteroid use, physical inactivity, and systemic inflammation. High prevalence of depression, anxiety, and psychological distress in idiopathic pulmonary fibrosis patients, attributed to chronic illness, physical limitations, functional decline, and uncertainty about prognosis.
Acute exacerbations are a significant predictor of poor prognosis, with increased risk of disease progression and mortality. Advanced age is a negative prognostic factor in idiopathic pulmonary fibrosis, with older patients generally experiencing more rapid disease progression and shorter survival compared to younger individuals. Presence of comorbid conditions, such as cardiovascular disease, diabetes mellitus, and chronic kidney disease, is associated with increased mortality risk in idiopathic pulmonary fibrosis patients. Various prognostic scoring systems, such as the GAP index (gender, age, physiology) and the ILD-GAP index (interstitial lung disease-GAP index), integrate clinical, radiological, and physiological parameters to stratify idiopathic pulmonary patients into risk categories and predict survival outcomes.
Introduction
Post-pandemic alcohol consumption is on the rise due to people starting to adapt themselves to the practice of consuming alcoholic beverages at home. In addition to the direct effects of intoxication and addiction, estimates suggest that alcohol contributes to approximately 20-30% of global cases of oesophagal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy, and motor vehicle accidents. In India, one-fifth of alcohol consumers were found to be alcohol dependent. The study was done with the primary objective of finding out the prevalence of alcohol dependence among alcohol users and exploring the reasons for alcohol dependence among alcohol users in an urban area of Chengalpattu District, Tamil Nadu.
Methodology
The study design is an explanatory sequential mixed-methods study. It was done among 624 adult male alcohol consumers in the Chennai district, selected by the cluster sampling method in a community setting. The Alcohol Use Disorders Identification Test (AUDIT) was used to diagnose alcohol dependence. Using the purposive sampling method, in-depth interviews were conducted among 24 alcohol-dependent people to explore and understand their experiences, identify common themes, and provide insights into the problem. Quantitative data were analysed using Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY), and qualitative data were analysed using deductive content analysis using Qualcoder software.
Results
The mean age of the study participants was 38±7 years. Among current alcohol consumers, 16.9% (106/624) were found to be suffering from alcohol dependence. The significant predictors of alcohol dependence were found to be unskilled occupation (adjusted odds ratio [AOR] = 2.09), having suicidal ideation (AOR = 2.4), alcohol consumption by family members (AOR = 1.90), depression (AOR = 3.98), drinking pattern-affected interpersonal relationships (AOR = 2.29), and not receiving health education about alcohol use in school/college (AOR = 1.74). The major themes and codes identified among alcohol dependents were factors related to mental health, physical health, and social factors.
Conclusion
This study provides essential points of reference for policymakers and primary care physicians to develop prevention strategies for people to understand and overcome the problem of alcohol addiction, and it also sheds light on the burden of alcohol dependence and their lived experiences.
Patients diagnosed with posttraumatic stress disorder (PTSD) present with a spectrum of debilitating anxiety symptoms resulting from exposure to trauma. Women are twice as likely to be diagnosed with anxiety and PTSD compared to men; however, the reason for this vulnerability remains unknown. We conducted four experiments where we first demonstrated a female vulnerability to stress‐enhanced fear learning (SEFL) with a moderate, acute early life stress (aELS) exposure (4 footshocks in a single session), compared to a more intense aELS exposure (15 footshocks in a single session) where males and females demonstrated comparable SEFL. Next, we demonstrated that this female vulnerability does not result from differences in footshock reactivity or contextual fear conditioning during the aELS exposure. Finally, using gonadectomy or sham surgeries in adult male and female rats, we showed that circulating levels of gonadal steroid hormones at the time of adult fear conditioning do not explain the female vulnerability to SEFL. Additional research is needed to determine whether this vulnerability can be explained by organizational effects of gonadal steroid hormones or differences in sex chromosome gene expression. Doing so is critical for a better understanding of increased female vulnerability to certain psychiatric diseases.
Disorders of behavior represent some of the most common and disabling diseases affecting humankind; however, despite their worldwide distribution, genetic influences on these illnesses are often overlooked by families and mental health professionals. Psychiatric genetics is a rapidly advancing field, elucidating the varied roles of specific genes and their interactions in brain development and dysregulation. Principles of Psychiatric Genetics includes 22 disorder-based chapters covering, amongst other conditions, schizophrenia, mood disorders, anxiety disorders, Alzheimer's disease, learning and developmental disorders, eating disorders and personality disorders. Supporting chapters focus on issues of genetic epidemiology, molecular and statistical methods, pharmacogenetics, epigenetics, gene expression studies, online genetic databases and ethical issues. Written by an international team of contributors, and fully updated with the latest results from genome-wide association studies, this comprehensive text is an indispensable reference for psychiatrists, neurologists, psychologists and anyone involved in psychiatric genetic studies.
