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The effect of depression on return to drinking: A prospective study
Abstract
Background: The effect of depression on return to drinking among individuals with alcohol dependence is controversial. From February 1, 1993, to April 15, 1996, we consecutively recruited 40 women and 61 men hospitalized for alcohol dependence and followed them up monthly for I year to assess the effect of depression on drinking outcomes. Methods: We conducted structured interviews during hospitalization and monthly following discharge for l year to determine whether depression at treatment entry affected the likelihood of return to drinking and whether this effect differed between sexes. Using survival analysis, we examined the effect of depressive symptoms and a diagnosis of current major depression at treatment entry on times to first drink and relapse during follow-up. Results: A diagnosis of current major depression at the time of hospitalization was associated with shorter times to first drink (hazard ratio, 2.03; 95% confidence interval [CI], 1.28-3.21; P=.003) and relapse (hazard ratio, 2.12; 95% CI, 1.32-3.39; P=.002). There was no significant difference between women and men in this effect. Depressive symptoms as measured by the Beck Depression Inventory did not predict time to first drink or relapse in women or men. Conclusions: A diagnosis of current major depression at entry into inpatient treatment for alcohol dependence predicted shorter times to first drink and relapse in women and men. Our results differ from earlier reports that men and women differ in the effect of depression on return to drinking.
... and 2.4, respectively). 2 3 Individuals with co-morbidity present great challenge to treatment since they have more severe symptoms, 3 greater disability and poor quality of life 4 than individuals with only alcohol use disorder, and may pose a greater economic burden to society due to their higher utilization of treatment services. 4 Among those with an AUD, comorbid depression is associated with an earlier onset of alcohol dependence, higher rates of lifetime drug dependence; 5 worse outcomes among those entering treatment for alcohol and drug problems; 6 higher relapse following AUD treatment among adolescents 7 and adults; 8 greater severity of suicidality in adult psychiatric patients; 9 and higher likelihood of suicide attempts 10 and completed suicides. 11 Research indicates that individuals with co-occurring mood disorders and AUD more frequently use a significant amount of alcohol prior to their suicide attempts compared to individuals with mood disorders without a history of AUD and that this acute alcohol use increases the lethality of suicide attempts. ...
... [4] Among those with an AUD, comorbid depression is associated with an earlier onset of alcohol dependence, higher rates of lifetime drug dependence; [5] worse outcomes among those entering treatment for alcohol and drug problems; [6] higher relapse following AUD treatment among adolescents [7] and adults; [8] greater severity of suicidality in adult psychiatric patients; [9] and higher likelihood of suicide attempts [10] and completed suicides. [11] Research indicates that individuals with co-occurring mood disorders and AUD more frequently use a significant amount of alcohol prior to their suicide attempts compared to individuals with mood disorders without a history of AUD and that this acute alcohol use increases the lethality of suicide attempts. ...
... [4] Among those with an AUD, comorbid depression is associated with an earlier onset of alcohol dependence, higher rates of lifetime drug dependence; [5] worse outcomes among those entering treatment for alcohol and drug problems; [6] higher relapse following AUD treatment among adolescents [7] and adults; [8] greater severity of suicidality in adult psychiatric patients; [9] and higher likelihood of suicide attempts [10] and completed suicides. [11] Patients with a mood disorder who also have an AUD are more likely to consume a large amount of alcohol before attempting suicide, increasing the likelihood that a suicide attempt will be lethal. ...
... These disorders are frequently comorbid; those with AUD have a 1.2-fold increased likelihood of having MDD in the previous year (2). The co-occurrence of these conditions is associated with increased severity of symptoms and overall worse prognosis (3,4). Sleep disturbance (SD) is common in both conditions and when present, impacts associated morbidity, treatment response, and relapse risk (5-8). ...
... To our knowledge, no previous studies have examined the prevalence of SD in subjects with comorbid AUD and MDD. Patients with MDD+AUD had greater rates of SD compared to controls and those with either condition alone in our study; this is in keeping with prior literature demonstrating that other morbidity is worse in patients with both conditions versus either condition (3,4). ...
Introduction:
Current understanding of the differences in sleep disturbance (SD) and associated risk factors in patients with alcohol use disorders (AUD), major depressive disorders (MDD), and comorbid AUD+MDD is limited.
Methods:
Data from the UK Biobank (UKB) (n=47,825) were utilized to categorize subjects into those with MDD (n=5,991), AUD (n=12,952), both (MDD+AUD )(n=3,219), and controls (n=25,663). We used generalized linear models (GLMs) to test whether rates of SD and sleep duration differed among the groups and determine the clinical predictors of SD. Rates of SD and sleep duration were compared using regression analyses accounting for demographic (age, sex, ethnicity, and Townsend deprivation index) and clinical (body mass index, neuroticism score, and alcohol consumption) factors.
Results:
After accounting for diagnostic category, SD was associated with age, female sex, white ethnicity, and higher BMI, neuroticism and alcohol consumption scores (all p<0.0001).
The unadjusted prevalence of SD was 25.6%, 25.9%, 39.2%, and 41.1% in control, AUD, MDD, and MDD+AUD categories respectively. Rates of SD in controls and AUD group as well as MDD alone and MDD+AUD did not differ in unadjusted models (p=0.45 and 0.075, respectively). Prevalence of SD differed in the four groups (p<0.0001 for all pairwise comparisons) after adjusting for demographic confounders. After further adjustment for clinical factors, effect sizes were reduced, but pairwise comparisons remained significant, except in the AUD versus MDD group (all p<0.05). After adjusting for demographic and clinical factors, sleep duration did not differ among the groups.
Conclusion:
Demographic and clinical characteristics associated with SD were similar in patients with MDD, AUD, and MDD+AUD. The differences in rates of SD between the diagnostic groups were attenuated but persisted after accounting for these confounders. Genetic and other factors capable of influencing SD in patients with MDD, AUD, and comorbid MDD+AUD merit future investigation.
... Therefore, failure to treat depression after alcohol detoxification poses considerable risk. 9 A study of the effect of depression on the return to drinking among patients with alcohol dependence found that depression at entry into inpatient treatment for alcohol dependence predicted a shorter time to first drink. 9 The prognosis for a drinking relapse was worse no matter whether the depression came first or was triggered by the alcohol. ...
... 9 A study of the effect of depression on the return to drinking among patients with alcohol dependence found that depression at entry into inpatient treatment for alcohol dependence predicted a shorter time to first drink. 9 The prognosis for a drinking relapse was worse no matter whether the depression came first or was triggered by the alcohol. Depression does not predict drinking outcomes, but it is associated with a more rapid relapse to ethanol consumption. ...
This review details methods for meeting the challenges of diagnosing and treating mood disorders that coexist with substance use disorders.
... Furthermore depressed mood may also be an important trigger of alcoholic relapse 10,11 . In addition a significant comorbid expression of alcoholism and affective disorders (major depression, dysthymia) has been shown by clinical evidences [12][13][14] . The treatment becomes more complex because these patients have more physical, psychological, familial and social problems than alcoholics without comorbid depression 7,13 . ...
... In addition a significant comorbid expression of alcoholism and affective disorders (major depression, dysthymia) has been shown by clinical evidences [12][13][14] . The treatment becomes more complex because these patients have more physical, psychological, familial and social problems than alcoholics without comorbid depression 7,13 . The clinical and experimental data indicated that ethanol-induced depressive-like behavior was associated with alterations in corticotropin releasing factor (CRF) and neuropeptide Y (NPY) systems in the brain 15 . ...
Anxiety and depression like behavior induced by ethanol in mice is a consequence of changes in the CNS that are secondary to impaired serotonine and norepinephrine neurotransmitters. Treatment with selective norepinephrine or serotonine reuptake inhobitors are reported to produce beneficial effects in this model. Desvenlafaxine is reported to exhibit selective norepinephrine inhibitor. However, no report is available on the influence of desvenlafaxine on ethanol-induced anxiety and depression. Therefore, we tested its influence against anxiety and depression in ethanol-induced mice using locomotor activity, elevated plus maze and forced swim test paradigm. Fifteen days after ethanol treated mice showed decreased locomotor activity and time spend in open arm and, increased immobility time as parameter of anxiety and depression. In contrast, treatment with desvenlafaxine (20-80 mg/kg, p.o.) improved anxiety and depression like behavior, and increased locomotor activity and time spend in open arm and, decreased immobility time in ethanol treated rats. In conclusion, the present study demonstrates that treatment with desvenlafaxine prevents the anxiety and depression in ethanol treated mice.
... As a result, SUDs are a great detriment to health-related quality of life and the global economy, with alcohol use and drug use in general ideation and greater risk of social and personal impairment and additional psychiatric comorbidity [12]. Comorbidity of AUD and MDD also worsens prognosis for both disorders [13,14]. ...
Purpose of Review
In this narrative review, we discuss evidence for psilocybin- and LSD-assisted treatment of alcohol use disorder (AUD) and major depressive disorder (MDD). We describe limitations of psychedelic research and posit methodological considerations when designing a trial in patients with both disorders.
Recent Findings
In AUD, a growing evidence base for psilocybin treatment shows a promising beneficial and sustained effect on measures of drinking frequency. In MDD, a recent meta-analysis has demonstrated that psilocybin therapy provides a large and consistent reduction in depressive symptoms compared to no treatment. Co-occurrence of MDD and AUD is quite prevalent, and this comorbidity exacerbates symptomatology of the two individual disorders and complicates their treatment.
Summary
Theoretically, patients presenting with both AUD and MDD would benefit from an integrated therapy that could treat MDD and AUD simultaneously. We believe that more research into the efficacy of psilocybin in patients with both AUD and MDD is warranted and justified.
... Converging with our observations HRD, BD or both were shown to be significantly associated with depression [18,50,51], fatigue [18,19,52], PTSD [53,54], smoking [16,55,56], and cannabis use [51]. Studies have revealed the genetic link between heavy use of alcohol and depression [57,58,59] and have demonstrated depression as an outcome as well as a risk factor for excessive use of alcohol [60,61]. Fatigue is shown to reciprocate with stress (i.e., stress can give rise to fatigue or vice versa) [62] and as emphasized above, stress is associated with heavy alcohol use, thus fatigue could be accounted for as a risk factor for HRD, BD or both. ...
