Psychopathology as a Predictor of Treatment Outcome in Alcoholics

TLDR

The study aimed to determine how additional DSM‑III psychiatric diagnoses influence alcohol treatment outcomes, compare the prognostic value of categorical diagnoses versus a global symptom severity measure, and evaluate whether psychopathology ratings enhance the predictive power of alcohol‑dependence assessments. A one‑year follow‑up of 266 alcoholics who underwent comprehensive psychiatric evaluation, including DSM‑III diagnoses via the NIMH Diagnostic Interview Schedule, was conducted. Additional psychiatric diagnoses generally predicted poorer outcomes, with gender‑specific effects: men with major depression, antisocial personality, or drug abuse fared worse, whereas women with major depression showed better drinking outcomes but poorer prognosis with antisocial personality or drug abuse; these effects were independent of general psychopathology or dependence severity.

Abstract

• We performed a one-year follow-up study of 266 alcoholics who had received extensive psychiatric assessment, including diagnosis with the National Institute of Mental Health Diagnostic Interview Schedule and<i>DSM-III</i>criteria, during their index treatment episode. The aims were to (1) evaluate the relationship between additional<i>DSM-III</i>diagnoses in alcoholics and outcome at follow-up, (2) assess the relative prognostic power of different ways of measuring psychopathology by comparing categorical<i>DSM-III</i>diagnoses and a global symptom severity measure, and (3) assess whether ratings of psychopathology add to the prognostic power of an alcoholdependence measure. While coexistent psychiatric diagnoses generally predicted poorer treatment outcome, there were significant interactions in the relationship between diagnoses and treatment outcome for men and women. For men, having an additional diagnosis of major depression, antisocial personality, or drug abuse was associated with poorer outcome. For women, having major depression was associated with a better outcome in drinking-related measures, while antisocial personality and drug abuse were associated with poorer prognosis. The value of determining psychiatric diagnosis was supported by covariance analyses that suggested that prognostic significance of specific disorders was not accounted for by general psychopathology or general dependence dimensions.