Aims: The aim of this study was to investigate longitudinal changes in quality of life (QOL) as a function of transitions in alcohol use disorders (AUD) over a 3-year follow-up of a general US population sample. Methods: The analysis is based on individuals who drank alcohol in the year preceding the Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions and were reinterviewed at Wave 2 (n = 22,245). Using multiple linear regression models, changes in SF-12 QOL were estimated as a function of DSM-IV AUD transitions, controlling for baseline QOL and multiple potential confounders. Results: Onset and offset of AUD were strongly associated with changes in mental/psychological functioning, with significant decreases in mental component summary (NBMCS) scores among individuals who developed dependence and significant increases among those who achieved full and partial remission from dependence. The increases in overall NBMCS and its social functioning, role emotional and mental health components were equally great for abstinent and nonabstinent remission from dependence, but improvements in bodily pain and general health were associated with nonabstinent remission only. Onset of abuse was unrelated to changes in QOL, and the increase in NBMCS associated with nonabstinent remission from abuse only was slight. Individuals with abuse only or no AUD who stopped drinking had significant declines in QOL. Conclusions: These results suggest the possible importance of preventing and treating AUD for maintaining and/or improving QOL. They are also consistent with the sick quitter hypothesis and suggest that abuse is less a mental disorder than a maladaptive pattern of behavior.
Despite the substantial prevalence of alcohol use disorders (AUDs), prior research indicates that most people with AUDs never utilize either formal or informal treatment services. Several prior studies have examined the characteristics of individuals with AUDs who receive treatment; however, limited longitudinal data are available on the predictors of receiving AUD services in treatment-naive individuals with AUDs.
This study utilized data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to identify adults in Wave 1 who met criteria for an AUD within the last 12 months and reported no prior lifetime alcohol treatment (N=2,760). These individuals were surveyed again at Wave 2, approximately three to four years later (N=2,170). This study examined the Wave 1 demographic and psychiatric conditions that were associated with receipt of AUD treatment services between Wave 1 and Wave 2.
In multivariable analyses, use of AUD treatment services between Waves 1 and 2 was significantly more likely among those who were male, non-Caucasian, younger, had lower income, and who had health insurance. Additionally, those who met criteria for a baseline drug use disorder, anxiety disorder or a personality disorder were more likely to receive AUD treatment.
Treatment was more often utilized in those who had more severe baseline psychopathology and in those with fewer economic resources. These findings highlight the need to broaden the types of care available to individuals with AUDs to increase the appeal of AUD services.
Addictions treatment; service utilization; alcohol dependence; alcoholism
Existing information on consequences of the DSM-5 revision for diagnosis of alcohol use disorders (AUD) has gaps, including missing information critical to understanding implications of the revision for clinical practice.
Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to compare AUD severity, alcohol consumption and treatment, sociodemographic and health characteristics and psychiatric comorbidity among individuals with DSM-IV abuse versus DSM-5 moderate AUD and DSM-IV dependence versus DSM-5 severe AUD. For each pair of disorders, we additionally compared three mutually exclusive groups: individuals positive solely for the DSM-IV disorder, those positive solely for the DSM-5 disorder and those positive for both.
Whereas 80.5% of individuals positive for DSM-IV dependence were positive for DSM-5 severe AUD, only 58.0% of those positive for abuse were positive for moderate AUD. The profiles of individuals with DSM-IV dependence and DSM-5 severe AUD were almost identical. The only significant (p<.005) difference, more AUD criteria among the former, reflected the higher criterion threshold (≥4 vs. ≥3) for severe AUD relative to dependence. In contrast, the profiles of individuals with DSM-5 moderate AUD and DSM-IV abuse differed substantially. The former endorsed more AUD criteria, had higher rates of physiological dependence, were less likely to be White and male, had lower incomes, were less likely to have private and more likely to have public health insurance, and had higher levels of comorbid anxiety disorders than the latter.
Similarities between the profiles of DSM-IV and DSM-5 AUD far outweigh differences; however, clinicians may face some changes with respect to appropriate screening and referral for cases at the milder end of the AUD severity spectrum, and the mechanisms through which these will be reimbursed may shift slightly from the private to public sector.
DSM-5; AUD; treatment; severity; clinical profile
Antisocial personality disorder (ASPD) is associated with poorer treatment outcomes, but more help seeking, for alcohol use disorders (AUDs); however, associations of ASPD with AUD treatment in the general population have not been studied prospectively.
