Prevalence of female alcohol dependence and abuse in Sweden

Data on prevalence of female alcoholism are scarce, especially outside North America. It is even more rare that prevalence is estimated using clinical interviews, as well as by utilizing multiple sources of information. Our sample consisted of five cohorts of adult women (n = 3130) in a mainly suburban area. In a first phase we screened for alcohol-related problems. In a second phase a strategic sample was interviewed (n = 399). Prevalence was calculated for clinical and CIDI-SAM diagnoses, both according to DSM-III-R, also taking medical record data into consideration. It was found that life-lime prevalence of alcohol dependence and abuse was 3.27% and 12-month prevalence was 1.49%. Agreement over alcohol dependence was very high for the different diagnostic methods, but lower for alcohol abuse. Prevalence of dependency/abuse was not higher in the attrition group. The alcohol abuse concept was found to be relevant, both in epidemiological research and for clinical purposes.     

Quality of care for acute myocardial infarction in elderly patients with alcohol-related diagnoses

BACKGROUND: Elderly adults with alcohol-related diagnoses represent a vulnerable population that may receive lower quality of treatment during hospitalization for acute myocardial infarction. We sought to determine whether elderly patients with alcohol-related diagnoses are less likely to receive standard indicators of quality care for acute myocardial infarction. METHODS: We conducted a retrospective cohort analysis using administrative and medical record data from the Cooperative Cardiovascular Project. Subjects were Medicare beneficiaries with a confirmed principal discharge diagnosis of acute myocardial infarction from all acute care hospitals in the United States over an 8-month period. Our primary outcome was the receipt of 7 guideline-recommended care measures among all eligible patients and patients who were ideal candidates for a given measure. RESULTS: In all, 1,284 (1%) of the 155,026 eligible patients met criteria for an alcohol-related diagnosis. Among the alcohol-related diagnoses, 1,077/1,284 (84%) were for the diagnoses of alcohol dependence or alcohol abuse. Patients with alcohol-related diagnoses were less likely than those without alcohol-related diagnoses to receive beta-blockers at the time of discharge (55% vs. 60%, p = 0.02). We found no other significant differences in performance of the quality indicators after stratifying by indication and adjustment for baseline characteristics. CONCLUSIONS: Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized for acute myocardial infarction.     

Hepatitis C and hospital outcomes in patients admitted with alcohol-related problems

BACKGROUND/AIMS: Alcohol is known to act synergistically with chronic hepatitis C virus (HCV) infection to cause liver disease; however, their combined effect on outcomes in acutely hospitalized patients is less clear. We examined the impact of HCV infection on hospital mortality and length of stay among hospitalized patients with alcohol abuse problems. METHODS: We retrospectively identified 6354 admissions to an urban, public hospital between July 1996 and January 2002 with discharge diagnoses related to alcohol dependence or abuse. Hepatitis C diagnosis and other information were extracted from a clinical database and tested for associations with death and length of hospital stay using multivariable regression techniques. RESULTS: The prevalence of diagnosed HCV infection in this sample of patients with alcohol abuse was 15%. Patients with HCV were about twice as likely to die during hospital admission (4.4 vs. 2.4%; P-value < 0.01), and there appeared to be a trend toward increased mortality even after adjustment for demographics, medical service, homelessness and comorbidities (fully adjusted OR 1.41; 95% CI: 0.97-2.04). Length of stay was significantly longer for patients with HCV (19% longer; 95% CI: 12-27% after adjustment) than those without. CONCLUSIONS: Patients admitted to the hospital with alcohol-related diagnoses have longer hospital stays and are more likely to die in hospital if they have a diagnosis of HCV.     

