Prevalence of DSM-IV alcohol diagnoses and symptoms in adolescent community and clinical samples

OBJECTIVE: Summary prevalence data are critical to determining the utility of DSM-IV criteria for alcohol use disorders among adolescents. This study examined cross-study consistency in the relative prevalence of DSM-IV alcohol symptoms, the ratio of alcohol abuse to dependence diagnoses, the prevalence of the physiological dependence subtype, and the proportion of subthreshold cases of dependence. METHOD: DSM-IV alcohol diagnosis and symptom prevalence data were obtained from five community and four clinical adolescent samples. RESULTS: There was a moderate level of cross-study agreement on the relative prevalence of alcohol symptoms (mean Spearman p = 0.47). The most common symptoms were dependence criteria: tolerance and drinking more or longer than intended. A relatively high degree of variability in the ratio of abuse to dependence diagnoses and the proportion with physiological dependence was observed. All samples included a significant proportion of subthreshold cases of dependence: up to 12% in community and up to 34% in clinical samples. CONCLUSIONS: Alcohol dependence symptoms of tolerance and drinking more or longer than intended have relatively high prevalence among adolescents. These high prevalence symptoms affect the ratio of abuse to dependence diagnoses in some studies, the prevalence of the physiological dependence subtype, and the proportion of subthreshold cases of dependence.     

Craving and withdrawal as core symptoms of alcohol dependence

There is ongoing debate regarding the validity of the distinction of alcohol abuse and dependence, the distinction between normality and alcohol abuse, and the absence of craving in the DSM-IV classification of alcohol use disorders. In this study, we examine the discriminant validity of the DSM-IV alcohol use disorder diagnoses in three different populations (98 patients from an alcohol treatment service, 68 nontreatment-seeking heavy drinkers, and 75 psychiatric outpatients). We compare the results of the DSM-IV classification with an alternative classification that requires craving and withdrawal for the diagnosis of dependence and at least two DSM-IV abuse-dependence symptoms for the diagnosis of abuse: the Craving Withdrawal Model (CWM). Although the total prevalence of any alcohol use disorder did not differ between DSM-IV and CWM, the distinction between normality and abuse and between abuse and dependence was better for the CWM categories.     

Prospective evaluation of the four DSM-IV criteria for alcohol abuse in a large population

OBJECTIVE: In 1994 DSM-IV presented new criteria for substance abuse as repetitive problems in any one of four areas reflecting social, interpersonal, and legal difficulties. The authors systematically evaluate the performance of each of the four diagnostic criteria for alcohol abuse (problems in role functioning, alcohol use in hazardous situations, alcohol-related legal problems, and social or interpersonal problems) and determine the prognosis associated with a threshold of one versus two or more criterion endorsements. METHOD: Baseline and 5-year follow-up data were analyzed for 2,596 men and women from the Collaborative Study on the Genetics of Alcoholism, including 1,881 individuals with no alcohol-related diagnosis, and 715 with alcohol abuse, after excluding subjects with alcohol dependence. Performance of each criterion was analyzed for the entire group and for the 565 individuals who endorsed only one criterion at baseline. RESULTS: One alcohol abuse criterion was endorsed by 79% of subjects with alcohol abuse, 18.5% endorsed two, and 2.5% endorsed three. Compared with subjects who endorsed no criteria, individuals who reported any of the four diagnostic criteria at baseline had higher rates of alcohol and drug intake and related problems and higher rates of future difficulties. Diagnostic thresholds of one versus two abuse criteria at baseline performed equally well regarding most outcomes, although endorsement of two criteria predicted a higher risk for progression to dependence. The criterion most frequently endorsed--hazardous use--was associated with baseline substance use characteristics and problematic outcomes similar to those for the other criteria. CONCLUSIONS: The four DSM-IV alcohol abuse criteria performed well regarding both cross-sectional characteristics and the prediction of future problems, but no single diagnostic criterion was superior to any other. The similarity of outcomes for subjects with diagnostic thresholds of one versus two or more criteria may favor the continued use of a threshold of one criterion in the diagnosis of alcohol abuse.     