Introduction: Operational readiness is an integral aspect of all military organizations and hence all personnel should achieve and maintain optimal physical and mental health. However, unique stressors in the military milieu can give rise to a myriad of mental health problems and the alcohol-related issue [High-risk drinking (HRD) and binge drinking (BD)] is one out of many. This study aims to explore the extent of alcohol consumption and the existing risk factors for HRD, BD or both in the Sri Lanka army.Methodology: This was a cross-sectional descriptive survey, done among 147 officers (selected by systematic random sampling) and 3519 other ranks (ORs) (selected by multistage extension cluster sampling), in 2019 in the Army (Security Forces Head Quarters-East). A self-administered questionnaire was used, which included, questions on socio-demographic variables, WHO Alcohol Use Disorder Identification Test (AUDIT) for HRD and BD, 9-Item Patient Health Questionnaire (PHQ-9) for probable depression, PTSD Checklist Military Version (PCL- M) for PTSD, Chalder Fatigue Scale for fatigue, and questions ascertaining the degree of unit cohesion, aggression, cigarette smoking, cannabis use, family history of psychiatric disorders and exposure to childhood abuse. The psychosocial functioning was assessed by the tenth question of the PHQ-9.Results: The mean age was 31.7 years (SD±6.686 years), ranging from 19 years to 57 years. Among the respondents, 56.7% were not GCE /OL qualified, 66.1% were married and 50.4% were exposed to battle. Current alcohol consumption was 76.5% and among them, 43% were in HRD [i.e., 35.2% hazardous, 5.5% harmful, and 2.3% dependent drinkers] and 15.5 % (95% CI 14.1 %- 16.7%) were in BD category. Among the correlates of HRD and BD were younger age, being single, employment in the Infantry and Elite, probable depression, fatigue, PTSD, smoking, cannabis use, exposure to childhood abuse, aggression, and psychosocial dysfunction.Conclusions: Compared to the community, alcohol consumption was higher in the Army, which may be due to the unique military subculture and the role model effect. While younger age, being single, and exposure to childhood abuse were risk factors, probable depression, fatigue, lack of cohesion, smoking, and cannabis use were either risk factors or outcomes of HRD, BD, or both in the Army. Further, psychosocial dysfunction was observed as an outcome.
... [40][41][42] Our findings of an association between depression and increased prevalence of smoking and drinking are consistent with previous studies, 29,30 suggesting that, for individuals with depressive symptoms, unhealthy lifestyles may have worsened due to the pandemic. [43][44][45] In the present study, individuals with depressive symptoms had lower evaluations of the adequacy of the responses of the government, medical institutions, and neighbors to COV-ID-19. Such attitudes can produce a negative effect on individuals with depression in terms of following rules of quarantine, etc. Trust in government is associated with positive mental health outcomes, including depression and anxiety. ...
Objective This study evaluated protective behaviors against coronavirus disease-2019 (COVID-19) and related factors in individuals with depressive symptoms.Methods This cross-sectional study included data from the 2020 Korean Community Health Survey. Depressive symptoms, COVID- 19 protection behaviors, and related factors were investigated in 228,485 people. Chi-square test and logistic regression analysis were used to analyze categorical variables. Statistical analysis was performed using SPSS software (version 27.0).Results In the study, 3.9% (n=8,970) had depressive symptoms. The prevalence of depressive symptoms was higher in individuals in their 19–39 years , and ≥60s than in those in their 40–59 years (p<0.001). Lower education level and household income were associated with a higher prevalence of depression (p<0.001). Among the various occupations, service workers had the highest prevalence of depressive symptoms (p<0.001). Individuals with depressive symptoms were less likely to adopt protective behaviors against COVID-19 (p<0.001) or exhibit concerns regarding death and economic damage (p<0.001) compared to individuals without depressive symptoms. Individuals with depressive symptoms were more likely to have unhealthy behaviors than those without depressive symptoms (p<0.001). Individuals with depressive symptoms considered that the COVID-19 response by the government and other organizations was inadequate (p<0.001).Conclusion During the COVID-19 pandemic, individuals with depressive symptoms faced greater challenges in adopting protective behaviors. Therefore, it is crucial to develop strategies to protect people with depressive symptoms during another pandemic in the future.
... The following demographic characteristics were used as covariates in the analysis. These factors are linked to depressive symptoms and social isolation [23][24][25]: age (continuous), sex, education level (junior high school, high school, college or university or higher, and other), marital status (unmarried or married), number of household members (living alone or ≥ 2), work status (unemployed or employed), smoking habits (nonsmoker or current smoker), drinking habits (nondrinker or current drinker), body mass index (BMI, < 18.5, 18.5 to < 25, or ≥ 25 kg/m 2 ), and insomnia. Insomnia was defined as a score of ≥ 6 on the Athens Insomnia Scale [26,27]. ...
Background
Whether past disaster experiences affect the association between changes in social isolation and depressive symptoms is largely unknown. This study examined the association between changes in social isolation and depressive symptoms among survivors who experienced earthquake damage in the aftermath of the Great East Japan Earthquake (GEJE).
Methods
We analyzed longitudinal data from 10,314 participants who responded to self-report questionnaires on the Lubben Social Network Scale-6 (LSNS-6) and the Center for Epidemiological Studies-Depressive Scale (CES-D) in both the baseline survey (FY2013 to FY2015) and follow-up survey (FY2017 to FY2019) after the GEJE. According to changes in the presence of social isolation (< 12 of LSNS-6) at two time points, participants were categorized into four groups: “not socially isolated,” “improved socially isolated,” “newly socially isolated,” and “continuously socially isolated.” At the follow-up survey, a CES-D score of ≥ 16 indicates the presence of depressive symptoms. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using the logistic regression analysis to examine the influence of the change in social isolation over four years on depressive symptoms.
Results
Participants who were newly socially isolated had a significantly higher prevalence of depressive symptoms than those who were not socially isolated (AOR = 1.89, 95% CI = 1.61 − 2.23). In addition, AORs were highest for those who were continuously socially isolated and had experienced house damage (AOR = 2.17, 95% CI = 1.73 − 2.72) and those who were newly socially isolated and had not experienced the death of family members due to the GEJE (AOR = 1.88, 95%CI = 1.60 − 2.22).
Conclusion
Our longitudinal findings suggest that being newly or continuously socially isolated is associated with a risk of depressive symptoms, not only among those who had experienced house damage or the death of a family member, but also those who had not, in the disaster-affected area. Our study underlines the clinical importance of social isolation after a large-scale natural disaster and draws attention to the need for appropriate prevention measures.
... The interaction between chronic alcohol consumption and mental health is well established (McHugh & Weiss, 2019). Dual diagnosis of AUD and a psychiatric disorder is associated with greater severity and worse prognosis than either diagnosis alone (Greenfield et al., 1998). Alcohol is also frequently used by patients with mental health conditions to self-medicate (Crum et al., 2013). ...
Background
Ongoing alcohol use is strongly associated with progressive liver damage and higher mortality in patients with alcohol‐related liver disease (ArLD). Reduction in alcohol use is therefore the cornerstone of treatment to improve the long‐term outcome of these patients. However, a large proportion of patients continue to use alcohol and do not access or engage with alcohol treatment services after a diagnosis of ArLD. We reviewed the literature on factors associated with ongoing alcohol consumption among patients with ArLD to identify barriers or facilitators to their accessing alcohol treatment.
Methods
A search of MEDLINE and EMBASE was conducted using search strategies relating to ArLD and the psychosocial factors hypothesized to influence alcohol reduction and/or abstinence.
Results
There were few relevant studies pertinent to this population group. Several studies reported a high prevalence of mental health diagnoses associated with the severity of alcohol dependence. Social and environmental factors were shown to be important determinants of alcohol use. Common themes perceived as barriers to treatment from qualitative interviews with ArLD patients across studies included poor communication between the clinical team and patient, lack of symptoms recognized by patients themselves, and perceived loss of control over their condition.
Conclusions
We recommend that future clinical studies of patient cohorts with ArLD include detailed psychosocial assessments to capture information on mental health and social factors. Qualitative studies are required to explore the patient journey pre and post hospital admission, which should focus on identifying facilitators and barriers to accessing treatment. Well‐designed, controlled studies are needed to identify patient, social, and environmental factors associated with relapse to alcohol use after a diagnosis of ArLD. These data will enable us to adapt our support for patients to enhance engagement with services and improve long‐term outcomes.
... Mood disorders in general and depressive disorders in particular are the most common co-occurring disorders with alcohol use disorders (AUD) (Grant et al., 2004). The dual disorders had significantly greater severity and worse prognosis than either disorder alone (Greenfield et al., 1998;Hasin et al., 2002). Moreover, the co-existence of AUD increases the risk of suicidal behavior (Conner et al., 2014). ...
Aim
To determine the efficacy of individual-based, face-to-face screening and brief intervention (SBI) for hazardous alcohol use among treatment-seeking outpatients with mood disorders.
Methods
It was a parallel-group, single-blind, randomized controlled trial of 84 participants who met the selection criteria for hazardous alcohol use, defined by alcohol use disorder identification test (AUDIT) score 8–19. Participants were randomly allocated to either SBI or the general advice group. Both groups had received a standard of care for mood disorders. The outcome was assessed after 3 months. The primary outcome was a change in mean AUDIT score and the secondary outcomes were a change in frequency of heavy episodic drinking and stages of motivation.
Results
Majority (60%) had major depressive episodes. There was no significant difference in baseline demography and clinical variables between the groups. Both intention to treat and per-protocol analyses showed a small but significant effect of SBI on mean AUDIT score. Age, baseline AUDIT, and motivation did not moderate the effect. SBI was associated with a significant decrease in the frequency of heavy drinking and improvement in stages of motivation.
Conclusion
SBI among patients with mood disorders had a small but significant effect on alcohol use.
... The decodability of reward sensitivity in physiological signals could predict subsequent fast as well as slow mood fluctuations in healthy participants. As dysregulated reward sensitivity has also been linked to addiction [68] and mood is coupled to craving [69][70][71][72][73] similar intense sampling methods that combine EMA-based tasks, computational models, and wearable sensors could potentially be used to predict rapid and sudden shifts toward episodes of uncontrolled substance use. ...
