Patients with Depression, Anxiety, and Bulimia at Heightened Risk of Unhealthy Drinking and Associated Health Issues

People experiencing depression, anxiety disorder, or bulimia are at heightened risk of unhealthy drinking, according to a new study involving more than two million patients. Unhealthy drinking is known to frequently co-occur with behavioral health conditions, potentially impeding disease management and leading to more serious problems such as alcohol use disorder (AUD) and chronic medical issues. Although one in four US adults drink beyond recommended limits, little is known about the relationship between particular psychiatric diagnoses and varying levels of alcohol consumption. The study in Alcoholism: Clinical & Experimental Research aimed to change that.

The National Institute of Alcoholism and Alcohol Abuse (NIAAA) recommends that men aged 18–64 not exceed four drinks a day or 14 drinks per week; men 65+ and women should not exceed three drinks a day or seven per week. Investigators used data representing more than 2,720,000 primary care patients who were screened in Kaiser Permanente Northern California for alcohol use beyond those limits between 2014 and 2017. The researchers identified patients who had any of eight psychiatric diagnoses in the past year — depression, bipolar disorder, anxiety disorder, obsessive-compulsive disorder, schizophrenia, schizoaffective disorder, anorexia nervosa, and bulimia nervosa — and compared their self-reported alcohol use over the previous three months to that of patients without those diagnoses. They categorized alcohol consumption levels as no reported use, low-risk use (within NIAAA limits), and unhealthy use (beyond those limits). Unhealthy use was further differentiated into exceeding only daily limits, only weekly limits, or both limits — drinking patterns that are associated with varying health risks. The researchers used statistical analysis to explore associations at a single point in time between demographic and health characteristics and reported alcohol consumption.

Patients with psychiatric diagnoses were less likely than those without such conditions to say they used alcohol. Among those who reported drinking, however, mental health conditions and unhealthy alcohol consumption commonly co-occurred. Most strikingly, patients with anxiety disorder, bulimia nervosa, or depression were more likely than others to report exceeding daily and weekly alcohol limits. Patients diagnosed with both anxiety and depression were also more likely to report drinking beyond weekly limits. People with schizophrenia and schizoaffective disorder were particularly likely to report not drinking, suggesting that they may avoid alcohol as a means of self-care. These two conditions, along with anorexia nervosa and bipolar disorder, were not linked to unhealthy alcohol use in this study (the research on these associations is mixed). Overall, men, younger people (18–34), and smokers were more likely to report exceeding daily drinking guidelines, and both daily and weekly limits. Women, people aged 65+, and those with chronic medical conditions were more likely to report exceeding weekly limits.

The researchers recommend that health care systems and clinicians tailor and target alcohol use screening, assessment, and intervention for patients with depression, anxiety, and bulimia. This could potentially help them limit their drinking, manage their behavioral health conditions, and prevent additional health problems.

Associations between psychiatric disorders and alcohol consumption levels in an adult primary care population. V. Palzes, S. Parthasarathy, F. Chi, A. Kline-Simon, Y. Lu, C. Weisner, T. Ross, J. Elson, S. Sterling (pp xxx).

ACER-20-4419.R1