To examine prediction of treatment over 3-year follow-up among adults with AUDs by baseline ASPD and syndromal adult antisocial behavior without conduct disorder before age 15 (AABS).
Face-to-face interviews with 34,653 respondents to the National Epidemiologic Survey on Alcohol and Related Conditions, of whom 3875 had prevalent AUDs between Waves 1 and 2 and ASPD, AABS, or no antisocial syndrome at Wave 1.
In unadjusted analyses, baseline ASPD predicted AUD treatment but AABS did not. After adjustment for additional need, predisposing, and enabling factors, antisocial syndromes did not predict treatment. Baseline predictors of treatment included more past-year AUD symptoms, and past-year nicotine dependence and AUD treatment.
That baseline antisocial syndrome did not predict AUD treatment may reflect strong associations of antisociality with previously identified predictors of help seeking.
antisocial personality disorder; alcohol use disorders; epidemiology; comorbidity; treatment
Under the proposed DSM-5 revision to the criteria for alcohol use disorder (AUD), a substantial proportion of DSM-IV AUD cases will be lost or shifted in terms of severity, with some new cases added. Accordingly, the performance of the AUDIT-C in screening for DSM-IV AUD cannot be assumed to extend to DSM-5 AUD. The objective of this paper is to compare the AUDIT-C in screening for DSM-IV and DSM-5 AUD.
Using a broad range of performance metrics, the AUDIT-C was tested and contrasted as a screener for DSM-IV AUD (any AUD, abuse and dependence) and DSM-5 AUD (any AUD, moderate AUD and severe AUD) in a representative sample of U.S. adults aged 21 and older and among past-year drinkers.
Optimal AUDIT-C cutpoints were identical for DSM-IV and DSM-5 AUD: ≥4 for any AUD, ≥3 or ≥4 for abuse/moderate AUD and ≥4 or ≥5 for dependence/severe AUD. Screening performance was slightly better for DSM-5 severe AUD than DSM-IV dependence but did not differ for other diagnoses. At optimal screening cutpoints, positive predictive values were slightly higher for DSM-5 overall AUD and moderate AUD than for their DSM-IV counterparts. Sensitivities were slightly higher for DSM-5 severe AUD than DSM-IV dependence. Optimal screening cutpoints shifted upwards for past-year drinkers but continued to be identical for DSM-IV and DSM-5 disorders.
Clinicians should not face any major overhaul of their current screening procedures as a result of the DSM-5 revision and should benefit from fewer false positive screening results.
AUDIT-C; screening; alcohol use disorder; DSM-IV; DSM-5
Exposure to stress often is psychologically distressing. The impact of stress on alcohol use and the risk of alcohol use disorders (AUDs) depends on the type, timing during the life course, duration, and severity of the stress experienced. Four important categories of stressors that can influence alcohol consumption are general life stress, catastrophic/fateful stress, childhood maltreatment, and minority stress. General life stressors, including divorce and job loss, increase the risk for AUDs. Exposure to terrorism or other disasters causes population-level increases in overall alcohol consumption but little increase in the incidence of AUDs. However, individuals with a history of AUDs are more likely to drink to cope with the traumatic event. Early onset of drinking in adolescence, as well as adult AUDs, are more common among people who experience childhood maltreatment. Finally, both perceptions and objective indicators of discrimination are associated with alcohol use and AUDs among racial/ethnic and sexual minorities. These observations demonstrate that exposure to stress in many forms is related to subsequent alcohol consumption and AUDs. However, many areas of this research remain to be studied, including greater attention to the role of various stressors in the course of AUDs and potential risk moderators when individuals are exposed to stressors.
Alcohol use and abuse; alcohol use disorders; stress; stress as a cause of alcohol and other drug use; risk factors; psychological stress; stress response; coping; stressors; general life stress; catastrophe; child abuse; minority group; epidemiological indicators
To determine the prevalence of past 12 month DSM-5 alcohol use disorders (AUDs), to quantify and characterize individuals who remain stably unaffected or affected and those who diagnostically “switch” between DSM-IV and DSM-5 classifications.
Data from the nationally representative Wave 2 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) collected in 2004–2005.
General population survey.
All surveyed participants (N=34,653, aged 21 and older) and 29,993 individuals reporting lifetime alcohol use across both waves of NESARC.
DSM-IV and DSM-5 criteria were coded using proposed guidelines.