Introduction and objective: Psychoactive substance abusers are characterised by significantly stronger pathology of personality structure compared to non-addicted population. Therefore, identifying psychological resources that may provide a chance for more adequate functioning and effective treatment of these patients seems justified. One such resource is flexibility in coping, which helps reduce emotional tension and reinforces adaptive forms of functioning. The aim of the presented research was to verify whether there is a relationship between the dimensions of personality organisation and flexibility in coping among alcohol-dependent individuals, taking into account the age and gender of respondents. Materials and methods: The study involved 93 alcohol-dependent people, including 27 women (29%) and 66 men (71%) aged 20 to 77 years (mean, M = 43.72; standard deviation, SD = 12.83). The research used the Inventory of Personality Organization (IPO) by Otto F. Kernberg and colleagues (2001) in the Polish adaptation by Agnieszka Izdebska and Beata Pastwa-Wojciechowska (2013) and the Flexibility in Coping with Stress Questionnaire (Kwestionariusz Elastyczności w Radzeniu sobie ze Stresem, KERS-14) by Małgorzata Anna Basińska and colleagues (2021). Results: The research showed that more flexible coping strategies occur among those alcohol-dependent adults who use higher-order defence mechanisms and are characterised by greater identity coherence. The age was found to be a variable associated with a better personality organisation and greater flexibility in coping. Conclusions: Flexibility in coping is partially related to the dimensions of personality organisation in alcohol-dependent adults.
Introduction
In bipolar women who took lithium during pregnancy, several epidemiology studies have reported small increases in a rare fetal cardiac defect termed Ebstein’s anomaly.
Methods
Behavioral, environmental, and lifestyle-associated risk factors associated with bipolar disorder and health insurance status were determined from an Internet search. The search was conducted from October 1, 2023, through October 14, 2023. The search terms employed included the following: bipolar, bipolar disorder, mood disorders, pregnancy, congenital heart defects, Ebstein’s anomaly, diabetes, hypertension, Medicaid, Medicaid patients, alcohol use, cigarette smoking, marijuana, cocaine, methamphetamine, narcotics, nutrition, diet, obesity, body mass index, environment, environmental exposures, poverty, socioeconomic status, divorce, unemployment, and income. No quotes, special fields, truncations, etc., were used in the searches. No filters of any kind were used in the searches.
Results
Women who remain on lithium in the United States throughout their pregnancy are likely to be experiencing mania symptoms and/or suicidal ideation refractory to other drugs. Pregnant women administered the highest doses of lithium salts would be expected to have been insufficiently responsive to lower doses. Any small increases in the retrospectively determined risk of fetal cardiac anomalies in bipolar women taking lithium salts cannot be disentangled from potential developmental effects resulting from very high rates of cigarette smoking, poor diet, alcohol abuse, ingestion of illegal drugs like cocaine or opioids, marijuana smoking, obesity, and poverty.
Conclusions
The small risks in fetal cardiac abnormalities reported in the epidemiology literature do not establish a causal association for lithium salts and Ebstein’s anomaly.
Purpose of Review
Stress is associated with alcohol drinking, and epidemiological studies document the comorbidity of alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD), with higher comorbid prevalence in females than in males. The aim of this paper is to highlight information related to sex differences in stress-enhanced alcohol drinking from clinical studies and from preclinical studies utilizing an animal model of traumatic stress.
Recent Findings
Stress is associated with alcohol drinking and relapse in males and females, but there are sex differences in the alcohol-related adaptation of stress pathways and in the association of different prefrontal regions with stress-induced anxiety. The predator stress model of traumatic stress produced enhanced alcohol drinking in a subgroup of stress-sensitive male and female animals, which could be associated with sex and subgroup differences in stress axis responsivity, behavioral responses to predator odors, and epigenetic mechanisms engaged by traumatic experiences.
Summary
While additional studies in females are necessary, existing clinical and preclinical evidence suggests that biological mechanisms underlying stress-enhanced drinking likely differ between males and females. Thus, effective treatment strategies may differ between the sexes.
The idea that not all types of consumption benefit well-being is not new. However, its recent formalization within the framework of the behavioral and social sciences has led to a rapid expansion of knowledge about the goods that are most effective in increasing happiness. Most evidence has been obtained from the developed world and with a focus on broad categories that ignore meaningful heterogeneities. This paper contributes to this domain by conducting a detailed analysis of the relationship that happiness has with a variety of market goods and with aggregate measures of purchasing power. We do this using the data of Ecuador, a country characterized by a relational-oriented culture, high collectivist values, structural inequalities, and weak political institutions. Throughout the paper, we tested various hypotheses related to this particular context. The results show that consumption is superior to income as a predictor of happiness. Higher levels of happiness can also be seen among people who spend more on relational and time-saving goods; less on health and alcohol; and own a good quality of dwelling. As for basic goods, some seem beneficial in the whole sample analysis, but they exhibit a stronger relationship with happiness among the poor. Additionally, we find that, in most cases, public goods as well as paying taxes correlate negatively with happiness. Moreover, we identify some heterogeneities that shed light on the behavior of the poor and that reflect unequal distribution of household tasks.
Background
Binge alcohol drinking is a risk factor linked to numerous disease states including alcohol use disorder (AUD). While men binge drink more alcohol than women, this demographic gap is quickly shrinking, and preclinical studies demonstrate that females consistently consume more alcohol than males. Further, women are at increased risk for the co-expression of AUD with neuropsychiatric diseases such as anxiety and mood disorders. However, little is understood about chronic voluntary alcohol drinking and its long-term effects on behavior. Here, we sought to characterize sex differences in chronic binge drinking and the effects of protracted alcohol abstinence on anxiety- and affective-related behaviors in males and females.
Methods
We assessed binge alcohol drinking patterns in male and female C57BL/6J mice using a modified Drinking in the Dark (DID) paradigm in which mice received home cage access to one bottle of 10% or 20% alcohol (EtOH) or water for 2 h per day on Days 1–3 and to two bottles (EtOH/H 2 O + H 2 O) for 24 h on Day 4 for 8 weekly cycles. Mice were then tested for the effects of protracted abstinence on avoidance, affective, and compulsive behaviors.