Inhalant use, abuse, and dependence among adolescent patients: commonly comorbid problems

OBJECTIVE: Little is known about adolescents with DSM-IV-defined inhalant abuse and dependence. The aim of this study was to compare comorbidity among (1) adolescents with inhalant use disorders, (2) adolescents who reported using inhalants without inhalant use disorder, and (3) other adolescent patients drawn from an adolescent drug and alcohol treatment program. METHOD: The authors examined 847 admissions of patients who had completed structured diagnostic assessments. The three groups were compared for noninhalant substance use disorders, posttraumatic stress disorder, conduct disorder, major depression, previous suicide attempts, and physical/sexual abuse and neglect. RESULTS: Adolescents with inhalant abuse or dependence (group 1; n = 28) were significantly more likely to meet lifetime criteria for abuse or dependence on alcohol, hallucinogens, nicotine, cocaine, and amphetamines, to have had major depression, and to have attempted suicide compared with other adolescent patients who reported never using inhalants (group 3); adolescents with inhalant use disorders also reported significantly more abuse and neglect. Adolescents with inhalant abuse or dependence (group 1) did not differ significantly on any measure compared with adolescents who reported using inhalants without an inhalant use disorder (group 2). CONCLUSIONS: Adolescent patients with a history of inhalant use, abuse, or dependence entering treatment should be carefully screened for noninhalant substance use disorders, major depression, suicidality, and abuse and neglect.     

Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

CONTEXT: Epidemiologic information is important to inform etiological research and service delivery planning. However, current information on the epidemiology of alcohol use disorders in the United States is lacking. OBJECTIVES: To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, and treatment of DSM-IV alcohol abuse and dependence. Design, Setting, and PARTICIPANTS: Face-to-face interviews with a representative US adult sample (N = 43 093). MAIN OUTCOME MEASURES: Lifetime and 12-month DSM-IV alcohol abuse and dependence. RESULTS: Prevalence of lifetime and 12-month alcohol abuse was 17.8% and 4.7%; prevalence of lifetime and 12-month alcohol dependence was 12.5% and 3.8%. Alcohol dependence was significantly more prevalent among men, whites, Native Americans, younger and unmarried adults, and those with lower incomes. Current alcohol abuse was more prevalent among men, whites, and younger and unmarried individuals while lifetime rates were highest among middle-aged Americans. Significant disability was particularly associated with alcohol dependence. Only 24.1% of those with alcohol dependence were ever treated, slightly less than the treatment rate found 10 years earlier. Strong associations between other substance use disorders and alcohol use disorders (odds ratios, 2.0-18.7) were lower but remained strong and significant (odds ratios, 1.8-7.5) when controlling for other comorbidity. Significant associations between mood, anxiety, and personality disorders and alcohol dependence (odds ratios, 2.1-4.8) were reduced in number and magnitude (odds ratios, 1.5-2.0) when controlling for other comorbidity. CONCLUSIONS: Alcohol abuse and dependence remain highly prevalent and disabling. Comorbidity of alcohol dependence with other substance disorders appears due in part to unique factors underlying etiology for each pair of disorders studied while comorbidity of alcohol dependence with mood, anxiety, and personality disorders appears more attributable to factors shared among these other disorders. Persistent low treatment rates given the availability of effective treatments indicate the need for vigorous education efforts for the public and professionals.     

Five-year clinical course associated with DSM-IV alcohol abuse or dependence in a large group of men and women.

