Psychiatric Comorbidity

Abstract

When a primary care clinician identifies a patient with an alcohol use disorder, there is a high likelihood that this patient has a psychiatric comorbidity. In the National Epidemiologic Survey on Alcoholism and Related Conditions (NESARC), a study representative of the US population, 40.7 % of people who sought treatment for alcohol dependence had at least one mood disorder and 33 % had at least one anxiety disorder [Grant BF, Stinson FS, Dawson DA, et al. Prevalence and Co-occurrence of substance use disorders and independent mood and anxiety disorders. Arch Gen Psychiatry. 2004;61:807–816.]. People who are at-risk drinkers, though they do not meet criteria for dependence or abuse, have higher rates of psychiatric comorbidity than lower risk drinkers or those who abstain from alcohol [Bott K, Meyer C, Rumpf HJ, et al. Psychiatric disorders among at-risk consumers of alcohol in the general population. J Stud Alcgohol. 2005,66: 246–253]. If left untreated, mood, anxiety and other psychiatric disorders can interfere with successful treatment and recovery from alcohol dependence, increase the chance of relapse and lead to overall poorer health outcomes. In the worst-case scenario, these conditions can be fatal, as alcohol use is a significant risk factor for suicide. When treating a patient with an alcohol-related illness, it is important to detect and treat comorbid psychiatric illnesses. It is also important to be able to do an appropriate safety assessment so that a patient can be referred to a higher level of psychiatric care (e.g., psychiatrist, hospital), when necessary.