Results
Female mice consumed more alcohol than males consistently across cycles of DID and at 2, 4, and 24-h timepoints within the day, with a more robust sex difference for 20% than 10% EtOH. Females also consumed more water than males, an effect that emerged at the later time points; this water consumption bias diminished when alcohol was available. Further, while increased alcohol consumption was correlated with decreased water consumption in males, there was no relationship between these two measures in females. Alcohol preference was higher in 10% vs. 20% EtOH for both sexes. During protracted abstinence following chronic binge drinking, mice displayed decreased avoidance behavior (elevated plus maze, open field, novelty suppressed feeding) and increased compulsive behavior (marble burying) that was especially robust in females. There was no effect of alcohol history on stress coping and negative affective behaviors (sucrose preference, forced swim test, tail suspension) in either sex.
Conclusion
Female mice engaged in higher volume binge drinking than their male counterparts. Although females also consumed more water than males, their higher alcohol consumption was not driven by increased total fluid intake. Further, the effects of protracted abstinence following chronic binge drinking was driven by behavioral disinhibition that was more pronounced in females. Given the reciprocal relationship between risk-taking and alcohol use in neuropsychiatric disease states, these results have implications for sex-dependent alcohol drinking patterns and their long-term negative neuropsychiatric/physiological health outcomes in humans.
Background
While maternal at-risk drinking is associated with children's emotional and behavioral problems, there is a paucity of research that properly accounts for genetic confounding and gene–environment interplay. Therefore, it remains uncertain what mechanisms underlie these associations. We assess the moderation of associations between maternal at-risk drinking and childhood emotional and behavioral problems by common genetic variants linked to environmental sensitivity (genotype–environment [G × E] interaction) while accounting for shared genetic risk between mothers and offspring (G × E correlation).
Methods
We use data from 109 727 children born to 90 873 mothers enrolled in the Norwegian Mother, Father, and Child Cohort Study. Women self-reported alcohol consumption and reported emotional and behavioral problems when children were 1.5/3/5 years old. We included child polygenic scores (PGSs) for traits linked to environmental sensitivity as moderators.
Results
Associations between maternal drinking and child emotional ( β 1 = 0.04 [95% confidence interval (CI) 0.03–0.05]) and behavioral ( β 1 = 0.07 [0.06–0.08]) outcomes attenuated after controlling for measured confounders and were almost zero when we accounted for unmeasured confounding (emotional: β 1 = 0.01 [0.00–0.02]; behavioral: β 1 = 0.01 [0.00–0.02]). We observed no moderation of these adjusted exposure effects by any of the PGS.
Conclusions
The lack of strong evidence for G × E interaction may indicate that the mechanism is not implicated in this kind of intergenerational association. It may also reflect insufficient power or the relatively benign nature of the exposure in this sample.
Abstract Aim: There is a strong comorbidity between methamphetamine (MA) and alcohol use whereby MA use may contribute to increased alcohol consumption. This study aims to determine the associations between alcohol drinking and MA-associated behaviors among MA users in relation to mood disorders, suicidal ideation, and health-related quality of life (HR-QoL). Methods: Substance use characteristics were obtained in 106 participants with MA use at a substance abuse treatment center by using the Severity of Dependence Scale (SDS) and the Thai version of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). Current alcohol drinking behaviors were estimated using the Substance Outcomes Profile (SOP), which was developed and translated from the Treatment Outcomes Profile, by computing the number of alcohol units x days per month of alcohol use. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was used to estimate lifetime histories of mood disorders and substance abuse and current suicidal ideation. Results: Current suicidal ideation in MA users is to a large extent predicted by the severity of current alcohol and MA use, female gender, and a lifetime history of mood disorders (major depression, dysthymia, and hypo-mania). Moreover, a lifetime history of mood disorders is positively associated with the severity of MA, but not with alcohol use. Partial least squares (PLS) path modeling shows that lowered HR-QoL in MA users is predicted by the SDS score and alcohol dosing (both inversely) and that lifetime diagnoses of mood disorders and MA use (both inversely) and alcohol dependence (positively) have significant effects on HR-QoL which are completely mediated via the SDS score. Conclusions: In MA users, the severity of dependence, and MA and/or alcohol use exert adverse effects on current suicidal ideation and HR-QoL. Mechanistic explanations are given which may explain the inverse associations between the severity of MA and alcohol use in MA abusers.
Prevalence of psychiatric disorders in patients with alcohol use disorder (AUD) is significantly higher than in individuals without AUD diagnosis. For this reason, it is important to screen all patients with AUD for other mental disorders as well as to evaluate alcohol use in patients with psychiatric disorders. Dual diagnosis implicates more severe course of comorbid disorders, poorer treatment outcomes, higher risk of suicide, and worse social functioning. There are several explanations proposed for high comorbidity of AUD and mental disorders. Among them are shared neurobiological mechanisms and joint genetic background, self-medication hypothesis or substance-induced mental disorders. Providing health care for individuals with such comorbidity may be particularly challenging. Treatment of AUD, including pharmacotherapy, should be performed simultaneously with treatment of coexisting mental disorder, including use of antidepressants, mood-stabilizers or antipsychotics. First-line treatment for depression comorbid with AUD requires SSRIs, SNRIs or mirtazapine. For bipolar disorder and AUD, lithium in monotherapy or combined with valproate should be considered first, while in psychotic disorders and AUD, clozapine and long-acting injectable antipsychotics may be recommended.
