Severity of Alcohol Dependence and Its Relationship to Additional Psychiatric Symptoms in Male Alcoholic Inpatients

Abstract

Many alcoholics suffer from distress associated with psychiatric symptoms in addition to alcoholism. Although there may be many such symptoms reported by the alcoholic, there may not be enough in any one category to meet DSM III criteria for an additional psychiatric diagnosis, and consequently these symptoms may not be considered in treatment planning. In addition, the prevalence and severity of psychiatric symptoms may be dependent on the progression of alcoholism. The purpose of this study was to examine whether a relationship exists between patterns of psychiatric symptomatology and the level of severity of alcohol dependence in an inpatient male alcoholic sample, and to describe how this information can be utilized to differentiate large groups of alcoholics into clinical meaningful categories. The study sample was comprised of 100 male alcoholic inpatients from the Alcoholism Treatment Unit at a metropolitan Veterans Administration Hospital. Subjects were administered The Michigan Alcoholism Screening Test (MAST), the Severity of Alcohol Dependence Questionnaire (SADQ), and the Symptom Checklist-90-Revised (SCL-90-R). Correlational analysis of the data supported the hypothesis that a positive relationship exists between the severity of alcohol dependence and the prevalence of additional psychiatric symptom patterns. Partial correlational analysis indicated that the length of the alcoholic's illness and the number of inpatient treatments for alcoholism enhanced the relationship between the severity of alcoholism and most of the symptom scales. The utility of assessing concurrent psychiatric symptomatology as it relates to the severity of alcohol dependence is discussed in relation to treatment planning and prognostic assessment of the patient.

The association between DSM-III-R alcohol dependence, psychological distress and drug use

“…This confirms work by Allan (1991) and Schaeffer «£ a/. (Schaeffer et a/., 1987), although they used other measures of dependence and psychological distress. Among women, severity of dependence is associated with four areas of psychological distress as measured by the BSI: somatic, obsessive, depression and amdety.…”

Personality and substance use disorders: A prospective study.

“…For example, in another recent prospective study, Caspi et al (1997) examined the influence of personality on subsequent diagnosis of alcohol dependence but did not include other drugs and tobacco. Moreover, among studies that have examined personality correlates of clinically relevant SUD diagnoses, many have used clinical samples (e.g., Battaglia et al, 1996;Schaefer, Sobieraj, & Hollyfield, 1987), some containing individuals with multiple diagnoses (e.g., Gallucci, 1997;Nixon & Parsons, 1990). Studies examining use or abuse may suggest dimensions of temperament that relate to the onset of alcohol or other drug involvement, but they do not directly speak to those aspects of personality that may foreshadow more serious and longer lasting problems with substance abuse.…”

Dual Diagnosis

“…The "treatment" section of the patient's psychosocial history often indicates numerous treatments for both addiction and mental illness. In one study of one hundred male alcoholics, 50% had been in treatment once before and 26% had three or more inpatient treatments (Schaefer, 1987). Certainly one major reason for this high rate of recidivism is the chronicity and general nature of the disease of alcoholism.…”

“…Certainly one major reason for this high rate of recidivism is the chronicity and general nature of the disease of alcoholism. But Schaefer et al offer a second explanation: The presence of concurrent psychiatric symptoms that go untreated and unrecognized (Schaefer, 1987). He feels sobriety is not maintained despite the patient's efforts because of remaining psychiatric problems.…”

“…Since affective disorders appear more often in conjunction with alcoholism than with any other psychiatric disorder (Schaefer, 1987;Woodruff, et al, 1983;Shore, et al, 1975), a criteria to aid the clinician in making differential diagnosis for alcoholism and affective disorder is vitally important. For this paper, references to Groups I, I1 and 111 will be as follows:…”