Certain psychiatric disorders drive alcohol dependence.

SAN DIECO -- Mood or anxiety disorders, drug dependence, and nicotine dependence that co-occur with alcohol dependence can have negative effects on the long-term persistence of alcohol dependence.

Those are key conclusions from a 3-year follow-up of data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

"The effects of specific co-occurring psychiatric disorders on the persistence of alcohol problems are not well understood," Sharon Samet, Ph.D., and Deborah Hasin, Ph.D., of the department of psychiatry at Columbia University, New York, and the New York State Psychiatric Institute, reported in a poster presented at the annual scientific conference of the Research Society on Alcoholism.

"In patient samples, major depression is associated with greater risk for relapse to drinking and to alcohol dependence following treatment," they wrote.

"Patient samples provide important information about individuals in alcohol treatment, but these samples represent a small proportion of the total number of individuals with alcohol dependence. The present study uses general population data."

Dr. Samet and Dr. Hasin evaluated data from a nationally representative sample of adults who were interviewed in 2001-2002 for NESARC Wave 1 and re-interviewed in 2004-2005 for NESARC Wave 2. They used the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV (AUDADIS-IV) to diagnose DSM-IV alcohol dependence and other psychiatric disorders.

Then they used logistic regression to estimate the odds of persistence of alcohol dependence at follow-up among individuals who had co-occurring mood, anxiety, and substance disorders in the year before baseline or on year 1 or year 2 of follow-up, compared with individuals without comorbidity.

They adjusted the analyses for age, gender, race/ethnicity, education, employment status, marital status, and alcohol treatment.

At baseline, 1,172 individuals met criteria for DSM-IV alcohol dependence. Of those, 422 (36%) manifested persistence of alcohol dependence at follow-up.

Persistent alcohol use during the 3-year follow-up was predicted by major depressive episode (odds ratio 1.47), dysthymia (OR 1.96), and mania (OR 2.11), panic disorder (OR 2.19) and generalized anxiety disorder (OR 1.94), and nicotine (OR 1.74) and drug dependence (OR 1.94).

"This study improves on earlier studies of comorbidity in a number of ways," Dr. Samet and Dr. Hasin wrote in their poster. "The strengths of this study include first, a large representative general population sample that avoided potential biases of treated samples; second, the longitudinal collection of data that avoided potential recall problems in retrospective studies; and third, an extensively tested valid and reliable diagnostic measure."

The study was supported by the National Institute on Alcohol Abuse and Alcoholism and by the New York State Psychiatric Institute.