Objective: Recently, it has been observed that the prevalence of substance use in young adulthood has increased. Comorbidity of anxiety disorders is high in individuals with substance use disorder. In this study, it was aimed to investigate the relationship between anxiety sensitivity and social anxiety in young adults using methamphetamine. Material and Methods: 101 patients diagnosed with methamphetamine use disorder were included in the study. Participants were evaluated with sociodemographic data form, Addiction Profile Index (BAPI), Symptom Check List (SCL-90-R), Liebowitz Social Anxiety Inventory (LSAI) and Anxiety Sensitivity Index-3 (ASI-3). Results: It was determined that 70.3% of the subjects with SUD were diagnosed as SAD. ASI-3, SCL-90-R and BAPI scores were statistically significantly higher in the SAD group than in the non-SAD group (p
Purpose of Review
Research demonstrates a strong association between alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD). However, less is known about sex- and gender-based differences among individuals with AUD + PTSD. This narrative review examines recent literature in this area and aims to be a reference for future research endeavors.
Recent Findings
Extant literature shows that intertwining biological systems increase females’ risk of developing PTSD and experiencing more adverse effects from AUD compared to males. Sex-based physiological differences further interact with gendered sociocultural environments to influence the risk of AUD + PTSD. Emerging research suggests potential gender-specific pathways between PTSD, coping, and AUD which may inform prevention and treatment. However, barriers to care are often gender-specific and tailored approaches are needed to improve reach and uptake.
Summary
Additional research is needed to examine intersectional and contextual factors that synergistically influence sex/gender differences in AUD + PTSD, particularly beyond cisgender identities, and mechanisms of action.
Objective: Investigating the role of combat exposure on behavioral outcomes has been limited due to ethical and logistical constraints. Method: Using a large data set from UK BioBank of U.K. citizens (n = 157,161), we created hypothetical randomized experiments, with treatment conditions for combat exposure or no combat exposure matched for relevant covariates and compared differences in combat exposure groups on a broad range of alcohol-related and subjective well-being outcomes. Additionally, using a randomization-based approach, we calculated 95% Fisherian intervals for constant treatment effects consistent with the matched data and the hypothetical combat exposure intervention. Results: Results suggest that combat exposure plays a role in several negative outcomes related to alcohol behavior and subjective well-being, such as increased typical daily alcohol consumption (estimated average causal effect [ACE] = 0.0545, Fisher p-value = .0119) and less general health happiness (estimated ACE = −0.1077, Fisher p-value < 1/100,000). Conclusions: This study expands our current understanding of the role of combat exposure on many alcohol and subjective well-being-related measures. We also show that the Rubin Causal Model provides a rigorous and valid approach to better understand myriad other issues in psychological science.
This Clinical Handbook for the Management of Mood Disorders will equip clinicians with the knowledge to refine their diagnostic skills and implement treatment plans for mood disorders based on the most up-to-date evidence on interventions that work. Covering the widest range of treatments and techniques, it provides clear guidance for the management of all types and subtypes of both minor and major depression. Chapters cover the latest and most innovative treatments, including use of ketamine, deep brain stimulation and transcranial magnetic stimulation, effective integration of pharmacological and psychotherapeutic approaches, as well as providing a thought-provoking look at the future research agenda and the potential for reliable biomarkers. This is the most comprehensive review of depression available today. Written and edited by leading experts mostly from Columbia University, this is an essential resource for anyone involved in the care and treatment of patients with mood disorders.
Childhood trauma (CT) has been linked to increased risk for psychosis. Moreover, CT has been linked to psychosis phenotypes such as impaired cognitive and sensory functions involved in the detection of novel sensory stimuli. Our objective was to investigate if CT was associated with changes in hippocampal and superior temporal gyrus functional activation and connectivity during a novelty detection task. Fifty-eight young adults were assigned to High-CT (n = 28) and Low-CT (n = 24) groups based on their scores on the childhood trauma questionnaire (CTQ) and underwent functional Magnetic Resonance Imaging during an auditory oddball task (AOT). Relative to the Low CT group, High CT participants showed reduced functional activation in the left hippocampus during the unpredictable tone condition of the AOT. Furthermore, in the High CT group, psychophysiological interaction analysis revealed hypoconnectivity between the hippocampus and temporal and medial regions. The present study indicates both altered hippocampal activation and hippocampal-temporal-prefrontal connectivity during novelty detection in individuals that experienced CT, similarly to that reported in psychosis risk populations. Early stressful experiences and environments may alter hippocampal function during salient events, mediating the relationship between childhood trauma and psychosis risk.
The current chapter offers a summary of some of the challenges that confront individuals seeking support for psychological distress and alcohol use. It is proposed that the biomedical discourse that dominates respective mental health and alcohol services can contribute to affected individuals encountering a lack of collaborative care. Apparent dissonance between services operates on the levels of discourse, aetiology, treatment models, policy and interventions used to support individuals. The nature of challenges outlined is wide in scope and multi-faceted. The recommendations which follow call for a greater emphasis on individual’s idiography and their functional/contextual experiences of distress and alcohol use.KeywordsSelf-medicationDual diagnosisAlcohol use disorderIntegrated care
The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination Items. It is fully structured to allow administration by lay interviewers and scoring of diagnoses by computer. A special Substance Abuse Module covers tobacco, alcohol, and other drug abuse in considerable detail, allowing the assessment of the quality and severity of dependence and its course. This article describes the design and development of the CIDI and the current field testing of a slightly reduced "core" version. The field test is being conducted in 19 centers around the world to assess the interviews' reliability and its acceptability to clinicians and the general populace in different cultures and to provide data on which to base revisions that may be found necessary. In addition, questions to assess International Classification of Diseases, ninth revision, and the revised DSM-III diagnoses are being written. If all goes well, the CIDI will allow investigators reliably to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.