Introduction:
Over the last decades, our understanding of the cognitive, motivational, and neural processes involved in addictive behavior has increased enormously. A plethora of laboratory-based and cross-sectional studies has linked cognitive-behavioral measures to between-subject differences in drinking behavior. However, such laboratory-based studies inevitably suffer from small sample sizes and the inability to link temporal fluctuations in task measures to fluctuations in real-life substance use. To overcome these problems, several existing behavioral tasks have been transferred to smartphones to allow studying cognition in the field.
Method:
In this narrative review, we first summarize studies that used existing behavioral tasks in the laboratory and self-reports of substance use with ecological momentary assessment (EMA) in the field. Next, we review studies on psychometric properties of smartphone-based behavioral tasks. Finally, we review studies that used both smartphone-based tasks and self-reports with EMA in the field.
Results:
Overall, studies were scarce and heterogenous both in tasks and in study outcomes. Nevertheless, existing findings are promising and point toward several methodological recommendations: concerning psychometrics, studies show that - although more systematic studies are necessary - task validity and reliability can be improved, for example, by analyzing several measurement sessions at once rather than analyzing sessions separately. Studies that use tasks in the field, moreover, show that power can be improved by choosing sampling schemes that combine time-based with event-based sampling, rather than relying on time-based sampling alone. Increasing sampling frequency can further increase power. However, as this also increases the burden to participants, more research is necessary to determine the ideal sampling frequency for each task.
Conclusion:
Although more research is necessary to systematically study both the psychometrics of smartphone-based tasks and the frequency at which task measures fluctuate, existing studies are promising and reveal important methodological recommendations useful for researchers interested in implementing behavioral tasks in EMA studies.
... In addition, these disorders can co-occur; the presence of either disorder doubles the risk of the other disorder (Boden and Fergusson, 2011). Furthermore, this co-occurrence can be characterized by greater severity and worse prognosis than either disorder alone (Greenfield et al., 1998;Hasin et al., 2002), including a heightened risk for suicidal behavior (Conner et al., 2014). Three main hypotheses have been made to explain this comorbidity. ...
Background
: Depressive disorders (DD) and alcohol use disorders (AUD) frequently co-occur. They are key to understanding the current increases in “deaths of despair” among individuals with lower socioeconomic status (SES). The aim of this study was to assess the prospective bidirectional associations between AUD and DD, as well as the effect of SES on these two conditions.
Methods
: The National Epidemiologic Survey on Alcohol and Related Conditions is a cohort study representative of the US adult population, which began in 2001-2002, with follow-up interviews conducted 3 years later. SES was primarily operationalized as educational attainment. AUD, DD, and their levels of severity were defined according to the DSM-5 criteria.
Results
: The risk of developing an incident DD increased gradually with the recency and the severity of AUD at baseline, but the converse was not observed. Lower SES was an independent risk for incident AUD or DD. SES did not modify the prospective association between AUD and DD.
Limitations
: The absence of interaction between SES and moderate or severe AUD for the incident DD must be considered with caution due to the limited number of DD cases reported in these AUD categories.
Conclusions
: This result is consistent with a causal relationship between AUD and DD, and suggests that therapeutic interventions for AUD may also have beneficial effects to lower DD rates. The independent effects of a lower SES and AUD on DD may result in a vulnerable population cumulating disorders with heavy consequences on health and social well-being.
... Current findings are inconsistent with previous papers reporting time to relapse prediction from self-report measures such as craving in cocaine use disorder (Paliwal et al. 2008) or depression in AUD (Greenfield et al. 1998). Sample differences across studies may contribute to the discrepancy between the current and previous findings. ...
Theoretical models of addiction suggest that alterations in addiction domains including incentive salience, negative emotionality, and executive control lead to relapse in alcohol use disorder (AUD). To determine whether the functional organization of neural networks underlying these domains predict subsequent relapse, we generated theoretically defined addiction networks. We collected resting functional magnetic resonance imaging data from 45 individuals with AUD during early abstinence (number of days abstinent M = 25.40, SD = 16.51) and calculated the degree of resting-state functional connectivity (RSFC) within these networks. Regression analyses determined whether the RSFC strength in domain-defined addiction networks measured during early abstinence predicted subsequent relapse (dichotomous or continuous relapse metrics). RSFC within each addiction network measured during early abstinence was significantly lower in those that relapsed (vs. abstained) and predicted subsequent time to relapse. Lower incentive salience RSFC during early abstinence increased the odds of relapsing. Neither RSFC in a control network nor clinical self-report measures predicted relapse. The association between low incentive salience RSFC and faster relapse highlights the need to design timely interventions that enhance RSFC in AUD individuals at risk of relapsing faster.
... Nationally-representative samples have confirmed high rates of comorbidity between INT disorders and AUPs (Grant et al., 2004;Hasin, Goodwin, Stinson, & Grant, 2005;Kessler et al., 1997;Regier et al., 1990;Ross, 1995), and a worse prognosis is evident when these disorders co-occur compared to either condition alone (Bobo, McIlvain, & Leed-Kelly, 1998;S. A. Brown et al., 1995;Cornelius et al., 1995;Curran, Flynn, Kirchner, & Booth, 2000;Donohue, Acierno, & Kogan, 1996;Driessen et al., 2001;Greenfield et al., 1998;Lejoyeux & Lehert, 2011;Meyer, Rumpf, Hapke, & John, 2004;Pettinati, Pierce, Wolf, Rukstalis, & O'Brien, 1997;Röggla & Uhl, 1995;Salloum et al., 1995). ...
A longstanding hypothesis is that at least some alcohol use problems (AUP) develop and are maintained through the ‘self-medication’ of internalizing (INT) problems – defined broadly as negative affect, inhibition, and symptoms of anxiety and depression. Despite frequent co-occurrence between AUP and INT, evidence for the self-medication hypothesis is mixed likely due to variation in the effect across time and individuals. To address this, three studies were conducted that used different approaches to account for temporal and person specific effects that contribute to the INT-AUP link. Study 1 applied a longitudinal between-person approach to model the effects of INT on AUP over time after accounting for mediating and/or suppressing effects of externalizing (EXT) symptoms (e.g., antisocial behavior, disinhibited personality traits) – another individual differences variable associated with both INT and AUP. Study 2 used a longitudinal, behavioral genetic co-twin control approach to estimate the causal effect of mean-level variation in INT on AUP after controlling for common genetic and environmental liability shared within families. Finally, study 3 examined the degree to which the INT-AUP association is person-specific (i.e., only present for some individuals) along a granular time scale (i.e., day-to-day). Results across studies detected — and replicated — a prospective link between INT and AUP but highlighted that this effect is not uniform across time and individuals. The presence and nature of the INT-AUP link varied across stages of development, individual differences in levels of EXT and familial risk, and even appear person-specific in nature. Future work and clinical applications in this area should carefully account for variation in the INT-AUP across time and individuals.
... Withdrawal from chronic alcohol drinking elicits negative emotional states such as anxiety, anhedonia, and depression 1,2 . These psychological states are detrimental to achieving abstinence from alcohol use and are associated with increased risk for relapse to alcohol drinking 3,4 . The hippocampus is an alcohol-sensitive brain region involved in mood regulation and cognition [5][6][7][8] . ...
Alcohol use disorder (AUD) is highly comorbid with depression. Withdrawal from chronic alcohol drinking results in depression and understanding brain molecular mechanisms that drive withdrawal-related depression is important for finding new drug targets to treat these comorbid conditions. Here, we performed RNA sequencing of the rat hippocampus during withdrawal from chronic alcohol drinking to discover key signaling pathways involved in alcohol withdrawal-related depressive-like behavior. Data were analyzed by weighted gene co-expression network analysis to identify several modules of co-expressed genes that could have a common underlying regulatory mechanism. One of the hub, or highly interconnected, genes in module 1 that increased during alcohol withdrawal was the transcription factor, signal transducer and activator of transcription 3 ( Stat3 ), a known regulator of immune gene expression. Total and phosphorylated (p)STAT3 protein levels were also increased in the hippocampus during withdrawal after chronic alcohol exposure. Further, pSTAT3 binding was enriched at the module 1 genes Gfap, Tnfrsf1a , and Socs3 during alcohol withdrawal. Notably, pSTAT3 and its target genes were elevated in the postmortem hippocampus of human subjects with AUD when compared with control subjects. To determine the behavioral relevance of STAT3 activation during alcohol withdrawal, we treated rats with the STAT3 inhibitor stattic and tested for sucrose preference as a measure of anhedonia. STAT3 inhibition alleviated alcohol withdrawal-induced anhedonia. These results demonstrate activation of STAT3 signaling in the hippocampus during alcohol withdrawal in rats and in human AUD subjects, and suggest that STAT3 could be a therapeutic target for reducing comorbid AUD and depression.
... Furthermore, unhealthy lifestyle behaviors related with depression may have influenced our results. Depression is associated with unhealthy lifestyle behaviors including smoking, drinking, and physical inactivity [47][48][49] . Of note, patients with depression have been found to have increased risk of being obese, which may be attributed to genetics, alterations in homeostatic adjustments such as hypothalamic-pituitary-adrenal axis or immune responses, and antidepressants 50 . ...
Although depression and glaucoma share several common pathophysiology, the risk of glaucoma in patients with depression has not been reported. Thus, we investigated the effect of depressive symptom and depressive disorder on glaucoma incidence. In this nationwide population-based cohort study, all subjects receiving the National Screening Program at the age of 66 during 2009–2014 were included. These subjects were divided into depression group and no depression group based on subjective depressive symptoms and clinically diagnosed depressive disorder and were tracked until 2017 for development of glaucoma. Of the 922,769 subjects included in the study, 191,636 (20.77%) subjects were categorized as depression group. Subjects with depression showed increased hazard of developing glaucoma (adjusted HR = 1.12[95% confidence interval (CI), 1.09–1.15]) than those without depression. The risk of glaucoma increased sequentially from those with no depression to those with subjective depressive symptom (adjusted HR = 1.09[95% CI, 1.06–1.13]), those with clinically diagnosed depressive disorder (adjusted HR = 1.23[95% CI, 1.14–1.32]), and those with both subjective depressive symptom and clinically diagnosed depressive disorder (adjusted HR = 1.36[95% CI, 1.22–1.52]). Our analyses suggest that individuals with depression had a greater risk of developing glaucoma than those without depression. Subjective depressive symptoms and clinically diagnosed depressive disorder independently and synergistically increased the risk of glaucoma incidence.
