Alcohol comorbidity

Grant BF, Harford TC Comorbidity between DSM-IV alcohol use disorders and major depression results of a national survey. Drug Alcohol Depend 39 197-206, 1995 Grant BF, Dawson DA, Stinson FS, et al The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence United States, 1991-1992 and 2001-2002. Drug Alcohol Depend 74 223-234, 2004a... 

Lynskey MT The comorbidity of alcohol dependence and affective disorders treatment implications. Drug Alcohol Depend 52 201-209, 1998... 

Tollefson GD, Montague-Clouse J, Tollefson SL Treatment of comorbid generalized anxiety in a recently detoxified alcohol population with a selective serotonergic drug (buspirone). J Clin Psychopharmacol 12 19-26, 1992... 

Cacciola JS, Alterman Al, Rutherford MJ, et al The relationship of psychiatric comorbidity to treatment outcomes in methadone maintained patients. Drug Alcohol Depend 61 271-280, 2001... 

Regier DA, Farmer ME, Rae DS, et al Comorbidity of mental disorders with alcohol and other drug abuse. JAMA 264 2511-2518, 1990 Resnick RB, Schuyten-Resnick E, Washton AM Assessment of narcotic antagonists in the treatment of opioid dependence. Annu Rev Pharmacol Toxicol 20 463-474, 1980... 

In summary, research on the use of antidepressants to treat cannabis dependence, particularly among individuals with comorbid major depressive disorder, although limited, offers a promising avenue for the development of pharmacological aids to assist in the treatment of cannabis withdrawal. There are clear parallels between this literature and the existing research on the use of antidepressants in the treatment of alcohol dependence comorbid with major depressive disorder (see Chapter 1, Medications to Treat Co-occurring Psychiatric Symptoms or Disorders in Alcoholic Patients). 

Anthony JC, Warner LA, Kessler RC Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol 2 244—268, 1994... 

Harper MH, Winter PM, Johnson BH, et al Withdrawal convulsions in mice following nitrous oxide. Anesth Analg 59 19—21, 1980 Hasin D,Nunes E, MeydanJ Comorbidity of alcohol, drug, and psychiatric disorders epidemiology, in Dual Diagnosis and Psychiatric Treatment Substance Abuse and Comorbid Disorders, 2nd Edition. Edited by Kranzler HR, Tinsley JA. New York, Marcel Dekker, 2004, pp 1-34... 

Several studies with alcohol-dependent patients showed that BCT improves outcomes in relationship adjustment and reduces drinking (McCrady et al. 1991 O Farrell et al. 1992). In one study, BCT was found to be more cost-effective than individual or group counseling (O Farrell et al. 1996). However, little is known about the components of BCT that are associated with improved outcomes, and most studies have applied this therapy in groups of patients with little psychiatric comorbidity and with cooperative significant others. 

Out-patient treatment is substantially cheaper than in-patient management and is generally as effective (Lowman, 1991). A French study on patients with generalized anxiety disorder estimated costs per patient over 3 months to he US 423 for hospitalization, 335 for out-patient services and 43 for medications (Souetre et al, 1994). Comorbid conditions (mostly alcoholism and depression) doubled these direct health-care costs. Over three-quarters of all patients were taking anxiolytic medication. 

Finally, a recent meta-analysis of antidepressants to treat alcohol dependence with or without comorbid depression concluded that any beneficial effects were modest at best.44... 

Approximately one-third of patients with MDD do not respond satisfactorily to their first antidepressant medication.37 In such cases, the clinician must evaluate the adequacy of antidepressant therapy, including dosage, duration, and patient compliance.17 Treatment reappraisal also should include verification of the patient s diagnosis and reconsideration of clinical factors that could be impeding successful therapy, such as concurrent medical conditions (e.g., thyroid disorder), comorbid psychiatric conditions (e.g., alcohol abuse), and psychosocial issues (e.g., marital stress).16... 

Patients with bipolar disorder have a high risk of suicide. Factors that increase that risk are early age at disease onset, high number of depressive episodes, comorbid alcohol abuse, personal history of antidepressant-induced mania, and family history of suicidal behavior.15 In those with bipolar disorder, 1 of 5 suicide attempts are lethal, in contrast to 1 of 10 to 1 of 20 in the general population. 

Comorbid conditions can also provide a way to either narrow or extend the phenotype. An analysis of the COGA data showed a very strong signal for the broadened phenotype of alcoholism or major depression this was located in the same region of chromosome 1 in which the alcoholism phenotype gave a signal [55]. The data for the combined phenotype was much stronger than that for the alcoholism-only phenotype. 

Because of comorbidity with diabetes, dyslipidemia, hypertension, and stroke, the presence of increased serum uric acid levels or gout should prompt evaluation for cardiovascular disease and the need for appropriate risk reduction measures. Clinicians should also look for possible correctable causes of hyperuricemia (e.g., medications, obesity, and alcohol abuse). 

PTSD have comorbid alcohol abuse or dependence, and about 20% of patients attempt suicide. 

It is considered a second-line agent for GAD because of inconsistent reports of efficacy, delayed onset of effect, and lack of efficacy for comorbid depressive and anxiety disorders (e.g., panic disorder or SAD). It is the agent of choice in patients who fail other anxiolytic therapies or in patients with a history of alcohol or substance abuse. It is not useful for situations requiring rapid antianxiety effects or as-needed therapy. 

Patients with mixed states often have comorbid alcohol and substance abuse, severe anxiety symptoms, a higher suicide rate, and a poorer prognosis. 

Miller NS, Gold MS (1998) Comorbid cigarette and alcohol addiction epidemiology and treatment, J Addict Dis 17(l) 55-66... 

It is also important to know about comorbid psychiatric disorders. If these are overlooked, treating the substance use disorder becomes significantly more difficult. Recognizing this, most treatment centers have developed dual diagnosis programs to treat those patients who have another major psychiatric illness in addition to a substance use disorder. It may be virtually impossible to discern at first, but the other psychiatric illnesses might either contribute to or be a result of substance use. The social toll of alcoholism alone can trigger a severe clinical depression. However,... 

Historically, the treatment of alcohol use disorders with medication has focused on the management of withdrawal from the alcohol. In recent years, medication has also been used in an attempt to prevent relapse in alcohol-dependent patients. The treatment of alcohol withdrawal, known as detoxification, by definition uses replacement medications that, like alcohol, act on the GABA receptor. These medications (i.e., barbiturates and benzodiazepines) are cross-tolerant with alcohol and therefore are useful for detoxification. By contrast, a wide variety of theoretical approaches have been used to reduce the likelihood of relapse. This includes aversion therapy and anticraving therapies using reward substitutes and interference approaches. Finally, medications to treat comorbid psychiatric illness, in particular, depression, have also been used in attempts to reduce the likelihood of relapse. 

Although these medications have proved quite helpful in reducing alcohol use in depressed patients with comorbid alcoholism, they are not effective in treating nondepressed alcoholics. These antidepressants should only be used in alcohol-dependent patients with comorbid depression or anxiety. 

Antidepressants are only recommended in the rehabilitation and continuing care stages of treatment for alcohol and cocaine dependence if the patient has a comorbid depressive or anxiety disorder. 

Thase ME, Salloum IM, Cornelius JD. Comorbid alcoholism and depression treatment issues. J Clin Psychiatry 2001 62(Supplement 20) 32-41. 

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