Table:
Summarised results for alcohol use disorder and psychiatric comorbidities
| Prevalence of alcohol use disorder in people with comorbid diagnosis | Prevalence of comorbid diagnosis in people with alcohol use disorder | Longitudinal association between alcohol use disorder and psychiatric comorbidity | |
|---|---|---|---|
| Externalising disorders | |||
| Substance use disorders | ECA survey: 47·3% (in people with substance use disorder) | NCS survey: 40·6% lifetime substance use disorder in men; 47·1% in women | Substance use disorder to alcohol use disorder onset in early adulthood: HR 3·50 (95%CI 2·03–6·03) for early-to-middle adolescent substance use disorder;14 HR 3 96 (2·22–7·07) for late adolescent substance use disorder14 |
| Nicotine use disorders | Lifetime alcohol use disorder in people dependent on tobacco in the general population of Germany 18·1%;15 NESARC: current (12-month) alcohol use disorder of 22·8% in people currently dependent on nicotine16 | NESARC: current (12-month) nicotine dependence of 34·5% among people with current alcohol use disorder16 | Nicotine use disorders to alcohol use disorder: adjusted OR 1·92 (95%CI 1·35–2·74) for any use (past non-daily use up to present daily use) |
| Personality disorders | Lifetime alcohol use disorder in people with ASPD (pooled estimate from 6 studies): 77% (95%CI 66–86%);17 alcohol use disorder in people with BLPD (pooled estimate from 5 studies) 52% (42–63%)17 | ASPD in people with alcohol use disorder: median (across 16 studies) 18%, range 1–52%;18 BLPD in people with alcohol use disorder: median (across 7 studies) 21%, range 6–66%18 | Not found* |
| Internalising disorders | |||
| MDD | Median (across 35 studies) lifetime alcohol use disorder† in people with MDD: 30%, range 10–60%;19 ECA survey 16·5% MDD (lifetime) | MDD† in people with lifetime alcohol use disorder 37%;20 MDD† in people with 12-months alcohol use disorder 4–22%20 | Alcohol use disorder to MDD: pooled OR‡ 2·00 (95%CI 1·19–3·3);21 OR§ 3·2 (1·4–7·1) primary care attenders from 14 countries;22 MDD to alcohol use disorder: pooled OR¶ 2·09 (1·29–3·38)21 |
| Attention-deficit hyperactivity disorder | Alcohol use disorder|| in French students with ADHD 25·9%;23 alcohol use disorder** in young men enlisting to the Military Service in Australia with ADHD 19·3%24 | ADHD in adolescents with alcohol use disorder††: 19·9–23·6%;25 ADHD in adults with alcohol use disorder: 33% (current)25,26 | ADHD to alcohol use disorder: pooled OR‡‡ 1·35 (95%CI 1·11–1·64);27 pooled OR‡‡ 1·74 (1·38–2·20)28 |
| Anxiety disorder | Alcohol use disorder in people with any anxiety disorder 20–40%;20 ECA survey: 17·9% in people with any anxiety disorder, 28·7% in people with panic disorder | ECA survey: 19·4% any lifetime anxiety disorder; NCS survey: 8’6% lifetime GAD in men, 15·7% in women; NCS survey: 3·6% lifetime panic disorder in men, 12·9% in women; NCS survey: 19·3% lifetime social phobia in men, 30·3% in women | Alcohol use disorder to GAD: OR§ 1·5 (95%CI 0·5–4·7) primary care attenders from 14 countries;22 anxiety to alcohol use disorder: OR 1·61 (0·91–2·83) in adolescents and young adults of New Zealand followed up for 21 years29 |
| PTSD | Alcohol use disorder in young adults with PTSD in the general population of Brazil 34·4%;30 NESARC-III: 54·5% lifetime alcohol use disorder in people with lifetime PTSD31 | NCS survey: 10·3% lifetime PTSD in men, 26 ·2% in women; current PTSD in German patients with substance use disorder with alcohol dependence 22·9%32 | Alcohol use disorder to PTSD§§: OR 1·35 (95%CI 0·40–4·56) in unadjusted model; OR 0·70 (0·17–2·86) in fully adjusted model;33 PTSD to alcohol use disorder§§: OR 4·10 (1·41–11·89) in unadjusted model and OR 5·43 (1·56–18·93) in fully adjusted model33 |
| Thought and other psychiatric disorders | |||
| Schizophrenia and psychotic disorders | Median lifetime alcohol use disorder¶¶ 20·6% (IQR 13·5%, 35·9; range 1·3–57·0%)34 | ECA survey: 3·8% schizophrenia | Alcohol use disorder to psychotic experiences||||: OR 1·6 (95% CI 1·2–2·0);35 psychotic experiences to alcohol use disorder||||: 1·5 (1·2–2·0)35 |
| Bipolar disorders | Lifetime alcohol use disorder*** 24–44% in bipolar disorder or bipolar disorder I;36 lifetime alcohol use disorder*** 24–39% in bipolar disorder II36 | Bipolar disorder or bipolar disorder I*** 3·5–5% in people with lifetime alcohol use disorder36 | Not found* |
Results come from meta-analyses or nationally representative studies, whenever possible. Otherwise we present results from for comorbidity prevalence, and longitudinal studies for the association between alcohol use disorder and psychiatric comorbidities. ECA=Epidemiologic Catchment Area study (historical data [early 80s] on prevalence of psychiatric disorders in people with lifetime alcohol use disorder)37 NCS=National Comorbidity Survey (disorder prevalences are for people with lifetime alcohol dependence).38 HR=hazard ratio. NESARC=National Epidemiologic Survey on Alcohol and Related Conditions. OR=odds ratios. ASPD=antisocial personality disorder. BLPD=borderline personality disorder. MDD=major depressive disorder. ADHD=attention-deficit hyperactivity disorder. GAD=generalized anxiety disorder. PTSD=post-traumatic stress disorder.
No longitudinal studies on alcohol use disorder and psychiatric comorbidity were found.
Estimates from epidemiological studies in the general population; prevalence was extracted from figure 2 in Lai and colleagues,20 thus might not be exact.
Pooled OR from longitudinal and cross-sectional studies.
AUDIT score of 13 points or more.
The meta-analysis includes studies with heavy drinking in their alcohol use disorder category.
AUDIT score of 12 or more for man or 11 or more for woman indicates risk of addiction.
CAGE score of 2 or more for alcohol problems.
Results come from individual studies extracted from van Emmerik-van Oortmerssen and colleagues.25
Meta-analysis of longitudinal studies of childhood ADHD and later alcohol use disorder.
Study of 922 National Guard soldiers with pre-Iraq and post-Iraq deployment. Alcohol use disorder screened at baseline considered 12 months alcohol dependence and, at follow-up, 3 months dependence.
From a systematic review including inpatients and outpatients with schizophrenia and schizophrenia spectrum diagnoses.34
Results based on cross-sectional studies across 18 countries with retrospective reports about age at onset of psychotic experiences and alcohol use disorder.
Estimates from epidemiological studies in the general population; prevalence was extracted from figures 1 and 2 in Hunt and colleagues,36 thus might not be exact.