Follow-up Study of Anxiety Disorder and Alcohol Dependence in Comorbid Alcoholism Treatment Patients

Kushner, Matt G.; Abrams, Ken; Thuras, Paul; Hanson, Karen L.; Brekke, Marjorie; Sletten, Sandra

doi:10.1097/01.alc.0000175072.17623.f8

Cited by 216 publications

(188 citation statements)

References 44 publications

(56 reference statements)

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“…Identifying consistent predictors of chronic SUDs in prospective studies has been difficult. Some factors suggested in the literature include family history of substance use disorders 8, 9 and Axis I disorders such as major depression 10-15 and anxiety disorders 11, 12, 16, 17 . However, not all studies have had consistent findings on these relationships 5, 17-19 …”

Section: Introductionmentioning

confidence: 99%

Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

Hasin

Fenton

Skodol

et al. 2011

Arch Gen Psychiatry

185

100

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Context Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD), and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions. Objective To determine the association between the ten DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample. Design Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (N=1,172), cannabis use disorder (N=454) or nicotine dependence (N=4,017) at baseline and who were re-interviewed three years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main outcome measure Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period. Results Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis and nicotine use disorders (adjusted odds ratios: 2.46-3.51), as was borderline personality disorder (adjusted odds ratios: 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios: 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence. Conclusions The consistent findings on the association of antisocial, borderline and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality disorders and the role of specific components of these disorders, biological and environmental contributors to these relationships, and potential applications of these findings to treatment development.

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Section: Introductionmentioning

confidence: 99%

Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

Hasin

Fenton

Skodol

et al. 2011

Arch Gen Psychiatry

185

100

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“…Psychiatric comorbidity has received considerable attention as a potential predictor of poor treatment outcomes in alcohol-dependent individuals (Bradizza et al, 2006;Kranzler et al, 1996;Krushner et al, 2005). Several studies have found that affective, anxiety, and antisocial personality disorders are associated with a high risk of relapse to heavy drinking (Driessen et al, 2001;Galen et al, 2000;Greenfield et al, 1998;Kranzler et al, 1996;Strowig, 2000;Verheul et al, 1998;Willinger et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Wojnar

Ilgen

Jakubczyk

et al. 2008

Drug and Alcohol Dependence

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Background-The present study was designed to examine the influence of suicidality on relapse in alcohol-dependent patients. Specifically, a lifetime suicide attempt at baseline was used to predict relapse in the year after treatment. Also, the unique contribution of impulsive suicide attempts was examined.Methods-A total of 154 patients with alcohol dependence, consecutively admitted to four addiction treatment facilities in Warsaw, Poland participated in the study. Of the 154 eligible patients, 118 (76.6%) completed a standardized follow-up assessment at 12 months.Results-Previous suicide attempts were common in adults treated for alcohol dependence with 43% patients in the present sample reporting an attempt at some point during their lifetime. Additionally, more than 62% of those with a lifetime suicide attempt reported making an impulsive attempt. Lifetime suicide attempts were not associated with post-treatment relapse (chisquare=2.37, df=1, p=0.124). However, impulsive suicide attempts strongly predicted relapse (OR=2.81, 95%C.I. = 1.13-6.95, p=0.026) and time to relapse (OR=2.10, 95% C.I. = 1.18-3.74, p=0.012) even after adjusting for other measures of baseline psychopathology, depression, impulsivity, hopelessness and alcohol use severity.Conclusions-This study is the first to document the relationship between pre-treatment impulsive suicide attempts and higher likelihood of post-treatment relapse in alcohol-dependent patents. Clinicians should routinely conduct an assessment for previous suicide attempts in patients with alcohol use disorders, and when impulsive suicidality is reported, they should recognize the increased risk for relapse and formulate their patients' treatment plans accordingly with the goals of reducing both alcoholic relapse and suicide rates.

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“…In addition, GABRA2 genotype has been associated with Conduct Disorder problems (Dick et al, 2006,) which have, in turn, also been linked to poor outcome (Myers et al, 1995). Thus, the potential exists for GABRA2 genotype to join the long list of clinical [e.g., severity of dependence (Bottlender and Soyka 2005), comorbid psychopathology (Ciraulo et al, 2003;Kushner et al, 2005;Pettinati et al, 1999)], psychological [e.g., self-efficacy, coping skills (Ciraulo et al, 2003;Maisto et al, 2000)], or biological [e.g., fast β EEG activity, sleep disturbance (Bauer 1994;Bauer 2001;Prichep et al, 1999;Saletu-Zyhlarz et al, 2004;Winterer et al, 1998;Brower et al, 1998;Brower et al, 2001;Clark et al, 1998;Drummond et al, 1998;Gillin et al, 1994)] variables for which a relationship to substance abuse treatment outcome has been demonstrated. If an association with GABRA2 could be demonstrated, then the field may benefit from an expansion of the theoretical framework for interpreting the causes of treatment failure.…”

Section: Introductionmentioning

confidence: 99%

Variation in GABRA2 Predicts Drinking Behavior in Project MATCH Subjects

Bauer

Covault

Harel

et al. 2007

Alcoholism Clin & Exp Res

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Follow-up Study of Anxiety Disorder and Alcohol Dependence in Comorbid Alcoholism Treatment Patients

Cited by 216 publications

References 44 publications

Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Variation in GABRA2 Predicts Drinking Behavior in Project MATCH Subjects

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