Introduction to Diagnosis and Treatment of Alcoholism[1]

Comorbidity General Lecture Marc A. Schuckit, M.D. Department of Psychiatry University of California, San Diego Copyright Alcohol Medical Scholars Program 1 Some Explanations for Comorbidity 1. Substance induced temporary disorders 2. Substances intensify prior psychiatric conditions 3. A few psychiatric disorders increase the risk for substance use disorders Copyright Alcohol Medical Scholars Program 2 Rationale • Drugs can cause psychiatric symptoms • These last days to weeks • They clear spontaneously Copyright Alcohol Medical Scholars Program 3 Hamilton Depression Score > 20* 40% * Mood swings last longer 30% Source: Brown S, Schuckit M. (1988) J Stud Alcohol;49:412-417. 20% 10% 0% 1 2 3 4 Weeks Abstinent 16 4 Copyright Alcohol Medical Scholars Program Anxiety In 171 Primary Alcoholics Symptom Withdrawal palpitations and/or shortness of breath 80% Panic while drinking 4% Panic while sober 2% Generalized anxiety while sober 4% • • • • Source: Brown S, Schuckit M. J Stud Alcohol. 1990;51:34-41. Copyright Alcohol Medical Scholars Program 5 When 2+ Disorders Are Observed: • Which one(s) should be treated? • What is best therapy? • Will disorders and/or treatments interact? Copyright Alcohol Medical Scholars Program 6 Comorbidity is Common in SUD • 2 / 3 have 2nd diagnosis BUT • Most are ASPD and other SUD • Many others are organic Copyright Alcohol Medical Scholars Program 7 Studies of Children Of Alcoholics Don't reveal increased psychiatric disorders Copyright Alcohol Medical Scholars Program 8 Diagnosis Can Indicate: • When to intervene • Treatment with best asset to risk ratio Copyright Alcohol Medical Scholars Program 9 DSM IV Major Depressive Episode • A. 5/9 symptoms for two weeks with either (1) depressed mood or (2) loss of interest or pleasure • B-E. Exclusion criteria • MDD is diagnosed by symptoms and history Copyright Alcohol Medical Scholars Program 10 Alcoholism Course • Fluctuating: – controlled use – problems – abstinence • 20% spontaneous remission Copyright Alcohol Medical Scholars Program 11 Anxiety Disorders • Panic Disorder with or without Agoraphobia • Agoraphobia • Social Phobia • Specific Phobia • Obsessive-Compulsive Disorder • Posttraumatic Stress Disorder • Generalized Anxiety Disorder Copyright Alcohol Medical Scholars Program 12 Depressive Symptoms in Alcoholics • 80% Sadness • 30% - 40% Depressive Episodes • Question: What is the best treatment? Copyright Alcohol Medical Scholars Program 13