Seventy-Five Years of Comorbidity Research

Kushner, Matt G.

doi:10.15288/jsads.2014.s17.50

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…However, recent and historic data have shown that these numbers were significantly higher in individuals diagnosed with diseases such as major depressive disorder or trauma and stressor-related disorders and these populations tended to be less responsive to treatment (Grant et al, 2016; Kranzler and Rosenthal, 2003). These findings are consistent with a large body of literature suggesting a high degree of comorbidity between AUD and a wide range of affective disorders (Brenhouse and Andersen, 2011; Brodie et al, 1999; Buckley, 2006; Buckley and Brown, 2006; Kessler, 2004; Kushner, 2014). …”

supporting

confidence: 90%

Adolescent Social Isolation as a Model of Heightened Vulnerability to Comorbid Alcoholism and Anxiety Disorders

Butler

Karkhanis

Jones

et al. 2016

Alcoholism Clin & Exp Res

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Individuals diagnosed with anxiety-related illnesses are at increased risk of developing alcoholism, exhibit a telescoped progression of this disease and fare worse in recovery, relative to alcoholics that do not suffer from a comorbid anxiety disorder. Similarly, preclinical evidence supports the notion that stress and anxiety represent major risk factors for the development of alcohol use disorder (AUD). Despite the importance of understanding the link between anxiety and alcoholism, much remains unknown about the neurobiological substrates underlying this relationship. One stumbling block has been the lack of animal models that reliably reproduce the spectrum of behaviors associated with increased vulnerability to these diseases. Here, we review the literature that has examined the behavioral and neurobiological outcomes of a simple rodent adolescent social isolation procedure and discuss its validity as a model of vulnerability to comorbid anxiety disorders and alcoholism. Recent studies have provided strong evidence that adolescent social isolation of male rats leads to the expression of a variety of behaviors linked with increased vulnerability to anxiety and/or AUD, including deficits in sensory gating and fear extinction, and increases in anxiety measures and ethanol drinking. Neurobiological studies are beginning to identify mesolimbic adaptations that may contribute to the behavioral phenotype engendered by this model. Some of these changes include increased excitability of ventral tegmental area dopamine neurons and pyramidal cells in the basolateral amygdala and significant alterations in baseline and stimulated catecholamine signaling. A growing body of evidence suggests that adolescent social isolation may represent a reliable rodent model of heightened vulnerability to anxiety disorders and alcoholism in male rats. These studies provide initial support for the face, construct, and predictive validity of this model and highlight its utility in identifying neurobiological adaptations associated with increased risk of developing these disorders.

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supporting

confidence: 90%

Adolescent Social Isolation as a Model of Heightened Vulnerability to Comorbid Alcoholism and Anxiety Disorders

Butler

Karkhanis

Jones

et al. 2016

Alcoholism Clin & Exp Res

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“…Consistent with this, DTC has been associated with life stressors such as poverty and work difficulties (c.f., Kushner, 2014) in the absence of AnxD. Further, affect regulation training (ART) has been shown to significantly improve abstinence rates among AUD treatment outpatients who endorse DTC in the absence of an AnxD (Stasiewicz et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Drinking to cope with negative emotions moderates alcohol use disorder treatment response in patients with co-occurring anxiety disorder

Anker

Kushner

Thuras

et al. 2016

Drug and Alcohol Dependence

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Background Epidemiological studies and theory implicate drinking to cope (DTC) with anxiety as a potent moderator of the association between anxiety disorder (AnxD) and problematic alcohol use. However, the relevance of DTC to the treatment of alcohol use disorder (AUD) in those with a co-occurring AnxD has not been well studied. To address this, we examined whether DTC moderates the impact of two therapies: (1) a cognitive behavioral therapy (CBT) designed to reduce DTC and anxiety symptoms; (2) a progressive muscle relaxation training (PMRT) program designed to reduce anxiety symptoms only. Methods Patients undergoing a standard AUD residential treatment with a co-occurring AnxD (N = 218) were randomly assigned to also receive either the CBT or PMRT. DTC in the 30 days prior to treatment was measured using the Unpleasant Emotions subscale of the Inventory of Drinking Situations. Results Confirming the predicted moderator model, the results indicated a significant interaction between treatment group and level of pre-treatment DTC behavior. Probing this interaction revealed that for those reporting more pre-treatment DTC behavior, 4-month alcohol outcomes were superior in the CBT group relative to the PMRT group. For those reporting less pre-treatment DTC behavior, however, 4-month alcohol outcomes were similar and relatively good in both treatment groups. Conclusions These findings establish a meaningful clinical distinction among those with co-occurring AUD-AnxD based on the degree to which the symptoms of the two disorders are functionally linked through DTC. Those whose co-occurring AUD-AnxD is more versus less strongly linked via DTC are especially likely to benefit from standard AUD treatment that is augmented by a brief CBT designed to disrupt this functional link.

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“…Despite this, the bulk of psychopathology research is still conducted on specific manifestations of comorbidity, or on specific disorders in isolation, as if they are etiologically and pathophysiologically unique (Caspi et al, 2014; Lahey et al, 2011). If this were the case, every possible disorder pairing would also be unique, and would require its own comorbidity model (Kushner, 2014). However, analyses of the correlations among DSM disorders have taught us that, empirically, these disorders are best conceptualized as indicators of the IE spectra.…”

Section: The Case For Moving Beyond Comorbidity As a Focus In Researchmentioning

confidence: 99%

Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span

Tackett²,

et al. 2016

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In this review, we propose a novel developmentally informed framework to push research beyond a focus on comorbidity between discrete diagnostic categories, and to move towards research based on the well-validated dimensional and hierarchical structure of psychopathology. For example, a large body of research speaks to the validity and utility of the Internalizing and Externalizing (IE) spectra as organizing constructs for research on common forms of psychopathology. The IE spectra act as powerful explanatory variables that channel the psychopathological effects of genetic and environmental risk factors, predict adaptive functioning, and account for the likelihood of disorder-level manifestations of psychopathology. As such, our proposed theoretical framework uses the IE spectra as central constructs to guide future psychopathology research across the lifespan. The framework is particularly flexible, as any of the facets or factors from the dimensional and hierarchical structure of psychopathology can form the focus of research. We describe the utility and strengths of this framework for developmental psychopathology in particular, and explore avenues for future research.

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Seventy-Five Years of Comorbidity Research

Cited by 10 publications

References 23 publications

Adolescent Social Isolation as a Model of Heightened Vulnerability to Comorbid Alcoholism and Anxiety Disorders

Adolescent Social Isolation as a Model of Heightened Vulnerability to Comorbid Alcoholism and Anxiety Disorders

Drinking to cope with negative emotions moderates alcohol use disorder treatment response in patients with co-occurring anxiety disorder

Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span

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