The Effect of Psychiatric Comorbidity on Persistence of Alcohol Dependence: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Purpose. The effects of co-occurring psychiatric disorders on the persistence of alcohol problems have been controversial and are not well understood. These relationships have been studied frequently in patient groups, but until recently, longitudinal data from large, representative general population samples in which these associations could be investigated, were not available. We hypothesized that substance dependence (nicotine or illicit drugs), primary mood disorders (major depression, dysthymia, mania, and hypomania) and primary anxiety disorders (specific phobia, social phobia, panic disorder, and generalized anxiety disorder) would increase the risk for the persistence of alcohol dependence.

Method. This analysis is based on longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative adult sample originally interviewed in 2001-2002 and re-interviewed in 2004-2005. DSM-IV diagnoses were made with the AUDADIS interview. At baseline, 1,172 individuals met criteria for past-year alcohol dependence and were the sample for this analysis. Logistic regression models were used to estimate the odds of persistence of alcohol dependence at follow-up among individuals with co-occurring mood, anxiety and substance disorders in the year prior to baseline or in Year 1 or Year 2 of follow-up compared to individuals without comorbidity, adjusting for age, sex, race/ethnicity, education, employment status, marital status, and alcohol treatment.

Results. At follow-up, 36.3% of the sample (N=422) manifested full criteria for DSM-IV alcohol dependence and were thus characterized as having persistent dependence. Psychiatric disorders predicting persistent alcohol dependence were mania (OR 2.11), dysthymia (OR 1.96), major depressive episode (OR 1.46), panic disorder (OR 2.19), generalized anxiety disorder (OR 1.94), nicotine dependence (OR 1.74) and any illicit drug dependence (OR 1.94).

Conclusion. In a representative sample that avoided potential biases of treated samples, mood, anxiety or substance use disorders co-occurring with alcohol dependence were shown to have negative effects on alcohol outcomes even when alcohol treatment and marital status were taken into account. These results highlight the influence of co-occurring disorders in the persistence of alcohol dependence. Thorough assessment and integrated treatment strategies that address problems associated with each disorder are critical for successful treatment outcomes in patients presenting with alcohol disorders and co-occurring psychiatric disorders.