The prevalence of DSM-5 AUDs was 10.8% with the corresponding prevalence of DSM-IV abuse/dependence being 9.7%, implying a modest 11.3% increase. Those who diagnostically switched from affected to unaffected (19.6% of DSM-IV affected) were most likely to have endorsed hazardous use, particularly due to drinking and driving while those who transitioned from unaffected to affected (3.3% of DSM-IV unaffected) were primarily DSM-IV diagnostic orphans reporting larger/longer and quit/cut-back. Dropping the legal criterion did not significantly affect the prevalence while the addition of craving also had a relatively modest impact on prevalence.
The proposed DSM-5 revisions successfully eliminate individuals previously diagnosed with DSM-IV alcohol abuse primarily due to hazardous use alone and incorporate diagnostic orphans into the diagnostic realm. Definitions of craving and importantly, hazardous use require considerable attention as it is likely that they will contribute to variations in reports of increased prevalence of AUDs between DSM-IV to DSM-5.
alcohol; Alcohol Use Disorders; DSM-5; NESARC
The present study examined the dimensionality of DSM-IV Alcohol Use Disorder (AUD) criteria using Item Response Theory (IRT) methods and tested the validity of the proposed DSM-V AUD guidelines in a sample of college students.
Participants were 396 college students who reported any alcohol use in the past 90 days and were aged 18 years or older. We conducted factor analyses to determine whether a one- or two-factor model provided a better fit to the AUD criteria. IRT analyses estimated item severity and discrimination parameters for each criterion. Multivariate analyses examined differences among the DSM-V diagnostic cut-off (AUD versus No AUD) and severity qualifiers (no diagnosis, moderate, severe) across several validating measures of alcohol use.
A dominant single-factor model provided the best fit to the AUD criteria. IRT analyses indicated that abuse and dependence criteria were intermixed along the latent continuum. The "legal problems" criterion had the highest severity parameter and the tolerance criterion had the lowest severity parameter. The abuse criterion "social/interpersonal problems" and dependence criterion "activities to obtain alcohol" had the highest discrimination parameter estimates. Multivariate analysis indicated that the DSM-V cut-off point, and severity qualifier groups were distinguishable on several measures of alcohol consumption, drinking consequences, and drinking restraint.
Findings suggest that the AUD criteria reflect a latent variable that represents a primary disorder and provide support for the proposed DSM-V AUD criteria in a sample of college students. Continued research in other high-risk samples of college students is needed.
College students; Item Response Theory; reliability; validity; alcohol use
Alcohol abuse and/or dependence (Alcohol Use Disorders, AUDs) and problem and/or pathological gambling (PPG) frequently co-occur with each other and other psychiatric disorders. However, prior studies have not investigated the relative influence of AUD on the associations between PPG and other psychiatric disorders.
To use nationally representative data (the National Epidemiologic Survey on Alcohol and Related Conditions, NESARC, n = 43,093 U.S. Residents ages 18 years and older) to examine the influence of DSM-IV AUD on the associations between gambling and other psychiatric disorders and behaviors.
Main Outcome Measures
Co-occurrence of past-year AUD and Axis I and II disorders and severity of gambling based on the ten inclusionary diagnostic criteria for pathological gambling.
Among non-AUD respondents, increasing gambling severity was associated with increasingly elevated odds for the majority of Axis I and II disorders. Among AUD respondents, this pattern was typically not observed. Alcohol-by-gambling-group interactions for PPG were also found and the odds of these disorders was significantly increased in non-AUD respondents with PPG, but either unchanged or significantly lower in AUD respondents with PPG.
Gambling-related associations exist with multiple psychiatric disorders, but particularly in those without AUD. These associations have important implications with respect to conceptualization, prevention and treatment of psychiatric disorders in individuals with gambling and/or alcohol use disorders.
gambling; co-occurring disorders; alcohol dependence; impulse control disorders; epidemiology
Exposure to stress often is psychologically distressing. The impact of stress on alcohol use and the risk of alcohol use disorders (AUDs) depends on the type, timing during the life course, duration, and severity of the stress experienced. Four important categories of stressors that can inQuence alcohol consumption are general life stress, catastrophic/fateful stress, childhood maltreatment, and minority stress. General life stressors, including divorce and job loss, increase the risk for AUDs. Exposure to terrorism or other disasters causes population-level increases in overall alcohol consumption but little increase in the incidence of AUDs. However, individuals with a history of AUDs are more likely to drink to cope with the traumatic event. Early onset of drinking in adolescence, as well as adult AUDs, are more common among people who experience childhood maltreatment. Finally, both perceptions and objective indicators of discrimination are associated with alcohol use and AUDs among racial/ethnic and sexual minorities. These observations demonstrate that exposure to stress in many forms is related to subsequent alcohol consumption and AUDs. However, many areas of this research remain to be studied, including greater attention to the role of various stressors in the course of AUDs and potential risk moderators when individuals are exposed to stressors.
