Alcoholism and psychiatric comorbidity
DOI:
https://doi.org/10.20882/adicciones.524Keywords:
alcoholism, dual disorders, relapse, suicide, integrated treatmentAbstract
Alcoholic patients have psychiatric syndromes associated, mostly anxiety and depression. Psychiatric syndromes are usually induced by heavy drinking, and tend to improve in a few weeks, when the patient has been detoxified, and a stable remission of alcoholism has been achieved. However, sometimes alcoholic patients suffer independent psychiatric disorders, that warrant an specific treatment, in addition to the treatment of alcoholism. They are considered dual disorders, with one or more psychiatric disorders, associated to addictive pathology, including abuse or dependency of some other substances (cocaine, opiates, benzodiazepines), in addition to alcohol. Alcoholic patients with other severe psychiatric disorders may be at greater risk of psychosocial problems, relapse, and suicide. Their treatment can be important in order to stop progressive worsening, associated morbidity and increased mortality risks. These patients need an integrated treatment of their dual disorder, in specialized units, with intensive follow-up, and for longer periods of time than usual. Treatment programs should deal with patient’s motivation, in order to enhance their decision to leave substance use, to stabilize their psychiatric disorder (with pharmacotherapy) and to train in relapse prevention coping skills.References
(1) WOODY G: The challenge of dual diagnosis. Alcohol Health & Research World 1996; 20: 76-80.
(2) REGIER DA; FARMER MA; RAE DS; LOCKE BZ; KEITH SJ; JUDD LL; GOODWIN FK: Comorbidity of mental disorder with alcohol mand other drug abuse. Results from the epidemiologic
catchment area (ECA) study. JAMA 1990; 264:2511-2518.
(3) KESSLER RC; McGONAGLE KA; ZHAO S; NELSON CB; HIGES m; ESHLEMAN S; WITTCHENHU; KENDLER KS: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch. Gen. Psychiatry 1994; 51:8-19.
(4) HELZER JE; PRYZBECK TR: The co-occurence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. J. Stud. Alcohol, 1988; 49: 219-224.
(5) KUSHNER MG; SHER KJ; ERICKSON DJ: Prospective analysis of the relation between DSMIII anxiety disorders and alcohol use disorders. Am. J. Psychiatry 1999; 156:723-732.
(6) DRIESSEN M,; VELTRUP C; WETTERLING T; JOHN U; DILLING H: Axis I and Axis II comorbidity in alcohol dependence and the two types of alcoholism. Alcohol. Clin. Exp. Res. 1998;
: 77-86.
(7) MERIKANGAS KR; STEVENS D; FENTON B: Comorbidity of alcoholism and anxiety disorders. Role of family studies. Alcohol Health & Research World 1996; 20: 100-106.
(8) MODESTO-LOWE V; KRANZLER HR: Diagnosis and treatment of alcohol-dependent patients with comorbid psychiatric disorders. Alcohol Health & Research World 1999; 23:144-149.
(9) ASOCIACIÓN AMERICANA DE PSIQUIATRÍA: DSM IV. Manual diagnóstico y estadístico de los trastornos mentales. Barcelona. Masson. 1995.
(10) KENDLER KS; WALTERS EE; NEALE MC; KESSLER RC, HEALTH AC; EAVES LJ: The structure of the genetic and environmental risk factors for six major psychiatric disorders in
women. Phobia, generalized ansiety disorder, panic disorder, bulimia, major depression, and alcoholism. Arch. Gen. Psyciatry 1995; 52:374-383.
(11) SCHUCKIT MA: Alcohol, anxiety, and depressive disorders. Alcohol Health & Research World 1996; 20: 81-86.
(12) BERGLUND M; ÖJEHAGEN A: The influence of alcohol drinking and alcohol use disorders on psychiatric disorders and suicidal behavior. Alcohol. Clin. Exp. Res. 1998; 22: 333S-345S.
(13) ANTON RF: What is craving? Models and implications
for treatment. Alcohol Research & Health 1999; 23: 165-173.
(14) SCHUCKIT MA; IRWIN M; SMITH TL: Oneyear incidence rate of major depression and other psychiatric disorders in 139 alcoholic men. Addiction 1994; 89: 441-445.
(15) MERIKANGAS KR; LECKMAN JF; PURSOFF BA; PAULS DL; WEISSMAN MM: Familial transmission of depression and alcoholism. Arch. Gen. Psychiatry 1985; 42:367-372.
(16) BROWN SA; SCHUCKIT MA: Changes in depression among abstinent male alcoholics. J. Stud. Alcohol. 1988; 52:55-61.
(17) SCHUCKIT MA; TIPP JE; BUCHOLZ KK; NURNBERGERE JI; HESSELBROCK VM; CROWE RR; KRAMER J: The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls. Addiction 1997; 92:1289-1304.