OBJECTIVE: The prognostic validity of the DSM-IV diagnoses of alcohol abuse and alcohol dependence was evaluated by examining the 5-year clinical course associated with those diagnoses in a large group of predominantly blue-collar men and women. METHOD: Personal semistructured interviews were carried out 5 years after an initial evaluation with 1,346 (75%) of the approximately 1,800 men and women participating in the Collaborative Study on the Genetics of Alcoholism who were eligible for follow-up. RESULTS: About two-thirds of the 298 subjects with DSM-IV alcohol dependence at baseline maintained that diagnosis during the 5-year study period. Fifty-five percent of the 288 subjects with DSM-IV alcohol abuse at baseline continued to meet one or more of the 11 DSM-IV abuse/dependence criteria, and 3.5% went on to meet the criteria for dependence at follow-up. Among the 760 subjects with no alcohol diagnosis at baseline, 2.5% met the criteria for alcohol dependence and 12.8% for alcohol abuse at follow-up. Baseline characteristics that predicted the occurrence of any of the 11 DSM-IV abuse/dependence criteria during the 5-year interval included male gender, lack of marital stability, presence of several of the criteria for dependence, and history of illicit drug use. CONCLUSIONS: The data suggest that over 5 years the DSM-IV diagnosis of alcohol dependence predicts a chronic disorder with a relatively severe course, while DSM-IV alcohol abuse predicts a less persistent, milder disorder that does not usually progress to dependence.     

Hippocampal volume in adolescent-onset alcohol use disorders

OBJECTIVE: Alcohol use disorders (defined as DSM-IV alcohol dependence or abuse) are prevalent and serious problems among adolescents. As adolescence is marked by progressive hippocampal development, this brain region may be particularly susceptible to the adverse effects of adolescent alcohol use disorders. This study compared the hippocampal volumes of adolescents and young adults with adolescent-onset alcohol use disorders to those of healthy matched comparison subjects. METHOD: Magnetic resonance imaging was used to measure the hippocampal volumes and volumes of comparison brain regions in 12 subjects with alcohol use disorders and 24 comparison subjects matched on age, sex, and handedness. RESULTS: Both left and right hippocampal volumes were significantly smaller in subjects with alcohol use disorders than in comparison subjects. Total hippocampal volume correlated positively with the age at onset and negatively with the duration of the alcohol use disorder. Intracranial, cerebral, and cortical gray and white matter volumes and measures of the mid-sagittal area of the corpus callosum did not differ between groups. CONCLUSIONS: In the mature brain, chronic alcohol use disorders are associated with graded global brain dysmorphology. Although the etiology, neuropsychological consequences, and permanence of these hippocampal findings need to be further examined, these findings suggest that, during adolescence, the hippocampus may be particularly susceptible to the adverse effects of alcohol.     

The epidemiology of alcohol use in Izmir,Turkey: drinking pattern,impairment and help-seeking

Purpose

There is no report on various patterns of alcohol drinking and related impairment, help-seeking in Turkey. We investigated the 12-month prevalence and correlates of drinking patterns and alcohol use disorders in the general population of Izmir-Turkey, with further analyses on role impairment and help-seeking.

Method

A multi-stage clustered area probability sample of adult household residents in the Izmir Metropolitan Area was assessed using the Composite International Diagnostic Interview 2.1 (n? = 4011). Estimation focused on prevalence and correlates of 12-month drinking pattern and DSM-IV alcohol use disorders. The 12-month drinking pattern included groups of non-regular users, regular non-heavy drinkers, regular heavy drinkers, and alcohol abuse disorder and alcohol dependence. All respondents were questioned about receiving 12-month treatment for any psychological complaints, the route of help-seeking, and were assessed with Short Form-36 for functional impairments. Multinomial logistic regression was used for underlying associations between the covariates and the drinking patterns.

Results

The rate of lifetime alcohol abstinence was 52.3% while the prevalence of past-year users was 14.8%. The 12-month prevalence estimates of regular heavy drinkers, and alcohol abuse disorder and dependence were 2.5%, 3.2 and 1.6%, respectively. Any of the drinking patterns and alcohol use disorders was associated with male gender, and higher levels of education, monthly income and socioeconomic status. Alcohol dependence was associated with mental health impairment but not with physical impairment. The 12-month rates of help-seeking in alcohol abuse and dependence were 11.6 and 16.5%.