A preliminary study of the prevalence of DSM-III anxiety disorders in a group of inpatients treated for alcohol detoxification is presented. The rating was performed in accordance with the Structured Clinical Interview for DSM-III (SCID). The results showed that nineteen of 84 subjects (22.6%) met criteria for one or more anxiety disorders. In 12 of these subjects drinking followed the onset of anxiety by as long as 19 years. No conclusions can be drawn about the etiologic role of anxiety in alcoholism. However, to the extent that patients with treatable phobic and anxious states can be identified, there is a potential for prevention of alcoholism in some of these individuals.
Synopsis
To isolate determinants of any female preponderance in depressive disorder, we earlier selected a sample of young adults, then similar in terms of several potential social determinants of depression and with equivalent rates of lifetime depression. We now report a 10-year review, which initially suggested a female preponderance in DIS-generated RDC and DSM-III lifetime depressive categories. The presence of sex differences in rates of lifetime depression was influenced by the definition of caseness used and the vantage point from which rates were determined. The longitudinal design and earlier corroborative witness reports established, however, clear evidence of instability in prevalence estimates, together with a sex effect on stability. Men were more likely to ‘forget’ episodes, while women were more likely to ‘remember’ episodes that had generally not previously reached ‘case’ criteria. When correction was made for such artefactual influences, a sex difference in lifetime depression rates was no longer evident. Such findings require review in general community samples, and suggest modifications to ‘case’ definition in epidemiological enquiries.
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.
The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.
The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
Associations between psychopathology among parents and among their offspring were examined among families of drug abusers. Patterns of transmission of disorders were examined in the context of several potential moderator variables, including gender of parent, ethnicity, and type of drug abused by the proband relative. The sample consisted of 492 parents and 673 siblings of cocaine abusers, and 400 parents and 476 siblings of opioid addicts. Results indicated that a) maternal depression was associated with several psychiatric disorders among all groups of offspring; b) paternal alcoholism yielded less powerful effects, showing associations with offspring substance abuse among blacks but not Caucasians; c) incidence of disorders among offspring showed sequential increases depending on whether neither, one, or both parents were affected; and d) there was little evidence for specificity of aggregation of disorders among these families. Results are discussed in terms of implications for empirical studies as well as intervention programming.
This article describes a generalized program for the computation of sampling errors. It employs computerized linearization of nonlinear estimates by the use of the first-order Taylor approximation. It can be used for any estimate derived from any “large” probability sample. In most instances the only inputs required are the weighted sample data and the form of the estimate whose precision is to be measured. In these cases, both the estimate and its sampling error can be produced with the same amount of data preparation and programming effort as is required to produce the estimate only.
Balanced repeated replications (BRR) is a general method for computing standard errors. It is useful when mathematical distribution theory is impractical or lacking, and especially for analytical statistics based on complex samples where clustering destroys the independence of observations. Presented are results of methods used to measure standard errors of regression coefficients for several multivariate techniques. The basic designs of the several samples comprised two primary selections (PS) per stratum.Each replication was a half-sample, created by selecting one PS from each stratum. The variance of the coefficient , estimated from the entire sample, is measured by , where bj is the same estimator based on a half-sample. To increase the precision of the variance estimate, select k repeated replications and obtain the mean of the k computed variances, . Balanced repeated replications reduce the number of repetitions needed; e.g., 48 balanced replications sufficed for 47 strata in our samples. Though proofs are complete only for linear statistics, rationale and results are offered to indicate that BRR provides needed estimates of errors for nonlinear statistics.The ratios, , of actual standard errors to those of simple random sampling, (srs), are investigated for several statistics in five empirical studies. In each study the average values of exceed 1.00 and range from 1.05 for less clustered to 1.46 for more clustered samples.
Seventy-five alcohol-dependent patients (35 males, 40 females) treated by a Minnesota Model in-patient programme were followed up for 1 year. A variety of outcome measures were included, and patients' GPs were also questioned with regard to various aspects of their involvement in treatment for alcohol problems. Males admitted to the programme had a longer history of drinking, consumed more alcohol and showed greater expenditure on alcohol. At 6 months, 66% of males and 45% of females were abstinent; at 1 year, the proportions abstinent were 53% and 39%, respectively. Good outcome for both sexes was associated with attendance of Alcoholics Anonymous meetings. Poor outcome at 1 year was associated with a lack of GP involvement in aftercare and failure to provide alcohol counselling in the community. Females appeared to be particularly disadvantaged by depressive comorbidity. Males showed poorer outcome if they belonged to social class IIIM or lower, were unemployed, or had a family history of alcoholism. It is suggested that closer attention should be paid to monitoring patients' mood state, with appropriate treatment of depression, and that GPs need on-going support and education for helping patients with alcohol problems.
The aim of this study was to assess the relationships between specific personality disorders and DSM-III axis I conditions in a community sample.
A total of 810 subjects were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey, part of the Epidemiological Catchment Area Program of the National Institute of Mental Health. A semistructured examination, the Standardized Psychiatric Examination, was employed to assess axis I and axis II conditions. Scales for compulsive and antisocial personality disorders were derived from DSM-III criteria. The relationships between scores on these personality disorder scales and the presence of generalized anxiety disorder, alcohol use disorders (alcohol abuse and alcohol dependence), and simple phobia were evaluated by using logistic regression.
