Lecture Notes: Psychiatric Comorbidities with Alcohol Use Disorder

Key Topics

• Psychiatric Comorbidities
  • Mood and anxiety disorders co-occur frequently with substance use disorders.
  • Bi-directional relationship between mood/anxiety disorders and alcohol use.

Alcohol Use and Mood Disorders

• Statistics from NIAAA Study:

  • 40% of individuals with alcohol use disorder have a current mood disorder.
  • 30% have a current anxiety disorder.

• Bi-directional Relationship:

  • Alcohol can worsen depression and anxiety (alcohol as a depressant).
  • Mood disorders can lead to alcohol use as a form of self-medication.
  • Shared vulnerabilities such as genetic predispositions and early life adversities.

Treatment Challenges

• Complicated Diagnosis:

  • Mood/anxiety symptoms can mimic alcohol use disorder symptoms.
  • Important to discern between independent and substance-induced disorders.

• Diagnosis and Treatment:

  • Look at the order of symptom appearance and family history.
  • Anxiety disorders often pre-date substance use disorder.
  • Assess mood/anxiety symptoms during abstinence periods.

Treatment Strategies

• Independent Disorders:

  • Target mood/anxiety disorders independently if they are primary.

• Substance-Induced Disorders:

  • Focus on cessation or reduction of alcohol use.

• Antidepressants and Psychosocial Treatments:

  • Antidepressants offer mild benefits for concurrent mood and substance disorders.
  • Psychosocial treatments (e.g., CBT) recommended for mild-moderate depression.
  • Severe depression may require early medication intervention.

Clinical Trials and Medications

• Sertraline and Naltrexone Combination:

  • Combined treatment can outperform monotherapies in independent mood and alcohol disorders.

• Medication Recommendations:

  • SSRIs like Sertraline have the most evidence base.
  • Patient preference and severity guide treatment start.

• Anxiety Disorders:

  • Gabapentin as dual treatment for anxiety and alcohol use.

• Benzodiazepines:

  • Not recommended for long-term treatment due to misuse potential.
  • Alternative medications include trazodone, anticonvulsants, and lifestyle changes.

Key Points

• Assessment:

  • Clinicians need to assess if mood/anxiety symptoms are independent or substance-induced.

• Treatment Initiation:

  • Psychosocial treatments first unless severe symptoms or patient preference.
  • Combine treatments for severe or persistent mood symptoms.

• Medication Use:

  • Avoid simultaneous initiation of two medications unless necessary due to severity.