Conclusion

Although alcohol use disorders are lower than estimates of Western countries, alcohol use constitute a major reason of disability with prominent treatment gap.

     

Substance use disorder comorbidity among inpatient youths with psychiatric disorder

OBJECTIVE: Substance abuse/dependence has been reported to show significant association with psychopathology, and is likely to influence the course and outcome of psychiatric illness. The aim of this study was to determine the rate of substance use disorders (other than alcohol) comorbidity among inpatient adolescents with severe Axis 1 psychiatric disorder. METHOD: A retrospective analysis of systematically collected data was carried out. The subjects were 16-18-year-old youths, admitted to an inpatient unit for severe psychiatric disorder. The data collection process utilized the DSM-IV criteria for diagnostic categorization of psychiatric disorder and substance use disorder. Demographic data, and data on suicide attempts were also collected. RESULTS: Over a period of one year (March 2001-March 2002), 62 patients were admitted to the Christchurch Youth Inpatient Unit; 40 (64.5%) had a comorbid Substance Abuse Disorder (SAD) according to DSM-IV criteria and none had a Substance Dependence Disorder. The vast majority involved cannabis and stimulants. Sixty per cent of those with mood disorder, 63% of those with anxiety disorder and 80% of those with schizophrenia spectrum disorder had a comorbid SAD. Internalizing problems, especially mood disorders, pre-dominated among those with SAD reflecting the Unit's admission criteria. There were no differences in attempted suicide rates between those with SAD and those without SAD, but those with SAD were more likely to have unstable accommodation/living arrangements than those without SAD. CONCLUSIONS: Our findings confirm previous reports suggestive of high rates of SAD comorbidity among youth with severe psychiatric illness. There are clinical and process implications for these findings particularly identification of substance use disorders and their treatment as well as resource availability and staff training.     

Course and outcome of anxiety disorders in adolescents

The aim of this article was to examine the course and outcome of anxiety disorders in German adolescents. Anxiety and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. About 22.6% of the adolescents who fulfilled DSM-IV criteria of any current anxiety disorders at the index investigation (T1) continued to have anxiety at the follow-up investigation (T2), 17.7% had depression, 27.4% somatoform, 6.5% substance use disorders, and 41.9% had no disorders. The factors that were significantly associated with the persistence of anxiety disorders included older age, presence of somatoform and substance use disorders, as well as a high number of negative life events at the T1-interview. Adolescents with "chronic" compared to "transient" anxiety disorders and those without any disorders were significantly more impaired in various life domains. Despite these high levels of psychosocial impairment, only a few of them did seek professional help in the last 12 months before the T2-interview.     

Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of Mental Health and Wellbeing

Background: This paper presents findings from the Australian National Survey of Mental Health and Wellbeing (NSMHWB) regarding prevalence and treatment seeking for Australians with DSM-IV alcohol dependence and examines the influence of alcohol use variables on treatment seeking. Method: A standardised interview (including CIDI 2.1) was administered to a stratified random sample of 10,641 Australians aged 18 years and over. Demographic variables, common DSM-IV mental disorders, physical health status, perceived disability and treatment-seeking behaviour were assessed. Multiple logistic regression was used to ascertain the independent effects of all variables considered. Results: The prevalence of DSM-IV alcohol dependence was 4.1 % in this population, with 75 % being male and nearly 60 % in the 18–34 year age group. Variables that correlated independently with alcohol dependence were sex (male), age (young), not being in a married or de facto relationship and having any affective, anxiety or other substance use disorder. Functional disability did not correlate with a dependence diagnosis. Correlates of treatment seeking for those with dependence were sex (female) and having a comorbid affective disorder. Having a diagnosis of dependence and/or abuse and having more dependence symptoms did not predict treatment seeking. However, meeting either of two criteria assessing psychological, physical or social problems due to alcohol use tended to increase service use. Conclusions: People with alcohol dependence do not perceive themselves as disabled and do not seek treatment. However, having a comorbid affective disorder or other problems directly attributable to alcohol use increases the likelihood that such individuals will seek treatment. Efforts should be made at the primary care level to encourage those engaged in harmful drinking practices to recognise the risks of such drinking and reduce it or seek treatment. Similarly, it is recommended that integrated services are enhanced at both primary and specialist levels in order that those with multiple problems are appropriately treated. Further research is required to refine measurement of disability and diagnoses of alcohol use disorders and to examine the relationship between disability and alcohol use. Accepted: 29 April 2002     

Depressive illness among chemically dependent adolescents.