(18) ROY A; DE JONG J; LAMPARSKI D; GEORGE D; LINNOILA M: Mental disorders among alcoholics. Arch. Gen. Psychiatry 1991; 48:428-432.
(19) ROY A; LAMPARSKI D; DE JONG J; et al.: Characteristics
of alcoholics who attempt suicide. American Journal of Psychiatry 1990; 147:781-785.
(20) HASSIN DS; TSAI W-Y; ENDICOTT J; MUELLER TI; CORYELL W; KELLER M: The effects of major depression on alcoholism. Five-year course. Am. J.Addict. 1996; 5: 144-155.
(21) BROWN SA; INABA RK; GILLIN JC; SCHUCKIT MA; STEWART MA; IRWIN MR: Alcoholism and affective disorder: clinical course of depresive symptoms. Am. J. Psychiatry. 1995;
: 45-52.
(22) MONRAS M; MARCOS V; RAMON G: Tentativas de suicidio en pacientes alcohólicos. Adicciones 1992; 4: 45-56.
(23) HIMLE JA; HILL EM: Alcohol abuse and the anxiety disorders: evidence from Epidemiologic Catchment Area survey. J. Anxiety Disorders 1991; 5: 237-245.
(24) ROSS HE; GLASER FB; GERMANSON T: The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Arch. Gen. Psychiatry 1998; 45: 1023-1031.
(25) STOCKWELL T: Alcohol withdrawal: an adaptation to heavy drinking of no practical significance? Addiction 1994; 89: 1447-1453.
(26) HESSELBROCK MN, MEYER R; KEENER JJ: Psychopathology in hospitalized alcoholics. Arch. Gen. Psychiatry 1985; 42: 1050-105.
(27) MILLER WR; BENNETT ME: Treating alcohol problems in the context of other drug abuse. Alcohol Health & Research World 1996;20:118-123.
(28) SLUTSKE WS; EISEN S; TRUE WR; LYONS MJ; GOLDBERG J; TSUANG M: Common genetic vulnerability for pathological gambling and alcohol dependence in men. Arch. Gen. Psychiatry 2000; 57: 666.673.
(29) KESSLER RC; CRUM RM; WARNER LA; NELSON CB; SCHULENBERG J; ANTHONY JC: Lifetime co-occurence of DSM-III-R alcohol abuse and dependence with other psychiatric
disorders in the National Comorbidity Survey. Arch. Gen. Psychiatry 1997; 54:313-321.
(30) LILENFELD LR; KAYE W: The link between alcoholism and eating disorders. Alcohol Health & Research World. 1996; 20:94-99.
(31) HIGUCHI S; SUZUKI K; YAMADA K; PARRISH K; KONO H: Alcoholics with eating disorders: prevalence and clinical course-a study from Japan. British Journal of Psychiatry. 1993;
: 403-406.
(32) DRAKE RE; MUESER KT: Alcohol-use disorder and severe mental illness. Alcohol Health & Research World. 1996; 20:87-93.
(33) CUFFEL BJ: Comorbid substance use disorder. Prevalence, patterns of use, and course. In: Drake RE and Mueser KT eds. Dual diagnosis of major mental illness and substance
disorder: recent research and clinical implications. San Francisco: Jossey-Bass, 1996. Pp. 93-105.
(34) McLELLAN AT; PARIKH G; BRAGG A, CACCIOLA J; FUREMAN B; INCMIKOFI R: Addiction-Severity Index Administration Manual. 5th ed. Philadelphia. Veterans Affairs Center for Studies of Addiction, 1990.
(35) ORGANIZACIÓN MUNDIAL DE LA SALUD (O.M.S.): Trastornos Mentales y del Comportamiento. Décima revisión de la Clasificación Internacional de Enfermedades CIE 10. Madrid. MEDITOR. 1992.
(36) SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) CENTER FOR SUBSTANCE ABUSE TREATMENT: Assessment and treatment of patients with
coexisting mental ilness and alcohol and other drug abuse. Tratment Improvement Protocol (TIP) Series 9. U. S. Rockville, MD. Department of Health and Human Services. 1994.
(37) LARSON EW; OLINCY A, RUMMANS TA, MORSE RM: Disulfiram in the treatment of patients with both alcohol dependence and other psychiatric disorders: a review. Alcohol.
Clin. Exp. Res. 1992; 16: 125-130.
(38) GUARDIA SERECIGNI, J.: Naltrexona en el tratamiento del alcoholismo. Psiquiatría Biológica. 1998; 5: 35-44.
(39) DACKIS ChA; GOLD MS: Psychiatric hospitals for treatment of dual diagnosis. In: Lowinson JH, Ruiz P, Millman R, Langrod JG (Eds.) Substance Abuse. A comprehesive textbook. Baltimore. Williams & Wilkins. 1992 (p. 467-485).