... Addicted persons become depressed when they stop consuming nicotine and alcohol. Antidepressant treatment is recommended for the patients when depression lasts 2-4 weeks of cessation of drug [7]; for alcoholism and drug treatment see [2]. In fact, over the past decades, both researchers and policy makers have taken addiction as a serious concern. ...
... In addition to cognitive deficits, those with a diagnosis of alcohol dependence are two times more likely to be diagnosed with major depression [12]. Greenfield et al. [13] found that those entering inpatient treatment for alcohol dependence who also had a diagnosis of major depression had a shorter time to first drink and relapse in the first year following treatment. ...
Background:
Alcohol dependence is a significant issue contributing to disease burden. Changes in cortisol concentrations during alcohol withdrawal are associated with cognitive deficits and symptoms of depression. Current treatments are only successful for a small proportion of people and do not target cognitive deficits and symptoms of depression experienced by those who are alcohol dependent. The aim of this research is to determine the potential efficacy of mifepristone, a type II glucocorticoid receptor antagonist, to prevent symptoms of depression and cognitive deficits following alcohol detoxification.
Methods:
This was a phase 2 therapeutic use trial. It was a double-blind randomised controlled clinical trial of mifepristone versus inactive placebo treatment. The trial aimed to recruit 120 participants who met the inclusion criteria: (1) male, (2) aged 18-60 years inclusive, and (3) alcohol dependent for 5 or more years. Participants were randomised to 600 mg a day mifepristone (200 mg morning, afternoon, and evening) for 7 days and 400 mg for the subsequent 7 days (200 mg morning and evening) or the equivalent number of placebo tablets for 14 days. Primary outcome measures were cognitive function (measured using the Cambridge Neuropsychological Test Automated Battery (CANTAB)) and symptoms of depression (measured using the Beck Depression Inventory (BDI)) at 4 weeks post-randomisation.
Results:
Difficulties recruiting participants due to significant changes in the provision of inpatient care for alcohol dependence resulted in only 27 participants recruited to the trial, with data available for 21 participants. Fourteen participants were randomised to receive mifepristone and 13 to receive placebo.
Conclusion:
Larger trials would be needed to draw conclusions about the efficacy of mifepristone.
Trial registration:
ISRCTN registry ISRCTN54001953 . Registered on 29 September 2011.
... [2][3][4][5] Moreover, alcohol dependence prolongs the course of depression and persistence of depressive symptoms in the abstinence period is a risk factor for relapse of alcohol use. [6][7][8][9][10] Thus it adds to considerable morbidity, disability and treatment difficulties, if left undiagnosed and untreated. Alcohol dependence syndrome (ADS) and depression are highly prevalent co-morbid conditions. ...
Background: Few studies have compared the pattern of alcohol use in Alcohol dependence syndrome (ADS) patients with and without co-morbid depression. Assessing the pattern may throw light into prevention of relapses more effectively in alcohol dependent patients with co-morbid depression. This study was undertaken to assess the difference in pattern of drinking of alcohol in patients with alcohol dependence with and without co-morbid depression.Methods: A descriptive comparative study was designed to compare the difference in pattern of alcohol use in alcohol dependent patients with co-morbid depression and without co-morbid depression. Severity of dependence on alcohol was assessed using Alcohol Use Disorders Identification Test (AUDIT). Drinking pattern was assessed using Timeline Follow back Calender and Drinking Pattern Questionnaire. The data were statistically analysed.Results: Total 96 alcohol dependent patients (24 had co-morbid depression and 72 without co-morbid depression) were included in the study. There were no significant differences in alcohol use in both the groups in terms of AUDIT scores, amount of drinking, abstinence days or binge drinking. More frequent drinking was observed in circumstances related to emotional, physiological, financial and children related situations in patients with co-morbid depression (p<0.05).Conclusions: Drinking circumstances like emotional, physiological, financial and children related situations require more attention while assessing, treating and aiming at relapse of prevention in ADS patients with co-morbid depression.
... 11,12 On the other hand, lingering depression increases not only the mood-induced episodes of heavy drinking, but also the risk of relapse during the early abstinence. 13,14 Therefore, the treatment and management of both AUD and depression are important public health issues. ...
Background
We aimed to compare and rank the efficacy of different pharmacotherapeutics for patients comorbid with alcohol use disorders and depressive symptoms.
Method
Bayesian network meta‐analysis was performed for three different outcome parameters: alcohol use disorders (AUD) remission rate, percent abstinent days, and scores of depression scales. The surface under the cumulative ranking curves (SUCRA) was used for ranking the efficacy of interventions. Sensitivity analysis and direct pairwise analysis were conducted to validate the main results.
Results
A total of 68 RCTs consisting of 5890 patients were included. Disulfiram could significantly increase the AUD remission rates (OR 5.02, 1.97‐12.95) and the percent abstinent days (MD 17.08, 3.48‐30.93). Disulfiram was associated with the best efficacy in achieving remission (SUCRA 95.1%) and increasing abstinent days (SUCRA 87.6%). Noradrenaline reuptake inhibitor was significantly more efficacious than controls (SMD −2.44, −3.53 to −1.36) and have the first rank (SUCRA 99.0%) in reducing the scores of depression scales. Antiepileptics have relatively higher ranks in efficacy for both AUD and depressive symptoms.
Conclusions
Disulfiram was associated with the best efficacy in achieving abstinence for comorbidity patients. Noradrenaline reuptake inhibitor was demonstrated to be associated with the best efficacy in reducing scores of depression scales. Antiepileptics might be beneficial to both alcohol‐related and depressive symptoms.
... Moreover, the significant effects in reducing alcohol use may be due to the similarities between the social connection and peer support contained in the trauma-informed curriculum and those of 12-step drug rehab and alcohol treatment programs (Worley et al., 2012). This finding is particularly significant as improvements in behavioral health and reductions in alcohol use may in turn improve prospects for employment and increased income (Goodman, 2017;Greenfield et al., 1998). ...
Rationale:
Integrating trauma-informed peer support curriculum into the Temporary Assistance for Needy Families (TANF) program can help address caregiver trauma symptoms (e.g., depression, low self-efficacy, economic hardship) caused by exposures to violence and adversity that negatively impact one's ability to maintain employment and improve earnings; yet, it is unclear if trauma-informed peer support interventions designed for TANF impact co-occurring disorders, such as depression and substance use, that inhibit resiliency in the labor market.
Objective:
The aim of this study is to examine whether integrating trauma-informed peer support curriculum into the TANF program is associated with reductions in co-occurring depression and substance use, and improvements in self-efficacy and economic security.
Method:
From October 2015 to May 2018, 369 caregivers were enrolled in the 16-week Building Wealth and Health Network Phase II single-group cohort study. Participants responded to questions regarding their socio-demographic characteristics, mental health, economic security, and use of drugs and alcohol at baseline and four three-month follow-up surveys. Associations between the trauma-informed peer support curriculum and health outcomes were assessed using maximum likelihood estimation.
Results:
Using class attendance records, participants were separated into a low-exposure group (<four classes; n = 156) and a high-exposure group (≥four classes; n = 213). Maximum likelihood analysis revealed that the high-exposure group reported a lower Center for Epidemiologic Studies Depression Scale (CES-D) score (-1.245; p = 0.027) and lower economic Hardship Index score (-0.499; p < 0.001) than the low-exposure group. The analysis also revealed that for the high-exposure group, attending an additional class was associated with declines in CES-D score (-1.024; p = 0.016) and 12-point Alcohol Use Disorders Identification Test score (-0.557; p = 0.012).
Conclusions:
These findings suggest that trauma-informed peer support programming improves economic security and self-efficacy and reduces the co-occurrence of depressive symptoms and alcohol use.
... Poly drug users were suffering more with depression and relapse as compare to single drug abusers. The results for relapse and concurrent depression, in current study are Risk factors associated with relapse of drug dependence after treatment and rehabilitation in areas under the influence of war on terror You're reading als in line with early study which was in War and terrorism free areas, reporting that depression is among one of the factor for returning to drinking showing 95% relapse due to depression [23]. Domino et al. has reported the similar results of 95% relapse in subjects having concurrent psychiatric disorder using major opioids [19]. ...
Background: People exposed to war on terror are more prone to neuropsychiatric disorders and drug addiction. The present study was aimed to investigate the risk factors associated with relapse of drug dependence after treatment and rehabilitation in areas under the influence of war and terrorism.
Methods: Total 57 individuals who had a relapse from the war affected area were included in current study. Retrospective data were collected from Drug Detoxification and Health Welfare Research Center, Bannu, KPK, Pakistan. Along with demographic characteristics, current study also focused on the prevalence of psychological problems due to war, in association with prevalence of relapse.
Results: A total of 93% of Individuals with relapse have concurrent stress. Similarly, depression was also common in 78.9% of relapsed individuals. Relapse was more common in Polydrug abusers (66.7%) as compared to single drug abusers. As far as abstinence duration is concerned, subjects having depression and stress due to war, relapsed in less time as compared to individuals with no psychological disorders.
Conclusion: Wars are related with mental and psychological problems like stress and depression and these factors significantly contribute to the relapse of drug dependence as suggested by results of current study. B Abstract www.als-journal.com/ ISSN 2310-5380/ May 2020, (2020). Risk factors associated with relapse of drug dependence after treatment and rehabilitation in areas under the influence of war on terror. Adv. Life Sci. 7(3): 117-121.
... The relationship between chronic alcohol exposure and alterations in sensitivity to subsequent stressors has been extensively studied. Clinically, alcohol withdrawal can induce a depressed mood and negative affect that can persist into abstinence and increases risk of relapse (Greenfield et al., 1998;Heilig et al., 2010;Heilig and Koob, 2007;Koob, 2003;Koob, 2015;Sinha et al., 2009;Witkiewitz and Villarroel, 2009). In animal models, exposure to chronic alcohol results in increased reactivity in various paradigms that assess stress sensitivity and anxiety-like behavior, including the Vogel test of punished drinking (Sommer et al., 2008), elevated plus maze (Perez and De Biasi, 2015;Valdez et al., 2002;Valdez et al., 2003), social interaction (SI) following restraint stress (Breese et al., 2005), open field test (Perez and De Biasi, 2015), marble burying (Perez and De Biasi, 2015), and fear extinction (Holmes et al., 2012). ...