OBJECTIVE: The purpose of this study was to investigate the prevalence and correlates of depression among adolescents being treated for chemical dependence. METHOD: Using the National Institute of Mental Health Diagnostic Interview Schedule, the authors interviewed 223 adolescents, aged 15-19 years, who were in residential treatment for alcohol or drug dependence diagnosed according to DSM-III-R criteria. Data on sociodemographic characteristics, school and social performance, past history, family composition, familial alcohol and drug abuse, and previous victimization of the subjects were also gathered. RESULTS: Fifty-four (24.7%) of the subjects met the DSM-III-R criteria for depression. Very few of the traditional correlates of depression discriminated depressed from nondepressed subjects, suggesting that the presence of chemical dependence overrides other predictors of depression. Only female gender, paternal psychopathology, and victimization (physical abuse, sexual abuse) emerged as important variables associated with depression. However, subjects whose onset of depression preceded their chemical dependence had different characteristics from those whose depression began after their chemical dependence. CONCLUSIONS: The prevalence of depressive illness in these chemically dependent adolescents was approximately three times that reported for nonreferred groups of similar age. This high rate of depression reflects the contributions of two distinct groups--those with primary depression and those with depression subsequent to chemical dependence--whose characteristics differed, suggesting the possibility of two pathologic processes, similar in manifestation but with different associated features and possibly with distinct etiologies. Confirmation of these findings in further research could indicate that the two forms of depression may require different treatment approaches.     

Psychiatric comorbidity including nicotine dependence among individuals with eating disorder criteria in an adult general population sample

The goal was to analyze psychiatric disorders among individuals who satisfied at least one eating disorder criterion (EDC). The data derived from a cross-sectional survey study with a probability sample of residents of a northern German area with 4075 study participants, aged 18-64 years (participation rate 70.2%). Face-to-face in-home computer-aided interviews (Composite International Diagnostic Interview) were used to assess the diagnostic criteria of eating disorders and nicotine dependence, alcohol dependence, depressive, anxiety, and somatoform disorders according to the Diagnostic and Statistical Manual (DSM-IV). Former or current smokers had an odds ratio (OR) of 1.7 (95% confidence intervals, CI, 1.1-2.4 and 1.1-2.6, respectively) for one EDC compared with never smokers. Subjects with a lifetime psychiatric disorder were more likely to have two or more EDC than individuals who never had the respective disorder (nicotine dependence: OR 2.5, CI 1.5-4.2; alcohol dependence or abuse: OR 2.4, CI 1.2-4.7; depressive disorders: OR 2.2, CI 1.4-3.4; anxiety disorders: OR 2.9, CI 1.9-4.5). To conclude, nicotine dependence, alcohol dependence or abuse, depressive disorders, and anxiety disorders are related to two or more EDC in this adult general population sample.     

Rates of DSM-IV psychiatric disorders among adolescents in a large metropolitan area