Alcohol use and abuse; alcohol use disorders; stress; stress as a cause of alcohol and other drug use; risk factors; psychological stress; stress response; coping; stressors; general life stress; catastrophe; child abuse; minority group; epidemiological indicators
The purpose of this study was to examine the association between Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol-use disorders (AUDs) and nonmedical use of prescription drugs (NMPD) among U.S. college students. A secondary aim of this study was to identify individual-level and college-level characteristics associated with the co-occurrence of AUDs and NMPD.
Data were collected from self-administered mail surveys, sent to a random sample of approximately 14,000 college students from a nationally representative sample of 119 U.S. colleges and universities.
Among U.S. college students, those with AUDs represented approximately 75% of nonmedical users of prescription drugs. Multivariate logistic regression analyses indicated that college students with past-year DSM-IV alcohol abuse only (adjusted odds ratio [AOR] = 4.46, 95% confidence interval [CI] = 3.59-5.55) and students with past-year DSM-IV alcohol dependence (AOR = 9.17, 95% CI = 7.05-11.93) had significantly increased odds of NMPD in the past year compared with students without AUDs. The co-occurrence of AUDs and NMPD was more likely among college students who were male, white, earned lower grade point averages, and attended co-ed colleges and institutions located in Southern or Northeastern U.S. regions.
The findings provide evidence that NMPD is more prevalent among those college students with AUDs, especially individuals with past-year DSM-IV alcohol dependence. The assessment and treatment of AUDs among college students should account for other forms of drug use such as NMPD.
Alcohol and other substance use disorders (AUD/SUD) are common among youth and often continue into adulthood; therefore, the neurocognitive effects of substance use are of great concern. Because neuromaturation continues into young adulthood, youth with AUD/SUD may be at risk for lasting cognitive decrements. This study prospectively examines neuropsychological functioning over 10 years as a function of AUD/SUD history and outcomes.
The 51 participants consisted of 18 youth with persisting AUD/SUD, 19 youth with remitted AUD/SUD, and 14 community youth with no AUD/SUD history followed over 10 years (ages 16 to 27 on average) with neuropsychological testing and substance use interviews on 8 occasions. Neuropsychological performance from baseline to 10-year follow-up was compared between the three groups.
Despite scoring higher than controls at intake, both AUD/SUD groups showed a relative decline in visuospatial construction at 10-year follow-up (p=.001). Regressions showed that alcohol use (β=−.33, p < .01) and drug withdrawal symptoms (β=−.31, p<.05) over follow-up were predictive of year 10 visuospatial function. Alcohol use also predicted verbal learning and memory (β=−.28, p<.05), while stimulant use predicted visual learning and memory function (β=−.33, p=.01). More recent substance use was associated with poorer executive function (β=.28, p<.05).
These findings confirm prior studies suggesting that heavy, chronic alcohol and other substance use persisting from adolescence to young adulthood may produce cognitive disadvantages, primarily in visuospatial and memory abilities. Youth who chronically consume heavy quantities of alcohol and/or experience drug withdrawal symptoms may be particularly at risk for cognitive deterioration by young adulthood.
adolescence; young adulthood; alcohol; substance use disorders; withdrawal; neurocognition; memory; visuospatial function; executive function
Little is known about the psychometric properties of alcohol abuse and dependence criteria among recent-onset adolescent drinkers, particularly for those who consume alcohol infrequently. This study evaluated how well DSM-IV alcohol dependence criteria measure an alcohol use disorder (AUD) construct for recent onset adolescent drinkers at different levels of drinking frequency.
Data were drawn from the National Survey on Drug Use and Health, a nationally representative sample of 9,356 recent-onset adolescent drinkers, aged 12–21, who began drinking within the past year. Multiple group item response theory analysis was conducted to assess the 11 DSM-IV alcohol abuse and dependence criteria.
