Alcohol use disorder (AUD) is more common among people who have another, co-occuring psychiatric condition (such as depression or ADHD), and vice versa. These links are well established, and are based on meeting the diagnostic criteria for one or other disorder. However, investigating associations based on strict ‘yes/no’ diagnoses has its limitations – for example, it does not account for those people who may have a range of psychiatric symptoms and yet do not meet the threshold for a diagnosis of any single disorder. Further, it does not tell us anything about the severity of the disorders – for example, is depression occurring on its own more or less severe than depression occurring with AUD, and is depression accompanying more severe AUD more severe than depression accompanying milder forms of AUD? A new study published in the journal Alcoholism: Clinical and Experimental Research has addressed these issues by focusing on broad diagnostic spectra, characterized by the occurrence and number of specific psychiatric symptoms – which are often common to a number of related psychiatric disorders – as well as on specific diagnoses.
The study used data from two independent research samples, which both represented the noninstitutionalized, adult US population. Across both samples, approximately 48,000 participants reported having drunk alcohol within the previous year, and had provided information on their alcohol use, alcohol use disorder symptoms, and on symptoms and diagnoses of other psychiatric disorders. Through statistical analysis, the researchers found that individuals with more severe AUD experienced a greater number of psychiatric symptoms than those with milder AUD, whether looking across groups of psychiatric disorders or at specific (diagnosed) disorders in isolation. The findings were observed across both research samples and were broadly consistent for men and women. This suggests that an AUD diagnosis may predispose not only for a range of other psychiatric conditions, but for more severe variations of them.
The findings regarding severity have important clinical implications; for example, patients with co-occuring AUD and psychiatric conditions may benefit from different or more intensive interventions. The results also support a potential role for ‘transdiagnostic-oriented’ treatment, which seeks to address common features of related disorders rather than an individual disorder on its own. However, the researchers note that a more in-depth understanding of the causal relationships between AUD and other psychiatric disorders may be needed to further improve patient management.
Psychiatric Comorbidity as a Function of Severity: DSM-5 Alcohol Use Disorder and HiTOP Classification of Mental Disorders. A.C. Helle, T.J. Trull, A.L. Watts, Y. McDowell, K.J. Sher (pages xxx).
ACER-19-4128.R1
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