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The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment.
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1988
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Clinical PopulationsSubstance UsePsychiatric DisordersMultiple DiagnosesMental HealthPsychologyGeneral PopulationAlcohol MisuseComorbid Psychiatric DisorderAddiction MedicinePublic HealthOther Psychiatric DisordersHealth SciencesPsychiatryAddiction TreatmentAlcohol AbuseAlcohol ControlAlcohol DependenceSubstance AbuseAddictionOther Psychiatric DiagnosesMedicinePsychopathology
High comorbidity between alcoholism and other psychiatric disorders has been documented in clinical samples, though this may partly reflect Berkson’s bias from treatment‑seeking populations. The study analyzes data from the Epidemiologic Catchment Area survey of about 20,000 general‑population participants to assess comorbidity between alcohol use disorders, other substance use, and nonsubstance psychiatric disorders, and to evaluate how comorbidity influences psychiatric treatment utilization. Alcoholics were more likely to have any psychiatric diagnosis, particularly antisocial personality disorder, other substance use, and mania, while depression showed a weaker link; comorbidity raised treatment utilization but did not increase reporting of alcohol problems to doctors, confirming earlier clinical studies and underscoring the need for physicians to monitor alcoholism more closely.
It is apparent from previous studies in clinical populations that there is a high comorbidity rate between alcoholism and other psychiatric diagnoses. However, this may simply be an expression of Berkson's bias (i.e., an increased tendency for persons with multiple diagnoses to seek and receive treatment and thus fall into study populations drawn from treatment sources). In this article, we use data from the Epidemiologic Catchment Area survey to examine the comorbidity between alcohol abuse and dependence, other substances of abuse and nonsubstance psychiatric disorders in a sample of approximately 20,000 persons drawn from the general population. We also examine the effect of comorbidity on psychiatric treatment. Every one of the psychiatric diagnoses we examined was more likely to occur in alcoholics than in nonalcoholics. Associations were particularly strong with antisocial personality disorder, other substance use and mania. The association between alcoholism and depressive disorders was positive but not very strong. The presence of other illnesses increased the likelihood of utilization of treatment services by alcoholics but did not increase the likelihood that drinking problems would be communicated to a doctor. The findings confirm prior studies of comorbidity in clinical samples and suggest the need for increased vigilance toward alcoholism by physicians.