Comorbidity

Diagnostic Issues

(1)Overlap between diagnostic criteria;(2)rates vary according to the diagnostic methods used-clinical interview,research interview,chart review;(3)AUD can cause symptoms that resemble other psychiatric disorder symptoms(withdrawal may cause anxiety that looks like an anxiety disorder)

Summary

-Chance of having a psychiatric disorder is significantly increased among people with alcohol dependence -Antisocial Personality Disorder is the most common co-occurring disorder -Continuing research needed to better elucidate explanatory models -Integrated treatment approaches and evidence-based practices should be increasingly implemented and evaluated.

Comorbidity Rates for Specific Psychiatric Disorders

-National Comorbidity Study Mood Disorders 29.2% 3.6* Anxiety Disorders36.9% 2.6* -Epidemiologic Catchment Area Study Schizophrenia 24% 3.8* Antisocial Personality Dis.*74% 21.0* ->the first # is % with alcohol dependence who had the disorder ->second # is the odds ratio, the chance that someone with alcohol dependence will have the psych disorder

Common Factor Model

Proposes that both AUD and CM disorder are linked through a third, unspecified factor, such as genetic predisposition, that contributes to the development of both CM conditions. Common Factor-->Psych. Disorder and AUD Separately

Definition

Refers to the presence of two or more illnesses(medical or psychiatric conditions, including alcohol and other drug use disorders-in the same person)

Sampling Strategy

Studies assessing comorbidity divided into those conducted using patient (clinical) samples and those obtained from general population. Which would likely show higher rates of comorbidity?Why?Berkson's fallacy-people with two or more disorders are more likely to enter tx than those with one disorder, so CM rates likely to be higher in clinical samples as compared to population samples.

The Substance-Induced Anxiety Model

-AUD's lead to increased anxiety and vulnerability for co-occurring anxiety disorders.

AUD and Schizophrenia

-Contributing Factors; biological factors, psychological and social factors -Effects of AUD on Course and Outcome of Schizophrenia; AUD associated w/more severe course and poorer prognosis although comparison are methodologically complex -Treatment and Public Policy Implications; Need to implement and test integrated treatment, need to address policy barriers to increasing integrated treatment and evidence-based approaches

Interpretational Difficulties

Determining significance, Diagnostic issues, Sampling strategy

Secondary Alcoholism Model

Psych. Disorder--->AUD disorder contribute to development of AUD (i.e., attempts to self-medicate to relieve symptoms results in an AUD)

Potential Explanatory Models (meta-models to simplistically portray potential relations and important considerations)

Secondary Alcoholism Model, Secondary Psychiatric Disorder Model, Common Factor Model, Bi-Direcional Model

Bi-Directional Model

Sugests that regardless of which disorder is present first, each can make the other worse over time. AUD--->Psych. Disorder and AUD<---Psych. Disorder

General Comorbidity Rate

Takeaway; When AUD is present, prevalence rate for any other psychiatric disorder is nearly twice as high (19.9 vs 36.6%)

AUD and Anxiety 3 Primary Pathways

The Common-Factor Model, The Self-Medication Model, The Substance-Induced Anxiety Model

Why do these disorders often co-occur?

-Overlapping genetic vulnerabilities! Predisposing genetic factors may make a person susceptible to both addiction and other mental disorders or to having a greater risk of a second disorder once the first appears. -Overlapping environmental triggers; Stress, trauma, and early exposure to drugs are comma environmental factors that can lead to addiction and other mental illnesses. -Drug use disorders and other mental illnesses are developmental disorders; meaning they begin in the teen years or younger, during periods when the brain experiences dramatic changes. Early exposure can change the brain in ways that might increase the risk for mental disorders, and early symptoms may indicate increased risk for later drug use.

The Self-Medication Model

-People consume alcohol to cope with anxiety disorders, leading to co-occurring AUD's(negative reinforcement). -This model has received the most attention in the clinical and research literature.

Caveats to the Explanatory Models

-They are just simple explanations, actual models probably differ -Tx implications; if alcoholism leads to another disorder then treating alcoholism may be most useful way to tx second disorder and vice versa...

The Common Factor Model

-Third variable explains co-occurrence of anxiety and AUDs. -This model presumes there is no direct causal relationship existing between the two disorders. Instead, a third variable caused them both. -21year longitudinal study;early presence of anxiety disorders seemed to predict later development of alcohol dependence. But once they controlled for other variables, like drug or depression, the statistical sig failed, meaning the link between anxiety and AUD was not direct but may have been caused by the other variables. -the most consistently proposed third variables are genetic factors and personality traits such as anxiety sensitivity. -Overall, empirical data on this factor model is limited.

Treatment Implications

-Use and evaluation of integrated treatment approaches is increasing but still rare -Pharmacological Treatment Approaches -Psychosocial Treatment Approaches

Determining Significance

2 ways; statistical significance-refers to the finding that the presence of one disorder increases the risk for a sec on disorder beyond what the risk would be if the first disorder were not present. And clinical significance-reflects the extent to which the combined presence of another disorder affects the clinical course or optimal tx for either disorder.

Secondary Psychiatric Disorder Model

AUD--->Psych. Disorder suggests that AUD contributes to the development of a psychiatric condition(i.e., heavy drinking leading to physical dependence on alcohol, narrowing of social repertoires, and subsequent depression)

Consideration of comorbidity important for;

Understanding etiology of alcohol and other psychiatric disorders, Understanding course of alcohol use disorders,Developing and testing integrated treatment approaches for AUD's co-occurring with other psychiatric disorders,Developing optimal policies for best serving affected individuals and reducing costs to society.