We present prevalence data for adolescents in a large metropolitan area in the US and the association of DSM-IV diagnoses to functional impairment and selected demographic correlates. We sampled 4175 youths aged 11-17 years from households enrolled in large health maintenance organizations. Data were collected using questionnaires and the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Impairment was measured using the Child Global Assessment Scale and diagnostic specific impairment in the DISC-IV. 17.1% of the sample met DSM-IV criteria for one or more disorders in the past year; 11% when only DISC impairment was considered and 5.3% only using the CGAS. The most prevalent disorders were anxiety (6.9%), disruptive (6.5%), and substance use (5.3%) disorders. The most prevalent specific disorders were agoraphobia, conduct and marijuana abuse/dependence, then alcohol use and oppositional defiant disorder. Younger youths and females had lower odds for any disorder, as did youths from two parent homes. There was increased odds associated with lower family income. Females had greater odds of mood and anxiety disorders, males of disruptive and substance use disorders. There were greater odds of mood and disruptive disorders for older youths. Prevalences were highly comparable to recent studies using similar methods in diverse non-metropolitan populations. We found associations with age, gender, and to a lesser extent, socioeconomic status reported in previous studies. The inclusion of both diagnosis-specific impairment and global impairment reduced prevalence rates significantly. Our results suggest commonality of prevalences and associated factors in diverse study settings, including urban and rural areas.     

Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders

The main aim of this study was to examine the frequency and patterns of mental health services utilization among 12- to 17-year-old adolescents with anxiety and depressive disorders. Another aim was to examine the factors associated with the use of mental health services. The study population comprised 1,035 adolescents randomly recruited from 36 schools. Anxiety and depressive disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Only 18.2% of the adolescents who met DSM-IV criteria for anxiety disorders, and 23% of those with depressive disorders, used mental health services. Among adolescents with anxiety disorders, mental health services utilization was associated with past suicide attempt, older age, the presence of comorbid disorders, as well as parental anxiety and depression. The only factor that predicts the use of mental health service among adolescents with depressive disorder was a history of suicide attempt. The implication of the results in terms of tailoring services for children and adolescents with anxiety and depressive disorders are discussed.     

Major depression in 6050 former drinkers: association with past alcohol dependence

BACKGROUND: The association between alcoholism and major depression in the general population has been explained as misdiagnosed alcohol intoxication and withdrawal effects mistaken for depressive syndromes. To investigate whether this could account for the entire relationship, the association of past alcohol dependence with current major depression (ie, nonoverlapping time frames) was investigated in individuals who no longer drink or who drink very little. We conducted the study using data from the National Longitudinal Alcohol Epidemiologic Survey, a representative sample. METHODS: Former drinkers who did not use drugs or smoke in the past year (n = 6050) were divided into those with and without past DSM-IV alcohol dependence. These 2 groups were compared for the presence of current (last 12 months) DSM-IV major depression. The association between prior alcohol dependence and current major depression was tested with linear logistic regression, controlling for other variables. RESULTS: Prior alcohol dependence increased the risk of current major depressive disorder more than 4-fold. This relationship was not attenuated by control variables. The majority of subjects with major depression last used substances 2 or more years prior to the interview, which eliminates acute intoxication or withdrawal effects as an explanation of their depressions. CONCLUSIONS: The strong, specific association between prior alcohol dependence and current or recent major depression in a nationally representative sample of former drinkers indicates that the association is not entirely an artifact of misdiagnosed intoxication and withdrawal effects. A better understanding of the nature of the relationship between the 2 disorders should be sought and will have important public health significance.     

Age at first alcohol use: a risk factor for the development of alcohol disorders

OBJECTIVE: This study aimed to describe the natural course of DSM-III-R alcohol disorders as a function of age at first alcohol use and to investigate the influence of early use as a risk factor for progression to the development of alcohol disorders, exclusive of the effect of confounding influences. METHOD: Data were obtained from a community sample (N=5,856) of lifetime drinkers participating in the 1990-1991 Mental Health Supplement of the Ontario Health Survey.RESULTS: Survival analyses revealed a rapid progression to alcohol-related harm among those who reported having their first drink at ages 11-14. After 10 years, 13.5% of the subjects who began to drink at ages 11 and 12 met the criteria for a diagnosis of alcohol abuse, and 15.9% had a diagnosis of dependence. Rates for subjects who began to drink at ages 13 and 14 were 13.7% and 9.0%, respectively. In contrast, rates for those who started drinking at ages 19 and older were 2.0% and 1.0%. Unexpectedly, a delay in progression to harm was observed for the youngest drinkers (ages 10 and under). Hazard regression analyses revealed a nonlinear effect of age at first alcohol use, marked by an elevated risk of developing disorders among subjects first using alcohol at ages 11-14. CONCLUSIONS: First use of alcohol at ages 11-14 greatly heightens the risk of progression to the development of alcohol disorders and therefore is a reasonable target for intervention strategies that seek to delay first use as a means of averting problems later in life.     

Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

The objective of this study was to present nationally representative findings on sociodemographic and psychopathologic predictors of first incidence of Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) substance, mood and anxiety disorders using the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. One-year incidence rates of DSM-IV substance, mood and anxiety disorders were highest for alcohol abuse (1.02), alcohol dependence (1.70), major depressive disorder (MDD; 1.51) and generalized anxiety disorder (GAD; 1.12). Incidence rates were significantly greater (P<0.01) among men for substance use disorders and greater among women for mood and anxiety disorders except bipolar disorders and social phobia. Age was inversely related to all disorders. Black individuals were at decreased risk of incident alcohol abuse and Hispanic individuals were at decreased risk of GAD. Anxiety disorders at baseline more often predicted incidence of other anxiety disorders than mood disorders. Reciprocal temporal relationships were found between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. Borderline and schizotypal personality disorders predicted most incident disorders. Incidence rates of substance, mood and anxiety disorders were comparable to or greater than rates of lung cancer, stroke and cardiovascular disease. The greater incidence of all disorders in the youngest cohort underscores the need for increased vigilance in identifying and treating these disorders among young adults. Strong common factors and unique factors appear to underlie associations between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. The major results of this study are discussed with regard to prevention and treatment implications.     

Effects of topiramate in the treatment of alcohol dependence

BACKGROUND: Anticonvulsant drugs have been used in the treatment of alcohol addiction with relatively good results. The purpose of the present study was to evaluate tolerance and safety of topiramate in patients presenting alcohol dependence. METHODS: We studied 24 patients that fulfilled alcohol-dependence criteria (DSM-IV) and presented other psychiatric disorders for which the use of topiramate was indicated. During the 12 weeks of the study, the patients received topiramate (262 mg/day) plus the psychoactive drugs they were taking for the other disorders. Carbohydrate-deficient transferrin (CDT) values and measures of craving and alcohol use were taken every 2 weeks. RESULTS: Baseline rating of amount and frequency of craving and alcohol use decreased significantly by week 2, and CDT values decreased from week 6. Topiramate was well tolerated, and there were only three dropouts due to adverse events. CONCLUSION: Topiramate is safe and well tolerated, and may be beneficial in the treatment of alcohol dependence. A placebo-controlled study would be of interest.     

The relationship between cannabis use, depression and anxiety among Australian adults: findings from the National Survey of Mental Health and Well-Being

Background: This study aimed to examine the patterns of association between cannabis use, and anxiety and affective disorders, in the general population. Method: Data from the Australian National Survey of Mental Health and Well-Being, a representative survey of Australians aged 18 years and over, were analysed to address the following questions: (1) is there an association between cannabis use, DSM-IV abuse and dependence, and DSM-IV affective and anxiety disorders; (2) if so, is it explained by: demographic characteristics, levels of neuroticism, or other drug use; and (3) does the presence of a comorbid affective or anxiety disorder affect the likelihood of treatment seeking among cannabis users? Results: There was a moderate univariate association between involvement with cannabis use in the past 12 months and the prevalence of affective and anxiety disorders. Among those with DSM-IV cannabis dependence, 14 % met criteria for an affective disorder, compared to 6 % of non-users; while 17 % met criteria for an anxiety disorder, compared to 5 % of non-users. These associations did not remain significant after including demographics, neuroticism and other drug use in multiple regressions. Conclusions: Cannabis use did not appear to be directly related to depression or anxiety when account was taken of other drug use. However, the association between heavier involvement with cannabis use and affective and anxiety disorders has implications for the treatment of persons with problematic cannabis use.