Higher compulsive personality scores were associated with a greater odds of generalized anxiety disorder and simple phobia but a smaller odds of alcohol use disorders. In contrast, higher antisocial personality scores were associated with a greater odds of alcohol use disorders but a smaller odds of generalized anxiety disorder. There was no relationship between antisocial personality scores and simple phobia.
Personality disorders have specific relationships to axis I conditions, which suggests different vulnerabilities but also different protective influences.
This study investigates the impact of the screening process on the composition of the final sample of alcohol abusing and nonabusing hospitalized schizophrenics. The group of nonabusing schizophrenics had higher rates of study rejections by staff, refusals, inappropriate subjects, and a lower rate of study completers. The findings suggest that these differential attrition rates may have a significant impact on the interpretation of results of studies focusing on substance use in schizophrenic samples.
This analysis shows the effect of sociodemographic variables and psychopathology on attrition in a 1-year follow-up of 10,167 household-residing respondents, aged 18-64 years, from four sites of the National Institute of Mental Health Epidemiologic Catchment Area Program. Attrition is defined in two ways: failure to locate (n = 1,035) and refusal to participate (n = 1,010). As compared with 8,122 respondents successfully interviewed after 1 year, those who are not located are more likely to be male, Hispanic, young, and unmarried. Refusers are older and more likely to be married and to have lower educational attainment than those successfully reinterviewed. After adjusting for sociodemographic variables, psychopathology had a small to moderate effect on attrition. Panic and depression were associated with failure to locate, but no diagnoses, or selected symptoms, were strongly or significantly associated with refusal to participate in the second wave.
The cue-responsivity phenomenon to alcohol-associated stimuli in dependent drinkers was examined. In accordance with previous research, significant differences on both physiological and subjective cue-responsivity variables, between dependent and non-dependent drinkers were found. The unique contribution of this paper is two-fold. Firstly, evidence is presented which suggests that the Eysenckian personality traits of introversion and neuroticism are more predictive of cue-responsivity variance in the dependent drinkers than either severity of dependence or number of years' drinking. Secondly, within this dependent group, the relationship between cue-responsivity and 'craving' was seen to be less straightforward than traditionally thought. Specifically, it suggested that it was the extent to which autonomic cue-responsivity elicited increases in self-reported anxiety, which predicted most of the variance on the 'craving' variable. Taken together, these results raise the interesting possibility that a personality disposition akin to trait anxiety, and the degree to which cue exposure elicits state anxiety, mediated the relationship between cue-responsivity and 'craving' in dependent drinkers.
In a sample of 298 cocaine abusers seeking inpatient (n = 149) or outpatient (n = 149) treatment, rates of psychiatric disorders were determined by means of the Schedule for Affective Disorders and Research Diagnostic Criteria. Overall, 55.7% met current and 73.5% met lifetime criteria for a psychiatric disorder other than a substance use disorder. In common with previous reports from clinical samples of cocaine abusers, these overall rates were largely accounted for by major depression, minor bipolar conditions (eg, hypomania, cyclothymic personality), anxiety disorders, antisocial personality, and history of childhood attention deficit disorder. Affective disorders and alcoholism usually followed the onset of drug abuse, while anxiety disorders, antisocial personality, and attention deficit disorder typically preceded drug abuse.
Detailed clinical interviews focusing on depression and alcohol abuse/dependence were conducted with 1870 managers and professionals drawn from a major US corporation. Among men, the lifetime and 1-year prevalence rates of DSM-III-R major depression were 23% and 9%, respectively. Among women, the rates were 36% and 17%, respectively. Lifetime and 1-year prevalence rates of DSM-III-R alcohol abuse/dependence were 16% and 4% for men, and 9% and 4% for women. Imposing a requirement that alcohol-related symptoms cluster together in time reduced the lifetime and 1-year prevalence rates to 11% and 3% for men and 5% and 2% for women. The odds ratio for the lifetime occurrence of depression and alcohol abuse/dependence with such clustering was 2.28. The three most important risk factors for depression were being female, separated or divorced, and having a family history of depression. For alcohol abuse/dependence, the most important risk factors were being male, unmarried, and having a family history of alcoholism. Manager/professional status, length of employment, hours worked per day, and supervisory responsibility were not statistically associated with either DSM-III-R major depression or alcohol abuse/dependence.
The Tension Reduction Theory posits that alcohol is consumed to achieve tension reduction. The drinking patterns of high anxiety college students differed from low anxiety college students. Eighty-one students completed the Trait scale of the State-Trait Anxiety Inventory and the Khavari Alcohol Test (KAT). Several indices of alcohol use derived from the KAT were used to assess patterns of alcohol use. Five two-way analyses of variance were conducted using gender and anxiety as factors. Hypothesis One predicted that there would be a significant difference in alcohol consumption between high and low anxiety students when a comprehensive measure of alcohol use was used. This hypothesis was supported. Hypothesis Two predicted that frequency alone would not differentiate between anxiety levels; this was also supported. The Third Hypothesis was that volume measures of beer, wine and liquor would differentiate between the high and low anxiety levels; this hypothesis was partially supported--beer volume did differentiate between groups, while wine and liquor volume did not. The final hypothesis was that there would be an interaction between gender and anxiety; this was not supported.
Psychopathology coexisting with substance abuse in adolescents is often encountered in a variety of clinical settings. Research findings suggest a major role for substance use in the etiology and prognosis of psychiatric disorders such as affective disorders, conduct disorder and antisocial personality disorder, attention-deficit hyperactivity disorder, and anxiety disorders. Psychiatric disorders also appear to have an important role in the etiology of and vulnerability to substance use problems in adolescents. Although the comorbidity of substance abuse and other psychiatric disorders in adolescents is recognized as an important factor in the treatment of adolescents, further research is needed to establish its prevalence, genetics, and clinical implications.