Background
Comorbidity between alcoholism and depression is extremely common. Recent evidence supports a relationship between alcohol exposure and stress sensitivity, an underlying factor in the development of depression. Our laboratory has recently shown that chronic alcohol gavage increases sensitivity to social defeat stress (SDS). However, the effects of voluntary alcohol consumption, resulting from protocols such as intermittent ethanol access (IEA), on defeat stress sensitivity have yet to be elucidated.
Methods
We first assessed the effects of 4 weeks of IEA to 20% alcohol on sensitivity to subthreshold SDS exposure. Next, to examine neuroinflammatory mechanisms, we analyzed gene expression of inhibitor of NFkB (IkB) following IEA or chronic alcohol exposure (10 days of 3.0 g/kg alcohol via intragastric gavage). Then, we quantified NFkB activation via β‐galactosidase immunohistochemistry following IEA or chronic alcohol gavage in NFkB‐LacZ mice.
Results
IEA‐exposed mice displayed an increase in sensitivity to subthreshold SDS compared to water‐drinking controls. We also found that IkB gene expression was decreased in the nucleus accumbens (NAC) and amygdala (AMY) following IEA but was not altered following chronic alcohol gavage. Finally, we observed increased NFkB activity in the central amygdala (CEA), basolateral amygdala (BLA), and medial amygdala (MEA) after IEA, and increased NFkB activity solely in the CEA following chronic alcohol gavage.
Conclusions
These findings further corroborate that prior alcohol exposure, in this case intermittent voluntary consumption, can impact development of depressive‐like behavior by altering stress sensitivity. Furthermore, our results suggest the CEA as a potential mediator of alcohol's effects on stress sensitivity, as NFkB was activated in this region following both IEA and chronic alcohol gavage. Thus, this study provides novel insight on alterations in the NFkB pathway and identifies specific regions to target in future experiments assessing the functional role of NFkB in these processes.
... 6 and adults. 7 AUD with comorbid depression is also associated with greater severity of suicidality in adult psychiatric patients; 8 and higher likelihood of suicide attempts 9,10 and completed suicides. 11 Heavy drinking, especially binge drinking, has been found to produce depressive symptoms. ...
... According to the 2015 National Survey on Drug Use and Health, alcohol use disorder (AUD) affects over 15 million people in the US alone, and in 2010 it was estimated that alcohol misuse cost the United States $249 billion. 1 Approximately one third of that population also suffers from anxiety or depression ("internalizing") disorders, and, following treatment, patients who suffer from both AUD and internalizing disorders are twice as likely to relapse following treatment. [2][3][4][5] As in many psychopathology domains, the mechanisms that produce and maintain comorbidity between these disorders are not well understood, so there is a critical need for discoveries that inform the prevention and treatment of AUD. ...
Objective:
The objective of this study was to assess the potential of combining graph learning methods with latent variable estimation methods for mining clinically useful information from observational clinical data sets.
Materials and methods:
The data set contained self-reported measures of psychopathology symptoms from a clinical sample receiving treatment for alcohol use disorder. We used the traditional graph learning methods: Graphical Least Absolute Shrinkage and Selection Operator, and Friedman's hill climbing algorithm; traditional latent variable estimation method factor analysis; recently developed graph learning method Greedy Fast Causal Inference; and recently developed latent variable estimation method Find One Factor Clusters. Methods were assessed qualitatively by the content of their findings.
Results:
Recently developed graphical methods identified potential latent variables (ie, not represented in the model) influencing particular scores. Recently developed latent effect estimation methods identified plausible cross-score loadings that were not found with factor analysis. A graphical analysis of individual items identified a mistake in wording on 1 questionnaire and provided further evidence that certain scores are not reflective of indirectly measured common causes.
Discussion and conclusion:
Our findings suggest that a combination of Greedy Fast Causal Inference and Find One Factor Clusters can enhance the evidence-based information yield from psychopathological constructs and questionnaires. Traditional methods provided some of the same information but missed other important findings. These conclusions point the way toward more informative interrogations of existing and future data sets than are commonly employed at present.
... Individuals with this comorbidity are more disabled and demonstrate less treatment gains than individuals with AUD alone (Burns et al., 2005). Additionally, this dual diagnosis is associated with a greater relapse risk (Greenfield et al., 1998;Driessen et al. 2001). Maintaining early abstinence post treatment is vital as this predicts later abstinence in these comorbid patients (Farren et al., 2014), with abstinence at 6-months predicting abstinence at 2 years (Farren et al., 2013). ...
Aim:
The aim of this randomized controlled trial was to examine the impact of daily supportive text messages over a 6-month treatment period on mood and alcohol consumption in individuals with a dual diagnosis of alcohol use disorder (AUD) and depression following completion of an inpatient treatment programme.
Method:
Ninety-five adult participants with AUD and comorbid depression were recruited into this randomized control trial, which took place after completing a 30-day rehabilitation programme. The intervention group (n = 47) received twice-daily supportive text messages over 6-months while control participants (n = 48) had treatment as usual for a 6-month period, with an added 6-month post-treatment follow-up for both groups. Drinking history in the previous 90 days as well as symptoms of depression, anxiety and stress were measured at baseline, 3- and 6-month treatment points and 6-month post treatment follow up.
Results:
Depression scores (P = 0.02) and perceived stress scores (P < 0.01) were significantly reduced at 3-month treatment point in the intervention group relative to control participants with small to medium effect. The intervention group also showed a significantly greater reduction in units per drinking day from baseline to 6-month treatment point compared to the control group with a medium effect size (P = 0.03). There were no differences in drinking or mood measures at 6-month post treatment follow-up.
Conclusions:
Supportive text messages provide an early initial benefit in decreasing symptoms of depression and stress, with a further positive impact on alcohol consumption following a longer treatment period. Benefits did not persist six months after the intervention ended.
... AUD people with dual diagnosis are reported to be high users of the health care system [22] and to have a more severe course of alcohol dependence [23,24] than AUD people without a dual diagnosis [17,25]. Indeed, the comorbid condition of psychiatric impairments and AUD may predict both relapsing shorter time and increasing treatment drop-out [26][27][28]. Dual diagnosis and alcohol addiction severity are crucial at-risk factors for relapse and drop-out events [29][30][31], but only a few studies concurrently investigated their related conditions. Such studies used self-administered questionnaires as the symptom check list 90-R (SCL-90-R) [32] and the severity of alcohol dependence questionnaire (SADQ) [33] to assess psychiatric condition and alcohol addiction magnitude. ...
Aim:
In this study, we investigated in people suffering from alcohol use disorder (AUD) with or without dual diagnosis (concomitant psychiatric disability) how they feel their dependence condition. We predicted that AUD people with a dual diagnosis could feel potentiated their addiction.
Methods:
Alcohol habits and psychiatric conditions of 183 AUD men and 62 AUD women were measured by using the DSM-5, the severity of alcohol dependence questionnaire (SADQ), the alcohol anamnesis and psychiatric examination by the symptom check list 90-R (SCL-90-R).
Results:
We have shown that alcohol drinking does not correlate with both psychiatric examination and self-reported psychopathology. SADQ shows that severe alcohol dependence correlates with highest psychiatric symptoms and with the levels of alcohol consumption.
Conclusions:
This finding suggests that high SADQ scores may represent a tool to early disclose only patients with dual diagnosis. SADQ may provide information to address pharmacological interventions because revealing aspects of the dark side of addiction potentiated by AUD associated psychopathology.
... A wide series of studies has revealed that patients suffering from co-occurring mental disorders and substance abuse disorders are likely to show poorer treatment results than those patients, who are not presenting psychopathological symptoms, including decreased pace in moderating drug abuse, increased vulnerability to drug relapse and need of more health care services (Alterman, McLellan, & Shifman, 1993;Bobo, McIlvain, & Leed-Kelly, 1998;Driessen, Meier, Hill, et al., 2001;Greenfield, Weiss, Muenz, et al., 1998;Hasin, Tsai, Endicott, et al., 1996;Loosen, Dew, & Prange, 1990;Moos, Mertens, & Brennan, 1994;Rounsaville, Kosten, Weissman, & Kleber, 1986;Willinger, Lenzinger, Hornik, et al., 2002). However, there are some findings indicating that depression and stress can be associated with a better treatment outcome (Araujo, Goldberg, Eyma, et al., 1996;Charney, Paraherakis, & Gill, 2000;Finney & Moos, 1995). ...
... The functional link between AUD and depression is supported by preclinical studies demonstrating increased depression-like behavior in rodents during alcohol withdrawal (Ant on et al., 2017;Getachew, Hauser, Csoka, Taylor, & Tizabi, 2017;Kang, Li, Bekker, & Ye, 2018;Li et al., 2017;Pang, Renoir, Du, Lawrence, & Hannan, 2013;Roni & Rahman, 2017;Walker et al., 2010;Yawalkar, Changotra, & Gupta, 2018). Depression during abstinence from alcohol also contributes to relapse to alcohol drinking, thus perpetuating the cycle of addiction (Greenfield et al., 1998;Oliva et al., 2018). Depression and alcohol abuse negatively affect overall health, productivity, and quality of life. ...