Criteria most likely to be endorsed at lower AUD severity included ““withdrawal,” “problems at home, school or work” and “tolerance.” The criteria “drinking larger amounts/longer period of time,” “unsuccessful efforts to cut down” and “continuing to drink despite related health problems” were more likely to be endorsed at higher AUD severity. Two criteria, “tolerance” and “time spent getting, using or recovering from alcohol” showed differential item functioning between drinking frequency groups (< 7 vs. ≥ 7 days in past month), with lower discrimination and severity for more frequent drinkers. DSM-IV criteria were most precise for intermediate levels of AUD severity.
All but two DSM-IV criteria had consistent psychometric properties across drinking frequency groups. Symptoms were most precise for a narrow, intermediate range of AUD severity. Those assessing AUD in recent onset adolescent drinkers might consider additional symptoms to capture the full AUD continuum.
alcohol dependence; drinking frequency; item response theory; recent onset drinkers; adolescents
Comorbidies that commonly accompany those afflicted with an alcohol use disorder (AUD) may promote variability in the pattern and magnitude of neurocognitive abnormalities demonstrated. The goal of this study was to investigate the influence of several common comorbid medical conditions (primarily hypertension and hepatitis C), psychiatric (primarily unipolar mood and anxiety disorders), and substance use (primarily psychostimulant and cannabis) disorders, and chronic cigarette smoking on the neurocognitive functioning in short-term abstinent, treatment-seeking individuals with AUD. Seventy-five alcohol dependent participants (ALC; 51 ± 9 years of age; 3 females) completed comprehensive neurocognitive testing after approximately one-month of abstinence. Multivariate multiple linear regression evaluated the relationships among neurocognitive variables and medical conditions, psychiatric and substance use disorders, controlling for sociodemographic factors. Sixty-four percent of ALC had at least one medical, psychiatric or substance abuse comorbidity (excluding smoking). Smoking status (smoker or non-smoker) and age were significant independent predictors of cognitive efficiency, general intelligence, postural stability, processing speed and visuospatial memory after age-normed adjustment and control for estimated premorbid verbal IQ, education, alcohol consumption, and medical, psychiatric, and substance misuse comorbidities. Results indicated that chronic smoking accounted for a significant portion of the variance in the neurocognitive performance of this middle-aged AUD cohort. The age-related findings for ALC suggest that alcohol dependence, per se, was associated with diminished neurocognitive functioning with increasing age. The study of participants who demonstrate common comorbidities observed in AUD is necessary to fully understand how AUD, as a clinical syndrome, affects neurocognition, brain neurobiology, and their changes with extended abstinence.
alcohol use disorders; alcohol dependence; cigarette smoking; age effects; comorbidities
Current initiatives to update diagnostic criteria for alcohol use disorders (AUDs) have stimulated dialogue about the usefulness of indicators of alcohol consumption in the diagnosis of AUDs.
This study used Rasch model analyses to examine the properties of alcohol consumption descriptors and AUD symptoms among 3,382 treatment-seeking adolescents, aged 12–18 years, in the DATOS-A (USDHHS, 1993–1995) baseline assessment, and evaluated the predictive validity of different scoring methods (with and without alcohol consumption) for 12-month alcohol involvement.
Rasch model analyses supported the unidimensionality of indices of alcohol consumption and AUD symptoms. Test information functions showed that adding consumption items provides further information at all points of the alcohol involvement severity spectrum. Combining AUD symptoms with indices of alcohol consumption provided better prediction of alcohol involvement after treatment than either AUD symptoms counts or DSM-IV dependence diagnosis alone. Differential item functioning (DIF), however, was observed for select items. Generally, indices of drinking “too much too fast” were more severe for females, African Americans and Hispanics, while the opposite was true for items measuring “too much too often”. For age, “too much too often” items were more severe for the younger (12–14yrs) age group, and AUD symptoms were more severe for the older (15–18yrs) age group.
Indices of alcohol consumption can be validly scaled along with AUD symptoms in this population, and their inclusion provides statistical measurement advantages. Nevertheless, caution is necessary in using consumption items in measuring alcohol involvement due to DIF observed across sex, race and age.
Alcohol Consumption; DSM-IV; Rasch Modeling; Adolescence; Measurement
While there is an extensive literature on the correlates of alcohol use disorders (AUD; alcohol abuse and dependence), there are relatively few prospective studies of representative birth cohorts that have examined the unique effects of an adolescent onset and persistent course of AUD on a wide range of psychosocial variables.
