Comorbidity of alcoholism and psychiatric disorders: an overview

Alcohol Research & Health, Spring, 2002 by Ismene L. Petrakis, Gerardo Gonzalez, Robert Rosenheck, John H. Krystal

The approach to treating comorbid mood or anxiety disorders and alcohol use disorders is somewhat different, given the similarities and overlap among both the disorders and their treatments. For example, cognitive behavioral therapy has been shown to be effective in treating anxiety disorders and alcohol dependence separately and can be readily integrated for patients with comorbid alcoholism and anxiety disorders. Several psychotherapy components, such as relaxation training, stress management, and skills training, are emphasized in the treatment of both types of disorders. Because psychotherapy is usually tailored to the individual, one specialized area of focus may be the link between symptoms of anxiety and alcohol consumption. For example, techniques to identify and manage anxiety may also prevent relapse to alcohol use among comorbid patients.

12-Step Programs. Twelve-step programs have been the focus of controversy in the substance abuse literature, particularly for the treatment of dually diagnosed patients. Although these programs may be beneficial to many people, those with severe mental illness may feel alienated. One factor associated with successful outcomes from self-help meetings is regular attendance, which may be influenced by a person's level of motivation and early experience with 12-step treatment.

Referral to 12-step meetings can be beneficial and should be considered for many comorbid patients. Some areas to evaluate when considering whether to refer a patient to a 12-step group include the person's level of motivation, barriers to attendance (including inability to relate to other people), previous experience with 12-step meetings, and the patient's expectations and those of significant others. Special meetings for people with dual disorders exist in some geographical areas. Another possibility is to incorporate some of the aspects of the 12-step model into a specialized dual diagnosis program or an individually tailored psychotherapy.

SUMMARY AND CONCLUSIONS

The chance of having a psychiatric disorder is significantly increased among people with alcohol dependence but not among those with alcohol abuse. Among people with alcohol dependence and a comorbid psychiatric disorder, the 1-year prevalence of major depressive disorder was estimated to be the highest of the mood disorders, and generalized anxiety disorder was most frequent among the anxiety disorders. People with comorbid psychiatric disorders are far mote likely to receive treatment in specialized mental health services than those without comorbid disorders, although many people with comorbid psychiatric illness are not receiving specialized substance abuse treatment. Because these patients may receive treatment in mental health or substance abuse treatment facilities, it is important to implement and expand integrated services that address both addictive and psychiatric disorders. In addition, most research on treating alcohol use disorders has systematically excluded people with comorbid psychiatric dis orders. The result is a wide gap between research and clinical realities. Further well-controlled research is needed to identify treatments, both psychotherapeutic and pharmaceutical, that are safe and effective for this population.