Psychiatric Comorbidity in Alcohol Dependence

Abstract

We review our clinical studies of psychiatric comorbidity in short-term and long-term abstinent and in treatment naïve alcoholics (STAA, LTAA and TNA). TNA ypically have less severe alcoholism than treated abstinent samples and evidence less severe psychiatric disturbance. Lifetime psychiatric diagnoses are the norm for STAA and LTAA but not for TNA. Individuals with alcohol and drug use disorders show greater antisocial personality disturbance, but do not show differences in the mood or anxiety domains or in borderline personality disorder (BPD) symptoms. The studies show that alcoholics can achieve and maintain abstinence in the face of ongoing mood, anxiety, or BPD problems. By contrast, for ASPD, LTAA essentially stop current antisocial behaviors in all seven domains of antisocial behaviors. We believe that ongoing antisocial behavior is not consistent with maintaining abstinence, and that LTAA modify their antisocial behavior despite continued elevated social deviance proneness and antisocial dispositionality. Abstinent individuals without lifetime psychiatric disorders and TNA show more (subdiagnostic threshold) psychiatric symptoms and abnormal psychological measures than nonalcoholic controls in the mood, anxiety, BPD, and antisocial domains. In summary, our studies show that although LTAA have achieved multi-year abstinence, they still report significant psychological distress compared to NAC. We believe this distress may negatively affect their quality of life. This suggests the importance of developing effective care models to address comorbid mental health problems in LTAA. We also show that antisocial personality disorder symptoms decline to the levels seen in normal controls, and that excluding individuals from research with a psychiatric diagnosis does not control for subdiagnostic psychiatric differences between alcoholics and controls.

Resting state synchrony in long-term abstinent alcoholics: Effects of a current major depressive disorder diagnosis

“…After a complete description of the study to the subjects, written informed consent was obtained. As presented in our other publications (George Fein, 2013; G Fein, 2015), psychiatric comorbidity was very high in the LTAA sample.…”

Genome-Wide Expression Profiles Drive Discovery of Novel Compounds that Reduce Binge Drinking in Mice

“…The last (and only the third) FDA-approved treatment for AUD was acamprosate in 2004. Clearly, new approaches are required to advance treatment options for AUD and other psychiatric illnesses, which show extensive comorbidity (Fein, 2015). Our study highlights the utility of emerging computational approaches to prioritize compounds that may target molecular profiles associated with binge drinking, and potentially 'drug' the altered gene networks.…”

Una comparación entre los estudios de fase 3 y un estudio de fase 4 de nalmefeno en el trastorno por uso de alcohol. ¿Existen diferencias?

“…En comparación con los ensayos de fase 3, los pacientes de entornos reales mostraron una tasa más alta de comorbilidades adictivas y psiquiátricas, un contraste obvio con las muestras aleatorias y controladas de estudios con criterios de inclusión habitualmente más restrictivos. De hecho, la tasa alta de comorbilidades psiquiátricas en pacientes con TUA es un fenómeno claramente documentado (Fein, 2015;Flensborg-Madsen et al, 2009). Este hallazgo apoya las críticas respecto de la validez externa de estudios experimentales (Persaud y Mamdani, 2006) y, a la vez, sugiere que estudios como el SENSE (van den Brink et al, 2014), que incluyen a pacientes con comorbilidades psiquiátricas, deberían ser la norma en lugar de la excepción.…”