A longitudinal, community-based sample of 530 men was used to examine the impact of an adolescent onset (AUD+ at age 17) and persistent course (AUD+ at age 29) of AUD on adolescent and adult functioning including substance use, antisocial behavior, mental health problems, overall psychosocial functioning, environmental risk and protective factors, and social outcomes such as peer and romantic relationships, marriage, educational and occupational attainment, and parenthood.
An adolescent onset of AUD (n = 57) was associated with severe deficits across multiple domains of psychosocial functioning in adolescence. Measures of behavioral disinhibition in adolescence were strong predictors of a persistent course of AUD (n = 93). Nearly 40% of men with an adolescent onset were able to desist by age 29, and were similar, but not identical to men who never experienced an AUD in terms of adult functioning. Men with an adolescent onset and persistent course of AUD exhibited the most severe deficits in functioning.
Results emphasize the importance of examining developmental course to understand the etiology of AUD. Our findings are optimistic in that individuals who desist from AUD are able to achieve high levels of psychosocial functioning. Our findings suggest that future research on the persistence of AUD into adulthood should focus on the contributions of behavioral disinhibition and social environment variables including peer and romantic relationships.
Elevated lifetime prevalence rates of alcohol use disorders (AUDs) are a feature of bipolar disorder (BD). Individuals at-risk for AUDs exhibit blunted subjective responses to alcohol (low levels of response), which may represent a biomarker for AUDs. Thus, individuals at-risk for BD may exhibit low responses to alcohol. Participants were 20 unmedicated adult males who reported high rates of hypomanic experiences (bipolar phenotype participants; BPPs), aged 18 to 21 years, and 20 healthy controls matched on age, gender, IQ, BMI, and weekly alcohol intake. Subjective and pharmacokinetic responses to acute alcohol (0.8 g/kg) vs placebo administration were collected in a randomized, double-blind, cross-over, placebo-controlled, within-subjects design. BPP participants reported significantly lower subjective intoxication effects (‘feel high': F=14.2, p=0.001; ‘feel effects': F=8.1, p=0.008) across time, but did not differ in their pharmacokinetic, stimulant, or sedative responses. Paradoxically, however, the BPP participants reported significantly higher expectations of the positive effects of alcohol than controls. Our results suggest that unmedicated young males with previous hypomanic experiences exhibit diminished subjective responses to alcohol. These blunted alcohol responses are not attributable to differences in weekly alcohol intake, pharmacokinetic effects (eg, absorption rates), or familial risk of AUDs. These observations suggest that the dampened intoxication may contribute to the increased rates of alcohol misuse in young people at-risk for BD, and suggest possible shared etiological factors in the development of AUDs and BD.
alcohol abuse/dependence; bipolar disorder; adolescence; hypomania; mood; ethanol; alcohol and alcoholism; mood/anxiety/stress disorders; depression; unipolar/bipolar; psychopharmacology; adolescence; hypomania; mood; ethanol; bipolar disorder; alcohol use disorders
Understanding for whom moderated drinking is a viable, achievable, and sustainable goal among those with a range of alcohol use disorders (AUD) remains an important public health question. Despite common acceptance as severe risk factors, there is little empirical evidence to conclude whether co-occurring mental health disorders or drug dependence contribute to an individual’s inability to successfully moderate his drinking. Utilizing secondary data analysis, the purpose of this study was to identify predictors of moderation among both treatment seeking and non-treatment seeking, primarily alcohol dependent, problem drinking men who have sex with men (MSM), with an emphasis on the high risk factors psychiatric comorbidity and drug dependence. Problem drinkers (N=187) were assessed, provided feedback about their drinking, given the option to receive brief AUD treatment or change their drinking on their own, and then followed for 15 months. Findings revealed that neither psychiatric comorbidity or drug dependence predicted ability to achieve moderation when controlling for alcohol dependence severity. Those who were younger, more highly educated, and had more mild alcohol dependence were more likely to achieve moderated drinking. Impact of treatment on predictors is explored. Limitations of this study and arenas for future research are discussed.
moderation; controlled drinking; co-occurring mental health disorders; alcohol; drug dependence; problem drinkers; alcohol use disorder treatment
Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUD) yet the nature of this comorbidity remains unclear. To better understand these associations, we first examined whether SAD was related to AUD above and beyond relevant covariates. Second, we examined the psychosocial impairment associated with the comorbidity of SAD and AUD versus SAD without AUD. Third, the temporal sequencing of SAD and AUD among comorbid individuals was examined.
Participants included 5,877 (50% females) adults from the National Comorbidity Survey.