Withdrawal from chronic alcohol drinking can cause depression, leading to an inability to function in daily life and an increased risk for relapse to harmful drinking. Understanding the causes of alcohol withdrawal-related depression may lead to new therapeutic targets for treatment. Epigenetic factors have recently emerged as important contributors to both depression and alcohol use disorder (AUD). Specifically, acetylation of the N-terminal tails of histone proteins that package DNA into nucleosomes is altered in stress-induced models of depression and during alcohol withdrawal. The goal of this study was to examine depression-like behavior during alcohol withdrawal and associated changes in histone acetylation and expression of histone deacetylase 2 (HDAC2) in the hippocampus, a brain region critical for mood regulation and depression. Male Sprague-Dawley rats were treated with the Lieber-DeCarli ethanol liquid diet for 15 days and then underwent withdrawal. Rats were treated with the HDAC inhibitor, suberoylanilide hydroxamic acid (SAHA), during withdrawal and were tested for depression-like behavior. In a separate group of rats, the hippocampus was analyzed for mRNA and protein expression of HDAC2 and levels of histone H3 lysine 9 acetylation (H3K9ac) during chronic ethanol exposure and withdrawal. Rats undergoing ethanol withdrawal exhibited depression-like behavior and had increased HDAC2 and decreased H3K9ac levels in specific structures of the hippocampus. Treatment with SAHA during withdrawal ameliorated depression-like behavior and normalized changes in hippocampal HDAC2 and H3K9ac levels. These results demonstrate that ethanol withdrawal causes an altered epigenetic state in the hippocampus. Treatment with an HDAC inhibitor can correct this state and alleviate depression-like symptoms developed during withdrawal. Targeting histone acetylation may be a novel strategy to reduce ethanol withdrawal-induced depression.
... According to the 2015 National Survey on Drug Use and Health, alcohol use disorder (AUD) affects over 15 million people in the US alone, and in 2010 it was estimated that alcohol misuse cost the United States $249.0 billion 1 . Approximately one third of that population also suffers from anxiety or depression ("internalizing") disorders, and following treatment, patients who suffer from both AUD and internalizing disorders are twice as likely to relapse [2][3][4][5] . As in many psychopathology domains, the mechanisms that produce and maintain these disorders are not well understood, so there is a critical need for discoveries that inform the prevention and treatment of AUD. ...
Research in the domain of psychopathology has been hindered by hidden variables-variables that are important to understanding and treating psychopathological illnesses but are unmeasured. Recent methodological advances in machine learning have culminated in the ability to discover and identify the influence of hidden variables that confound the observed relationships among measured variables. We apply a combination of traditional methods and more recent advances to a data set of alcohol use disorder patients with comorbid internalizing disorders, and find that the increasingly advanced methods produce increasingly informative and reliable results. These results include novel findings evaluated positively by our psychopathologists, as well as findings validated with knowledge from existing literature. We also find that advanced graph discovery methods can guide the use of latent variable modeling procedures, which can in turn explain the output of the graph discovery methods, resulting in a synergistic relationship between two seemingly distinct classes of methods.
... Obesity is less common in the Chinese general population, 27 with only 14% of patients classified as obese in the current study; this restricted range of BMI may have affected our results. Some studies also have reported that depression is associated with greater alcohol use 28 and cigarette smoking. 29 One possible explanation for why we did not observe this relationship is that only 10% of ACS patients (primarily males) actually reported unhealthy drinking, and only 28% (6% female) were current smokers. ...
Purpose:
This study sought to examine associations between depression and unhealthy lifestyle behaviors in Chinese patients with acute coronary syndromes (ACS).
Methods:
This cross-sectional study included 4043 ACS patients from 16 hospitals across China who participated in the I-Care (Integrating Depression Care in Acute Coronary Syndromes Patients) trial. Patients were enrolled between November 2014 and January 2017. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9). Five lifestyle behaviors were assessed: smoking, drinking, body mass index (BMI), physical activity, and sleep quality.
Results:
A total of 135 patients (3.3%) were considered clinically depressed (PHQ-9 ≥10). After adjusting for covariates, physical activity and sleep quality were inversely related to PHQ-9 scores. Adjusted logistic models showed that depressed patients were 1.7 times likely to be physically inactive (OR = 1.74; 95% CI, 1.15-2.64) and 4.6 times likely to have poor sleep quality (OR = 4.60; 95% CI, 3.07-6.88) compared with nondepressed patients. The association of depression with smoking, unhealthy drinking, and unhealthy BMI was not significant after adjustment for demographic characteristics. Higher depression scores were found to be associated with a greater number of unhealthy lifestyle behaviors (P for trend < .001).
Conclusions:
The association of depression and unhealthy lifestyles in post-ACS patients suggests that reducing depressive symptoms and improving healthy lifestyle behaviors could potentially improve clinical outcomes in this vulnerable patient population.
... Anxiety and depressive disorders have been shown to be more prevalent in AUD patients in both epidemiological surveys [2][3][4][5][6][7][8][9] and clinical trials [10][11][12]. Indeed, anxiety and depressive disorders are associated with a greater risk of relapse following alcohol detoxification (OR 4.4, 95% CI 1.8-10.1 for anxiety disorders and OR 2.1, 95% CI 1.3-3.4 for depressive disorders of relapse at 1 year) [13,14]. ...
Background/aims:
The aim of this prospective study was to estimate gender differences in anxiety, depression, and alcohol use severity among patients with alcohol use disorder (AUD) before and after detoxification program and within 12 months after discharge.
Methods:
AUD severity, state and trait anxiety, and depression were assessed in 187 patients entering an inpatient alcohol detoxification program. Follow-up assessments were performed at 6 and 12 months after discharge. A between- and within-subjects analyses explored gender differences. The predictive value of anxiety and depression for alcohol relapse was analyzed by logistic and linear regression in both genders.
Results:
Females had higher levels of anxiety and depression than males both at admission and after discharge. Trait anxiety and depression significantly increased 6 months after discharge in males and females respectively. Both state and trait anxiety levels at the 6-month follow-up predicted alcohol relapse at the 12-month follow-up in males. Conversely, in females, depression level at the 6-month follow-up was a predictor of relapse at the 12-month follow-up.
Conclusions:
In both genders, the psychopathological dimension that showed the most significant worsening at 6-month follow-up (i.e., anxiety in males and depression in females) was found to be a significant predictor of relapse at the 12-month follow-up.
... Some researchers have reported that a high degree of comorbidity negatively affects clinical progress (Grant and Harford, 1995;Gilman and Abraham, 2001). For example, AUD prolongs the course of depression (Mueller et al., 1994), as persistent depressive symptoms during abstinence act as a risk factor in relapse drinking (Greenfield et al., 1998;Hasin et al., 2002), and AUD increases the risk of suicide (Berglund, 1984;Cornelius et al., 1995;Grant and Hasin, 1999) and aggravates other drug dependence such as nicotine (Rounsaville et al., 1987;Kranzler et al., 1996). ...
Aims:
The purpose of the current study was to examine the longitudinal reciprocal relationship between depression and drinking among male adults from the general population.
Methods:
This study used a panel dataset from the Korean Welfare Panel (from 2011 to 2014). The subjects were 2511 male adults aged between 20 and 65 years. Based on the Korean Version of the Alcohol Use Disorders Identification Test (AUDIT-K) scores, 2191 subjects were categorized as the control group (AUDIT-K < 12) and 320 subjects were categorized as the problem drinking group (AUDIT-K ≥ 12). An autoregressive cross-lagged modelling analysis was performed to investigate the mutual relationship between problem drinking and depression measured consecutively over time.
Results:
The results indicated that alcohol drinking and depression were stable over time. In the control group, there was no significant causal relationship between problem drinking and depression while in the problem drinking group, drinking in the previous year significantly influenced depression in the following second, third and fourth years.
Conclusion:
This study compared normal versus problem drinkers and showed a 4-year mutual causal relationship between depression and drinking. No longitudinal interaction between drinking and depression occurred in normal drinkers, while drinking intensified depression over time in problem drinkers.
Short summary:
This study found that problem drinking was a risk factor for development of depression. Therefore, more attention should be given to problem alcohol use in the general population and evaluation of past alcohol use history in patients with depressive disorders.
... Alcohol dependence (AD), a more severe form of alcohol use disorder, is a complex psychiatric disorder characterized by compulsive alcohol seeking and intake combined with a negative emotional state during withdrawal (Koob and Volkow, 2010). The interaction between alcohol dependence and negative emotional state is complicated; the depressed mood of withdrawal increases the risk of relapse to resume drinking and the likelihood of a major depressive episode (MDE) (Brown and Schuckit, 1988;Greenfield et al., 1998). Treatments specifically designed for the depressed mood of alcohol withdrawal are lacking, so it is important to identify potential therapeutic targets consequent to alcohol exposure that are also implicated in mood disorders and negative emotional states. ...
... While being female does not predict substance abuse treatment outcome ( Greenfield et al., 2007); victims of violence report poorer substance abuse treatment outcomes ( Greenfield et al., 2002;Kang et al., 2002), potentially due to the impact of violence not being adequately identified and addressed. In addition, comorbid psychiatric disorders may have a negative impact on substance abuse treatment outcome ( Greenfield et al., 1998;Hasin et al., 1996). Better substance abuse treatment outcomes for female drug users have been reported in women-focused programmes that address women's psychosocial needs including intimate partner violence and childhood abuse ( Grella, 1999;Hien et al., 2004). ...
Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determined the prevalence of psychiatric comorbidity and intimate partrner violence (IPV), and factors associated with psychiatric comorbidity among WWID recruited from drug treatment services (67%) and harm reduction services in five European regions in Austria, Catalonia, Italy, Poland, and Scotland. Psychiatric comorbidity was assessed among 226 WWID using the Dual Diagnosis Screening Instrument. IPV was assessed using the Composite Abuse Scale and injecting and sexual risk behaviors were assessed using a battery of questionnaires adapted and developed for the study. Eighty-seven percent met criteria for at least one lifetime psychiatric disorder. The most common disorders were depression (76%), panic (54%), and post-traumatic stress (52%). WWID recruited in drug treatment services were almost three times as likely (OR 2.90 95% CI 1.30–6.43; p = 0.007) to meet criteria for a lifetime psychiatric disorder than those recruited from harm reduction services, specifically dysthymia (OR 5.32 95% CI 2.27–12.48; p = 0.000) and post-traumatic stress disorder (OR 1.83 95% CI 1.02–3.27; p = 0.040). WWID who reported sharing needles and syringes were almost three times as likely to meet criteria for lifetime psychiatric comorbidity than those who did not (OR 2.65 95% CI 1.07–6.56). Compared to WWID who had not experienced IPV, victims (70%) were almost two times more likely to meet criteria for post-traumatic stress disorder (OR 1.95 95% CI 1.10–3.48). Psychiatric comorbidity and IPV among WWID are common. Drug treatment and harm reduction services should address psychiatric comorbidity and IPV to improve treatment outcomes.
