Alcohol dependence (AD) presents with substantial clinical
heterogeneity, including concurrent use of non-alcohol drugs. Here, we examine
specific patterns of concurrent non-alcohol substance use during the previous
year among a nationally representative sample of adults with DSM-IV AD, and
estimate their population prevalence in the U.S. We then evaluate alcohol use
behavior and comorbid psychopathology among respondents with AD according to
their patterns of concurrent non-alcohol substance use.
These analyses utilized data from Waves 1 and 2 of the
National Epidemiologic Survey on Alcohol and Related Conditions. Latent class
analyses classified respondents with AD into four clinically meaningful
patterns of concurrent substance use: (1) use of alcohol only; (2) use of
alcohol and tobacco only; (3) use of alcohol, tobacco and cannabis; and (4) use
of alcohol, tobacco, cannabis, cocaine, and other illicit drug(s).
Among AD respondents, the most prevalent pattern was the use
of alcohol and tobacco only (weighted percentage, 32.4%), followed by the use
of alcohol only (weighted percentage, 27.5%). AD respondents who used alcohol,
tobacco, cannabis, cocaine, and other illicit drug(s) (weighted percentage,
25.3%) manifested the most severe pattern of alcohol consumption, and had
significant overrepresentations of major depression, panic, and other anxiety
disorders as well as paranoid, schizotypal, borderline, antisocial, and
histrionic personality disorders compared with those who used alcohol alone.
Specific patterns of concurrent substance use convey
important information regarding the clinical presentation and prognosis for AD.
In particular, concurrent use of illicit drugs over the past year by AD
individuals was associated with greater severity and comorbid psychopathology.
These data suggest the need for pragmatic trials of AD interventions that take
into account patterns of substance use behavior in addition to an AD diagnosis.
By: Moss HB1, Goldstein RB1, Chen CM2, Yi HY2.
- 1National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA.
- 2Alcohol Epidemiologic Data System, CSR Incorporated, Arlington, VA 22201, USA.
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