As predicted, SAD was related to alcohol dependence (not abuse) after controlling for relevant conditions, indicating that SAD is linked to more severe alcohol impairment and that this link is not better accounted for by other pathology. Results also supported the hypothesis that the addition of alcohol dependence to SAD resulted in greater impairment across a variety of domains relative to SAD without alcohol dependence (e.g., greater rates of health care utilization, other psychiatric diagnoses, health problems, and greater interpersonal stress). Additionally, for the majority of comorbid individuals, SAD onset predated alcohol dependence onset, suggesting SAD increases vulnerability for misusing alcohol.
Together, these data lend support for the contention that SAD may serve as a risk for alcohol dependence and indicate that the co-occurrence of these two conditions may result in greater personal and public health care costs.
social phobia; social anxiety; alcohol; comorbidity; impairment
This study examined the relationship between past-year drinking behaviors and nonmedical use of prescription drugs (NMUPD) in a nationally representative sample. Prevalence estimates in the United States were derived based on data collected from face-to-face interviews using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093 individuals aged 18 years and older). Nonmedical use of prescription opioids, stimulants, tranquilizers, and sedatives was more prevalent among individuals with alcohol use disorders (AUDs) than those without AUDs. The odds of reporting NMUPD were 18 times higher among alcohol dependent participants compared to past-year abstainers (OR = 18.2, 95% CI = 13.9–23.8). Although individuals with AUDs constituted less than 9% of the total sample, those with AUDs accounted for more than one in every three nonmedical users of prescription drugs. The past-year co-occurrence of AUDs and NMUPD was more prevalent among young adults 18–24 years of age than individuals 25 years and older. More than one in every four young adults aged 18–24 years who met the criteria for past-year DSM-IV alcohol dependence also reported past-year NMUPD. These findings suggest that the treatment for AUDs should include a thorough assessment of NMUPD, especially among young adults.
Epidemiology; Prescription drugs; Nonmedical use; Alcohol use; DSM-IV alcohol abuse; DSM-IV alcohol dependence
Alcohol use disorders (AUDs) are clinically heterogeneous and strongly influenced by familial/genetic factors. Can we identify specific clinical features of AUDs that index familial liability to illness?
In twins from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders meeting DSM-IV criteria for lifetime AUDs, we examined whether clinical features of AUDs, including individual DSM-IV criteria for alcohol dependence (AD) and alcohol abuse (AA), predicted risk for AUDs in cotwins and/or parents. Analyses of individual criterion were repeated controlling for the total number of endorsed criteria.
Across these analyses, examining narrowly and broadly defined AUDs, risk of AUDs in relatives was more consistently predicted by abuse criteria than by dependence criteria, and by criteria reflecting negative psychosocial consequences rather than pharmacologic/biological criteria. Age at onset (AAO) poorly predicted risk in relatives. AUD associated legal problems, the one criterion slated for removal in DSM-5, was the most consistent single predictor of familial risk. Associations observed between individual criteria and risks of illness in relatives were generally stronger in monozygotic than dizygotic twin pairs, suggesting that these symptoms reflect a genetic risk for AUDs.
Individual DSM-IV criteria for AA and AD differ meaningfully in the degree to which they reflect the familial/genetic liability to AUDs. Contrary to expectation, the familial/genetic risk to AUDs was better reflected by symptoms of abuse and negative psychosocial consequences of AUD than by early AAO, or symptoms of tolerance and withdrawal.
Alcohol Abuse; Alcohol Dependence; Twin Studies; Heritability; Symptoms
Nearly 13 years have passed since Alcohol Research & Health (now titled Alcohol Research: Current Reviews) first visited the topic of “Alcohol and Stress.” Since that time, the field has advanced considerably. New terms have been developed to describe the complex physiological interactions that occur when an individual is faced with stressful events and more is known about how the brain and body work to offset the changes induced through stress-response mechanisms. An individual’s reactions to stress vary according to a number of factors, such as his or her genetic makeup, environment, life events, gender, age, and type and duration of stress. Drinking alcohol has the unique ability to both relieve stress and to be the cause of it, creating in a sense a double-edged sword. Understanding the link between alcohol drinking, stress, and alcohol use disorders (AUDs) is a critical area for ongoing investigation. Discoveries emanating from this field not only add to the burgeoning literature on stress and the risk for disease but also may provide answers to help prevent and intervene in the development of AUDs.