... However, if we take into account the documented association of depression with alcohol craving, interruption of therapy and return to drinking (i.e. Gamble et al., 2010;Greenfield et al., 1998;Witkiewitz et al., 2011), the resulting relationships gain new meaning -the intensity of the maladaptive schemas can be both a predictor and, by association with depression, mediator or moderator of these unfavourable phenomena. It opens a field for further research. ...
Purpose: The purpose of the study was to determine whether a link exists between early maladaptive schemas identified by
Young et al. and depression in alcoholics. The relationships of schemas with selected alcohol dependence variables
and suicidal thoughts in alcoholics were also checked. Material and methods: Seventy-seven alcohol addicts participated
in the study – 19 women and 58 men. Young Schema Questionnaire (YSQ-S3), Beck’s Depression Inventory (BDI)
and Michigan Alcoholism Screening Test (MAST) were used. Results: Based on the results obtained, 16 out of 18 schemas
are positively and statistically correlated with depression among alcoholics. The strongest relationships were noted for
emotional deprivation, social isolation/alienation and subjugation. Correlations between the schemas and the severity
of addiction and the age of drinking initiation were also found. Differences in the intensity of some schemas occurred
between people experiencing suicidal thoughts and people without these thoughts. Conclusions: There is a need to consider
inclusion therapy focused on changing maladaptive schemas in alcoholics. This is especially true of the schemas of social
isolation, emotional deprivation and subjugation. There is also a need for further research in this area.
... Literature has identified numerous patient characteristics that are associated with relapse in AUD. 3 More frequent and heavier alcohol consumption, use of secondary illicit drug, more substance-related psychological/social consequences and a concurrent psychiatric disorder are associated with relapse and with a poorer outcome. 3,[7][8][9][10][11][12][13][14][15] Although evidence suggests that relapse rates among men and women with an alcohol dependence diagnosis are relatively equivalent, 16 we have to consider that these previous predictors could be partially explained by gender differences because clinical samples are essentially male in alcohol-related studies. [17][18][19] Craving is also considered a crucial vulnerability factor of relapse. ...
Background:
Personality traits have been proposed as relapse risk factors in alcohol use disorders. So far, no study has assessed the association between affective temperamental traits and the prospective relapse risk.
Methods:
This was a 3-month prospective naturalistic study, designed to assess the impact of affective temperaments in relapse. A sample of 61 alcohol-dependent patients was collected from an ambulatory clinical setting. Socio-demographic information, drinking and substance use habits, drinking status, craving and affective temperament traits were assessed.
Results:
Age, age of onset of alcohol abuse and dependence and drug consumption correlate with drinking status. Male alcohol-dependent patients who relapsed presented higher scores on cyclothymic temperament than patients with an alcohol dependence diagnosis who remain sober. Hierarchical logistic regression indicates that cyclothymic temperament predicted relapse in a 3-month follow-up. However, the coefficient was marginally significant after controlling for all potential confounding predictors.
Conclusions:
Our results provide new insights about the role of affective temperaments in alcohol use disorders, specifically in predicting short-term relapse in detoxified male alcohol-dependent patients. Copyright © 2017 John Wiley & Sons, Ltd.
... Both clinical and epidemiological studies have indicated that alcohol use disorders (AUDs) and mood disorders co-occur at a higher rate than would be expected by chance. 1 For example, studies from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a US-based nationally representative dataset, have found more than a twofold increase in the risk of a mood disorder for those with an AUD (2.2 and 2.4 OR for 12 months and lifetime association, respectively). 2 3 Individuals with such comorbidity present a greater challenge to treatment since they tend to have more severe symptoms, 2 greater disability and poorer quality of life 4 than individuals with just an AUD and may pose a greater economic burden to society due to their higher utilisation of treatment services. 4 Among those with an AUD, comorbid depression is associated with an earlier onset of alcohol dependence, higher rates of lifetime drug dependence, 5 worse outcomes among those entering treatment for alcohol and drug problems, 6 higher relapse following AUD treatment among adolescents 7 and adults, 8 greater severity of suicidality in adult psychiatric patients 9 and higher likelihood of suicide attempts 10 and completed suicides. 11 Patients with a Supportive text messages for patients with alcohol use disorder and a comorbid depression: a protocol for a single-blind randomised controlled aftercare trial Open Access mood disorder who also have an AUD are more likely to consume a large amount of alcohol before attempting suicide, increasing the likelihood that a suicide attempt will be lethal. ...
Introduction
Alcohol use disorders (AUDs) and mood disorders commonly co-occur, and are associated with a range of negative outcomes for patients. Mobile phone technology has the potential to provide personalised support for such patients and potentially improve outcomes in this difficult-to-treat cohort. The aim of this study is to examine whether receiving supporting SMS text messages, following discharge from an inpatient dual diagnosis treatment programme, has a positive impact on mood and alcohol abstinence in patients with an AUD and a comorbid mood disorder.
Methods and analysis
The present study is a single-blind randomised controlled trial. Patients aged 18–70 years who meet the criteria for both alcohol dependency syndrome/alcohol abuse and either major depressive disorder or bipolar disorder according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV Axis I will be randomised to receive twice-daily supportive SMS text messages for 6 months plus treatment as usual, or treatment as usual alone, and will be followed-up at 3, 6, 9 and 12 months postdischarge. Primary outcome measures will include changes from baseline in cumulative abstinence duration, which will be expressed as the proportion of days abstinent from alcohol in the preceding 90 days, and changes from baseline in Beck Depression Inventory scores.
Ethics and dissemination
The trial has received full ethical approval from the St. Patrick’s Hospital Research Ethics Committee (protocol 13/14). Results of the trial will be disseminated through peer-reviewed journal articles and at academic conferences.
Trial registration number
NCT02404662; Pre-results.
... Rates of suicide attempt are also significantly higher than in the general population (Newman & Thompson, 2003). In the substance abuse research literature, the presence of psychiatric disorders generally is a poor prognostic indicator (e.g., Greenfield et al., 1998). Similarly, among DGs, several recent studies have explored psychiatric factors as potential predictors of poor treatment outcome. ...
Studies that examine putative pre-treatment predictors of treatment outcomes are important because they can ultimately inform both the treatment type and magnitude needed for success. This chapter highlights research that has explored these factors. Specifically, it discusses the evidence for individual (e.g., motivation, personality, psychopathology), environmental (e.g., family pressure, proximity of gambling venues) and treatment-related (e.g., therapeutic alliance, intensity) variables that have demonstrated relationships with disordered gambling (DG) treatment outcomes. The authors use the term treatment outcomes broadly to include several different variables, such as treatment attendance, dropout, gambling reduction, abstinence, relapse, improved quality of life and changes in co-occurring conditions. In addition to highlighting the current literature on predictors of DG treatment outcomes, the chapter also points out factors that have not yet been studied, but which may be appropriate targets of future research.
... The self-medication model, that addiction might be driven to some degree by an attempt to seek relief from underlying psychiatric symptoms, arose from clinical observations (Khantzian, 1985). Despite the fact that various antidepressants and mood stabilizing medications have been tested as treatments for addictions and that mood disorders are prevalent and of prognostic significance among substance-dependent patients (Brooner, King, Kidorf, Schmidt, & Bigelow, 1997;Greenfield et al., 1998;Hasin & Nunes, 1998;Rounsaville, Kosten, Weissman, & Kleber, 1986;Weiss, Mirin, Michael, & Sollogub, 1986), the hypothesis that antidepressants might be specifically effective in mood disordered subgroups of addicted patients has been tested less often (Nunes & Quitkin, 1997). Thus, among several clinical trials to test the efficacy of carbamazepine for cocaine dependence, the study of Brady et al. (2002) is the first to divide the sample into subgroups with and without a history of affective disorder. ...
This special issue represents an effort by the journal Experimental and Clinical Psychopharmacology to emphasize its interdisciplinary mission by encouraging the writing of articles on clinical research and the interchange between basic and clinical research on mental illness and the addictions. This special issue opens with a commentary from A. I. Leshner (2002), retired director of the National Institute on Drug Abuse, which emphasizes the importance of translating research findings into clinical practice. Four review articles and 12 original research reports provide a broad sampling of contemporary clinical research, including behavioral therapy, pharmacotherapy, psychiatric comorbidity, and special populations, and also illustrate linkages between clinical research and basic fields of inquiry, including behavioral theory, neuropsychology, neuropharmacology, and statistics.
... Currently, there are conflicting results for demographic characteristics, such as race and gender, as predictors of treatment outcomes for parents with substance use issues. Some studies identified gender as a positive predictor of treatment completion (Choi & Ryan, 2006; Hser et al, 2003), while others determined no difference between genders (Green, Polen, Lynch, Dickinson, & Bennett, 2004; Greenfield et al., 1998). Similarly, race has been shown to be a predictor of treatment retention and completion in several studies (Choi & Ryan, 2006; Mateyoke-Scrivner, Webster, Staton, & Leukefeld, 2004) but others show there is no difference between races (Roberts & Nishimoto, 1996). ...
... There is a critical need to understand the mechanisms underlying relapse to drug seeking. It has already been shown that several factors play a role in relapse susceptibility, including for instance the dysregulation of the hypothalamic-pituitary-adrenal axis and an overactivity of the CRF system (Fox, Hong, Siedlarz, & Sinha, 2008;McKee et al., 2011), a high cortisol/ACTH ratios , a lower amygdala volume (Wrase et al., 2008), or depressive symptoms (Dodge, Sindelar, & Sinha, 2005;Greenfield et al., 1998). Others studies have also suggested that higher serum brain-derived neurotrophic factor (BDNF) levels are highly predictive of addiction relapse, at least in cocaine abusers (D'Sa, Fox, Hong, Dileone, & Sinha, 2011). ...
Among the adaptations observed following drugs of abuse consumption, BDNF levels are widely altered in both brain and periphery. In this chapter, we first reviewed these adaptations in preclinical studies, in both juveniles and adult animals. A particular focus was made on protracted withdrawal as incubation is often associated with an increase in central BDNF levels. Then, we reported mixed results regarding the role of BDNF in drug-seeking behavior in animals as BDNF can either enhance reinstatement or have protective properties. Finally, we reviewed recent clinical studies that provide insight into the potential of BDNF to be a good biomarker of vulnerability to relapse.