Three person-based computer files were linked to provide a data-set of a random sample of 32,679 Swedes, drawn for interviews regarding perceived health, socioeconomic conditions, and psychoactive drug use. All diagnoses from inpatient psychiatric care in the sample during a 15-year period and the causes of death after the sampling point were combined with the interview responses. Among those admitted for inpatient psychiatric care, substance abuse was an infrequent diagnosis; the majority of schizophrenics and of those with an affective disorder appeared not to medicate regularly; survey non-responders had higher rates of mental disorders than responders. Drug use correlated with both subjective and objective measures of mental ill health. The rate of prescription drug abuse was low. Automated record-linkage is a feasible method to generate hypotheses about mental health in the general population.
Building upon previous studies stressing the importance of contextual effects in psychosocial behavior, we test a model of drug involvement among inner-city youths living in neighborhoods varying in the perceived degree of toughness/drug use. The drug involvement of the youths is hypothesized to result from the availability of drugs, image of drug-using/gang-involved persons, friends' drug use, and participation in street culture activities. In each of the toughness/drug use settings, image of drug-using/gang-involved persons related positively to friends' use of alcohol and marijuana, friends' use of alcohol and marijuana related positively to participation in street culture spare-time activities and drug involvement, and participation in street culture pursuits related positively to drug involvement. Neighborhood-setting-specific relationships are also observed. The complexity of the model, as reflected in the number of path coefficients, and the ability of the variables in the model to predict the youths' drug involvement increase as we proceed from low toughness/drug use (R2 = .28) to medium toughness/drug use (R2 = .30) to high toughness/drug use (R2 = .38) neighborhoods. The importance of examining youths' environmental experiences in understanding their drug involvement, especially their relationship to neighborhood drug use subcultures, is emphasized.
Various authors have described pre-alcoholic psychopathology in female problem drinkers;1 however, actual studies of rigorously defined antecedent and concurrent psychiatric disorders have been few. More recently, several authors have reported that both affective disorder and antisocial personality are quite prevalent as primary diagnoses in hospitalized alcoholic women,2,3,4 but the risk of subsequent alcoholism in women with these and other psychiatric syndromes needs to be clarified. In this study we investigate the prevalence of alcoholism in three populations of women with serious psychopathology. The first is a sample of psychiatrically hospitalized women with a history of depression at some time in their lives (hospitalized sample); second is a felon sample of women on probation and parole (felon sample); and third is a sample of female narcotics addicts admitted to the United States Public Health Service facility at Lexington, Kentucky for detoxification and treatment (Lexington sample). Our data set is unique in that despite being collected at different times and at different locations, uniform diagnostic criteria and uniform interview schedules were employed.5,6
This is the first in a series of reports on the long-term test-retest reliability and procedural validity of the UM-CIDI, a modified version of the Composite International Diagnostic Interview used in the US National Comorbidity Survey (NCS). This report focuses on DSM-III-R Generalized Anxiety Disorder (GAD). The NCS administered the UM-CIDI to a nationally representative sample of 8098 respondents in the age range 15-54. A subsample of 36 respondents was subsequently selected for clinical reappraisal of GAD, consisting of reinterviewing by a clinical reappraisal interviewer who blindly readministered the GAD section of the UM-CIDI followed by an expanded version of the GAD section of the Structured Clinical Interview for DSM-III-R (SCID). The test-retest reliability of UM-CIDI/DSM-III-R lifetime GAD is Kappa = .53. When the requirement that the worries be excessive or unrealistic (A2) is removed, as in ICD-10 and partially in DSM-IV, reliability increases to Kappa = .78. The concordance between the baseline UM-CIDI diagnosis and the SCID diagnosis is Kappa = .35, while the cross-sectional concordance is Kappa = .47 (.66 when the Criterion A2 requirement is removed). Item-level analysis shows that lack of concordance between the UM-CIDI and the SCID is due largely to Criteria A2 and D. The A2 problem could be addressed either by deemphasizing the cognitive-evaluative component of GAD as in ICD-10, or by removing consideration of the term "unrealistic" from the criterion as in DSM-IV and more clearly specifying the meaning of the term "excessive". These options require further research on similarities and differences in risk factors, course, family history, and treatment response of more narrowly and broadly defined GAD. The Criterion D problem is due to lack of clarity in what constitutes a symptom occurring "often". This is clarified in DSM-IV. It is likely that this clarification will make it possible to develop more precisely structured questions to evaluate Criterion D in subsequent revisions of the UM-CIDI, resulting in improved reliability and validity.
In this critical review the authors evaluate the literature regarding the relationship between lifelong DSM-III-R anxiety disorders and alcohol dependence. Many alcohol-dependent individuals demonstrate severe anxiety symptoms in the context of acute or protracted abstinence syndromes, but it is unclear whether these anxiety conditions are independent psychiatric disorders or temporary syndromes likely to disappear on their own.
Reports since 1975 describing the relationship between alcoholism and anxiety disorders were reviewed to determine whether 1) lifelong anxiety disorders are unusually prevalent among alcohol-dependent individuals, 2) children of alcoholics are more likely to develop anxiety disorders than comparison populations, 3) anxiety syndromes are likely to disappear with abstinence, 4) the rate of alcohol dependence among subjects with lifelong anxiety disorders is higher than normal, 5) there is familial crossover between alcohol dependence and anxiety disorders, and 6) alcoholism is often preceded by anxiety disorders in groups from the general population studied prospectively.