Alcohol consumption; alcohol use disorders; stress as a cause of alcohol and other drug use; stress; stressors; stress response; stress reactivity; physiological response to stress; brain; genetic factors; environmental factors; allostasis; allostatic load; allostatic state; homeostasis
As a quality improvement metric, the US Veterans Health Administration (VHA) monitors the proportion of patients with alcohol use disorders (AUD) who receive FDA approved medications for alcohol dependence (naltrexone, acamprosate, and disulfiram). Evidence supporting the off-label use of the antiepileptic medication topiramate to treat alcohol dependence may be as strong as these approved medications. However, little is known about the extent to which topiramate is used in clinical practice. The goal of this study was to describe and examine the overall use, facility-level variation in use, and patient -level predictors of topiramate prescription for patients with AUD in the VHA.
Using national VHA administrative data in a retrospective cohort study, we examined time trends in topiramate use from fiscal years (FY) 2009–2012, and predictors of topiramate prescription in 375,777 patients identified with AUD (ICD-9-CM codes 303.9x or 305.0x) treated in 141 VHA facilities in FY 2011.
Among VHA patients with AUD, rates of topiramate prescription have increased from 0.99% in FY 2009 to 1.95% in FY 2012, although substantial variation across facilities exists. Predictors of topiramate prescription were female sex, young age, alcohol dependence diagnoses, engagement in both mental health and addiction specialty care, and psychiatric comorbidity.
Veterans Health Administration facilities are monitored regarding the extent to which patients with AUD are receiving FDA-approved pharmacotherapy. Not including topiramate in the metric, which is prescribed more often than acamprosate and disulfiram combined, may underestimate the extent to which VHA patients at specific facilities and overall are receiving pharmacotherapy for AUD.
Alcohol use disorders; Addiction; Pharmacotherapy; Topiramate; Pharmacotherapy utilization; Veterans
Individuals who endorse one or two of the DSM-IV criterion items for alcohol dependence but do not meet criteria for either alcohol abuse or dependence have been referred to in the literature as “diagnostic orphans.” The goal of the present study is to compare diagnostic orphans for alcohol use disorders (AUD) to patients with lifetime DSM-IV alcohol abuse, alcohol dependence, and those with no-AUD symptoms on a series of demographic, diagnostic, and clinical measures. Participants were treatment-seeking psychiatric outpatients (n = 1793; 61.5% women) who completed an in-depth, face-to-face diagnostic evaluation for DSM-IV axis I and axis II disorders. Results revealed that diagnostic orphans were younger, had a higher frequency of family history positive for alcoholism, and higher rates of cannabis dependence, as compared to the no-AUD symptoms group. Diagnostic orphans differed significantly from patients with alcohol abuse and dependence on a number of demographic, diagnostic, and clinical measures. Most notably, on a lifetime basis, diagnostic orphans were less likely to meet diagnostic criteria for various substance use disorders, as compared to individuals with alcohol abuse and dependence. Taken together, these results generally do not support combining diagnostic orphans to individuals with alcohol abuse.
diagnostic orphans; alcohol; DSM-IV; alcohol use disorders
The accuracy of self-reported healthcare use among individuals with alcohol use disorders (AUD) has been questioned. The present study attempts to compare the accuracy of self-reported physician visits for individuals who differ with respect to their history of AUDs.
Our data source was a 14-year follow-up of individuals interviewed at the St. Louis site of the 1981-1983 Epidemiologic Catchment Area Study (ECA). We used a case-control design (N=237) to compare the accuracy of self-reports among ECA participants with stably-diagnosed AUDs (cases; n=75) to two comparison groups: those with problem/very heavy drinking (n=81) and those unaffected by alcohol (n=81). Intraclass correlation coefficients (ICC) described the concordance between self-reports and archival records of physician visits in the prior six months. We used multinomial logistic regression to identify characteristics associated with under-reporting and over-reporting, and zero-truncated Poisson regression to identify characteristics associated with discordance severity.
Self-reports of cases had substantial concordance with physician records (ICC=0.74, CI=0.61-0.83). As compared to cases, those with problem/very heavy drinking had a significantly higher ICC, and those who were unaffected by alcohol had a significantly lower ICC. However, differences in concordance disappeared when using regression models that adjusted for factors known to affect the accuracy of self-reported healthcare use. Utilization frequency was a strong predictor of inaccurate reporting.
These findings suggest AUD status may not independently affect the accuracy of self-reports. Counts of physician visits for those with AUD may be considered accurate when utilization frequency is low.
Alcohol use disorders; service use; concordance; self-report