Background
Unhealthy alcohol use negatively impacts many components of health and wellness, including mental health conditions like major depressive disorder (MDD). Globally, gender differences are common for both alcohol use behaviors and MDD, but these differences have not been studied within Moshi, Tanzania. To provide more effective and culturally appropriate mental health treatments, gender nuances around these conditions must be known. As such, this study aims to explore gender differences in MDD, alcohol use, and other aspects of mental well-being among patients at Kilimanjaro Christian Medical Center (KCMC) in Moshi.
Methods
Six hundred and seventy-six patients presenting for care at the KCMC Emergency Department (ED) and Reproductive Health Centre (RHC) were enrolled in this mixed-methods study between October 2021 and May 2022. Patients were selected through systematic random sampling and completed quantitative surveys including the Alcohol Use Disorder Identification Test (AUDIT) and the Patient Health Questionnaire 9 (PHQ-9). Nineteen patients were purposively chosen from the study population to participate in in-depth interviews (IDIs) exploring topics related to alcohol use, gender, and depression. Descriptive frequencies, univariate log-binomial regressions, and a linear regression model were used to analyze quantitative data, all of which were analyzed in RStudio. A grounded theory approach was used to analyze all IDIs in NVivo.
Results
Average [SD] PHQ-9 scores were 7.22 [5.07] for ED women, 4.91 [4.11] for RHC women, and 3.75 [4.38] among ED men. Similarly, ED women held the highest prevalence of MDD (25%) as compared to RHC women (11%) and ED men (7.9%) (p<0.001). Depressive symptoms were associated with higher AUDIT scores only for ED men (R2 = 0.11, p<0.001). Our qualitative analysis showed that while present for women, social support networks were notably absent for men in Moshi, the lack of which was seen to play a role in alcohol use. For men, alcohol was described as a coping mechanism for stress.
Conclusion
Intersectionality of gender, alcohol use, and depression is influenced by sociocultural and behavioral norms in Moshi. As such, multi-layered, gender-differentiated programming should be considered for the treatment of substance use and mental health conditions in this region.
Objective:
Early evidence suggests that ketamine may be an effective treatment to sustain abstinence from alcohol. The authors investigated the safety and efficacy of ketamine compared with placebo in increasing abstinence in patients with alcohol use disorder. An additional aim was to pilot ketamine combined with mindfulness-based relapse prevention therapy compared with ketamine and alcohol education as a therapy control.
Methods:
In a double-blind placebo-controlled phase 2 clinical trial, 96 patients with severe alcohol use disorder were randomly assigned to one of four conditions: 1) three weekly ketamine infusions (0.8 mg/kg i.v. over 40 minutes) plus psychological therapy, 2) three saline infusions plus psychological therapy, 3) three ketamine infusions plus alcohol education, or 4) three saline infusions plus alcohol education. The primary outcomes were self-reported percentage of days abstinent and confirmed alcohol relapse at 6-month follow-up.
Results:
Ninety-six participants (35 women; mean age, 44.07 years [SD=10.59]) were included in the intention-to-treat analysis. The treatment was well tolerated, and no serious adverse events were associated with the study drug. Although confidence intervals were wide, consistent with a proof-of-concept study, there were a significantly greater number of days abstinent from alcohol in the ketamine group compared with the placebo group at 6-month follow-up (mean difference=10.1%, 95% CI=1.1, 19.0), with the greatest reduction in the ketamine plus therapy group compared with the saline plus education group (15.9%, 95% CI=3.8, 28.1). There was no significant difference in relapse rate between the ketamine and placebo groups.
Conclusions:
This study demonstrated that treatment with three infusions of ketamine was well tolerated in patients with alcohol use disorder and was associated with more days of abstinence from alcohol at 6-month follow-up. The findings suggest a possible beneficial effect of adding psychological therapy alongside ketamine treatment.
Chronic alcohol abuse and depressive symptoms are both associated with peripheral cytokine changes. Despite this, cytokine adaptations have not been assessed in co-morbid populations or prospectively as predictors of relapse. We examine cytokine responses to stress in alcohol-dependent individuals and social drinkers, both with and without subclinical depression. We also examine the potential link between cytokine adaptations in response to stress and prospective alcohol relapse risk. Thirty-three, alcohol-dependent individuals (21 with and 12 without high depressive symptoms) and 37 controls (16 with and 21 without high depressive symptoms) were exposed to two 5-minute personalized guided imagery conditions (stress and neutral) across consecutive days in a randomized and counterbalanced order. Alcohol craving and serum measures of tumor necrosis factor alpha (TNFα), tumor necrosis factor receptor 1 (TNFR1), interleukin-6 (IL-6), and interleukin-1 receptor antagonist (IL-1ra) were collected prior to and following imagery exposure. Following treatment discharge, follow-up interviews were conducted over 90 days to assess relapse. Dampened IL-1ra and IL-6 in response to stress was observed as a function of alcohol dependence and not moderated by depressive symptoms. Lower levels of IL-6 following stress also predicted greater drinking days following treatment. Conversely, high depressive symptomatology was associated solely with pro-inflammatory adaptations. Stress-related suppression of TNFα predicted drinking severity only in alcohol-dependent individuals with subclinical depression, and suppressed TNFR1 following stress was only seen in individuals with subclinical depression. Stress-induced suppression of pro-inflammatory TNF markers may indicate a risk factor for alcohol-dependent individuals with co-occurring depressive symptoms.
Harmful use of alcohol is a key risk factor for noncommunicable diseases and mental health conditions. An evidence review was carried out to better understand the links between harmful alcohol use or dependence and mental health conditions (anxiety, depression, self-harm and suicidal behaviour) and opportunities for more integrated care.
Background: Suicide victims have been found to frequently suffer from mental disorders, often more than one, and comorbidity has also been found to be a risk factor for suicide. The aim of the present study was to determine the first disorder and possible subsequent disorders in suicide victims during their lifetimes and to compare their development with the development of mental and alcohol use disorders (AUDs) in a community sample.
Methods: The Lundby Study is a prospective longitudinal study of mental health in a general population comprising 3,563 subjects, including 68 suicide victims, followed by four field investigations from 1947 to 1997; mortality was monitored up to 2011.
Results: AUD was most common as a first diagnosis (26/68, 38.2%) among suicide victims, followed by “depression” (20/68, 29.4%) and “anxiety” (7/68, 10.3%). A predominance of AUD as a first diagnosis was found in the male group, whereas “depression” was the most common first diagnosis in the female group. However, there were very few females with AUD in the Lundby Study. In the whole population, it was more common for someone who started with an AUD to develop a subsequent mental disorder than the other way around. The same was true for AUD in relation to depression.
Conclusions: AUD was the most common first mental disorder among male suicide victims and could thus be considered a starting point in the suicidal process. We propose that in addition to detecting and treating depression, it is important to detect and treat AUD vigorously and to be alert for subsequent symptoms of depressive and other mental disorders in suicide prevention efforts.
L’objectif principal de cette étude descriptive, longitudinale et rétrospective est de mesurer l’influence possible de la dépression et de l’anxiété sur le risque de décrochage de suivi chez des patients débutant un programme de sevrage d’alcool en ambulatoire. L’objectif secondaire est d’identifier les facteurs de risque sociodémographiques d’interruption de suivi. Enfin, cette étude vise à évaluer la faisabilité du modèle méthodologique proposé, puisqu’il s’agit d’une étude pilote.L’échantillon comporte 78 patients admis consécutivement en consultation pour la première fois à partir du 1er janvier 2012 à la Maison de Addictions de Nancy pour un sevrage d’alcool. Les données sociodémographiques sont recueillies ainsi que les scores HADS (Hospital Anxiety and Depression Scale) pour l’anxiété et la dépression. L’analyse statistique comporte une analyse descriptive au moment de l’inclusion, la réalisation de courbes de survie selon Kaplan-Meier ainsi que leur comparaison en bivarié et enfin, l’élaboration d’un modèle multivarié à partir de variables considérées comme pertinentes. Les résultats témoignent d’un abandon massif durant les premiers mois du suivi. L’âge constitue un facteur protecteur par rapport au décrochage alors que le statut de parent isolé est un facteur de vulnérabilité. Le statut anxieux et/ou dépressif n’a pas un impact significatif sur l’adhésion au suivi dans l’analyse en bivarié. Dans le modèle multivarié, les sujets à la fois anxieux et dépressif ont deux fois plus de risque d’interrompre le suivi que les autres patients. Les patients engagés dans un programme de sevrage d’alcool sont particulièrement vulnérables au risque de décrochage. Une attention particulière doit accompagner le traitement des patients jeunes et des parents célibataires. Des travaux ultérieurs permettront de mettre en évidence l’influence des co-occurrences que sont l’anxiété et la dépression
Internalizing disorders co-occur with alcohol use disorder (AUD) at a rate that exceeds chance and compromise conventional AUD treatment. The "vicious cycle" model of comorbidity specifies drinking to cope (DTC) as a link between these disorders that, when not directly addressed, undermines the effectiveness of conventional treatments. Interventions based on this model have proven successful but there is no direct evidence for how and to what extent DTC contributes to the maintenance of comorbidity. In the present study, we used network analysis to depict associations between syndrome-specific groupings of internalizing symptoms, alcohol craving, and drinking behavior, as well as DTC and other extradiagnostic variables specified in the vicious cycle model (e.g., perceived stress and coping self-efficacy). Network analyses of 362 individuals with comorbid anxiety and AUD assessed at the beginning of residential AUD treatment indicated that while internalizing conditions and drinking elements had only weak direct associations, they were strongly connected with DTC and perceived stress. Consistent with this, centrality indices showed that DTC ranked as the most central/important element in the network in terms of its "connectedness" to all other network elements. A series of model simulations-in which individual elements were statistically controlled for-demonstrated that DTC accounted for all the relationships between the drinking-related elements and internalizing elements in the network; no other variable had this effect. Taken together, our findings suggest that DTC may serve as a "keystone" process in maintaining comorbidity between internalizing disorders and AUD. (PsycINFO Database Record
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