The interaction between alcohol use and anxiety disorders is complex. The available data, while imperfect, do not prove a close relationship between life-long anxiety disorders and alcohol dependence. Further, prospective studies of children of alcoholics and individuals from the general population do not indicate a high rate of anxiety disorders preceding alcohol dependence.
The high rates of comorbidity in some studies likely reflect a mixture of true anxiety disorders among alcoholics at a rate equal to or slightly higher than that for the general population, along with temporary, but at times severe, substance-induced anxiety syndromes.
Dual diagnosis in psychiatry and addiction refers to the presence of a substance use disorder coexisting with another major psychiatric disorder. This article reviews the prevalence and timing of occurrence of the various disorders and their combinations. The problems in diagnosis and management associated with these diagnoses are explored both from the point of view of the patient and of the treatment providers. The paper outlines a general management strategy for dual diagnosis cases and discusses specific strategies for treating particular psychiatric diagnosis combinations.
All schizophrenic patients admitted consecutively either to the Psychiatric Hospital of the University of Munich (group 1,N=183) or the Mental State Hospital Haar/Munich (group 2,N=447) between 1.8.1989 and 1.2.1990 were examined to assess prevalence estimates for substance abuse in schizophrenic inpatients. psychiatric diagnosis were made according to ICD-9 criteria. Psychopathology and psychosocial variables were documented by means of the AMDP-protocol on admission and discharge. The diagnostic procedure included a detailed semi-structured interview concerning the individual alcohol and drug history and sociodemographic data, the Munich Alcoholism Screening Test (MALT), a physical examination and the screening of various laboratory parameters such as GGT and MCV, among others.
The results show that substance abuse is a very common problem in schizophrenics. Lifetime prevalence rates for substance abuse were estimated at 21.8% in group 1 and 42.9% in group 2,3-month prevalence rates for substance abuse were estimated at 21.3% resp. 29.0%. Alcohol abuse was by far the most common type of abuse with prevalence estimates being 17.4% resp. 34.6%. Prevalence rates for substance abuse were much higher in the more “chronic” sample of the Mental State Hospital and in male patients. With respect to schizophrenic subtype few differences could be demonstrated with drug dependence being more common in patients with paranoid schizophrenia. The MALT proved to be a valuable sceening instrument for alcohol abuse in schizophrenics with both a high specifity and sensitivity. “Dual diagnosis” schizophrenics had a significantly higher rate of suicide attempts and were less likely to be married. Possible clinical implications of these findings are discussed.
Two hundred ninety-eight treatment-seeking and 101 community cocaine abusers were interviewed using the Schedule for Affective Disorders and Research Diagnostic Criteria. Alcoholism was the most frequently diagnosed current and lifetime psychiatric disorder in both samples. Several findings from this study converge with recent evidence which suggests a particularly strong relationship between cocaine abuse and alcoholism that may differ from other types of alcohol-drug comorbidity. First, rates of alcoholism among cocaine abusers doubled those of comparable samples of opioid addicts. Second, while virtually all cocaine abusers in this sample reported some alcohol use during the past month, a lifetime diagnosis of alcoholism was associated with more severe cocaine dependence. Third, the onset of alcoholism followed the onset of drug dependence for the majority of alcoholic cocaine abusers, a pattern which contrasts that typically seen in other types of drug-alcohol comorbidity and suggests that cocaine abuse may increase vulnerability to secondary alcoholism. Prognostically, cocaine abusers who were alcoholic at baseline interview were more likely to remain alcoholic at 1-year follow-up but did not differ from nonalcoholic cocaine abusers on other measures of outcome.
Synopsis
We evaluate the long-term test–retest reliability and procedural validity of phobia diagnoses in the UM-CIDI, the version of the Composite International Diagnostic Interview, used in the US National Co-morbidity Survey (NCS) and a number of other ongoing large-scale epidemiological surveys. Test–retest reliabilities of lifetime diagnoses of simple phobia, social phobia, and agoraphobia over a period between 16 and 34 months were K = 0·46, 0·47, and 0·63, respectively. Concordances with the Structured Clinical Interview for DSM-III-R (SCID) were K = 0·45, 0·62, and 0·63, respectively. Diagnostic discrepancies with the SCID were due to the UM-CIDI under-diagnosing. Post hoc analysis demonstrated that modification of UM-CIDI coding rules could dramatically improve cross-sectional procedural validity for both simple phobia ( K = 0·57) and social phobia ( K = 0·95). Based on these results, it seems likely that future modification of CIDI questions and coding rules could lead to substantial improvements in diagnostic validity.
Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study
Comorbidity of mental disorders with alcohol and other drug abuse. Results
from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264;2511-2518.
The epidemiology of euphoric grandiose DSM-III-R Bipolar I Disorder in a general population survey
- R C Kessler
- D R Rubinow
- C Holmes
- J M Abelson
- S Zhao
Kessler RC, Rubinow DR, Holmes C, Abelson JM, Zhao S. The epidemiology
of euphoric grandiose DSM-III-R Bipolar I Disorder in a general population
survey. Under Review.
Retrospective adult assessment of childhood psychopathology
- R C Kessler
- D K Mroczek
- R F Belli
Kessler RC, Mroczek DK, Belli RF. Retrospective adult assessment of
childhood psychopathology. In: Shaffer D, Richters J, eds. Assessment in
Child Psychopathology. New York, NY: Guilford Press; In Press.