Increased relative risk of subsequent affective disorders in patients with a hospital diagnosis of obesity

OBJECTIVE: To investigate the risk of clinical affective disorders of patients who were hospitalized because of obesity in the study period 1 January 1977 to 31 December 1999. METHOD: Using data from Danish hospital registers, three study cohorts were identified by their diagnoses at discharge from hospital: one cohort comprising all patients with a first hospital admission with an index diagnosis of obesity, and two control cohorts comprising all patients with a first hospital admission with an index diagnosis of osteoarthritis or of non-toxic goiter, respectively. Later admissions to psychiatric hospital wards with discharge diagnoses of affective disorders were used as outcome events. Rates of readmission were estimated using competing risks models in survival analyses. Age, sex, abuse, and calendar time were included as covariables in the analyses. RESULTS: A study sample of 165,425 patients discharged with an index diagnosis was identified. In total, 1081 events occurred in the observation period. An index diagnosis of obesity was associated with an increased risk of affective-disorders hospitalization when compared with patients with osteoarthritis (Rate ratio: 1.35 (95% CI: 1.09-1.67)) and tended to be associated with an increased risk when compared to patients with non-toxic goiter (Rate ratio: 1.23 (95% CI: 0.99-1.53)). Patients with obesity diagnoses who did not have additional hospital diagnoses of substance- or alcohol abuse had a risk of affective disorders that was 1.55 (95% CI: 1.23-1.95) times greater than that of osteoarthritis patients without abuse diagnoses. CONCLUSIONS: Patients hospitalized with obesity may be prone to developing affective disorders that require in-hospital treatment, but the excess risk is modest. Severe obesity seems to be associated with other risk factors for mood disorders than those related to comorbid alcohol- or substance abuse.     

Mental disorders in chronic obstructive pulmonary disease (COPD)

Recent research using questionnaire measures has demonstrated high prevalence rates of mental disorders in chronic obstructive pulmonary disease (COPD). However, clinical interviews and clinical rather than healthy control groups have rarely been employed. The aim of the present study was to assess mental disorders in patients with COPD with advanced methodology, to identify moderating factors explaining mental co-morbidities and to compare results with a clinical control group without COPD. A standardized clinical interview (F-DIPS) and a range of questionnaires were used to assess mental disorders, perceived physical symptoms and cognitions in 20 hospitalized patients with mild-to-moderate COPD (mean FEV(1)/VC (%)=61.3). Results were compared with a hospitalized clinical control group without pulmonary dysfunction (CCG; N=20). Results showed that 55% of patients with COPD received a diagnosis of a mental disorder compared to 30% of CCG patients. All principal mental diagnoses in the COPD group were anxiety disorders (especially Panic Disorder with Agoraphobia), while CCG patients received a wider range of diagnoses (anxiety, pain, alcohol abuse). There was no systematic association between anxiety levels and respiratory function in the whole COPD group, but a positive correlation between anxiety levels and perceived physical symptoms (p<0.001) as well as negative cognitions (p<0.001 and p<0.05, respectively) for COPD patients with anxiety disorder (N=11). The present results confirm the high prevalence rate of anxiety in patients with COPD and suggest further that anxiety in COPD patients may be mediated by cognitive processes. These findings are discussed in terms of their implications for treatment.     

The specificity of family history of alcohol and drug abuse in cocaine abusers

This study addresses the issue of whether the increased rates of substance-related problems for family members of cocaine abusers are specific for each substance. The present analysis examined the prevalence of problems due to alcohol or drug use separately for mothers, fathers, sisters, and brothers using the Family History Assessment Module. The probands were 343 out-of-treatment subjects with DSM-III-R cocaine disorders who did or did not have additional alcohol and opiate disorders. After accounting for age, race, gender, and antisocial personality, family history of alcohol-related problems had an odds ratio of 1.6 (p <.05) if a participant was alcoholic in addition to abusing cocaine. Specifically, a significantly greater proportion of participants' sisters (p <.001) and brothers (p <.05) had alcohol-related problems if the participant had a history of alcoholism. Among probands who reported opiate abuse or dependence, 38% had relatives with drug-related problems, while participants without opiate abuse or dependence had less than 31% of relatives with drug-related problems (p <.05). However, this association with opiate abuse or dependence and family history of drug-related problems was non-significant after controlling for participants' age, race, gender, treatment status, and antisocial personality diagnosis (odds ratio = 1.4, 95% C.I. = 0.8-2.4). Associations between participants' alcoholism and first-degree relatives' drug-related problems (and vice versa) showed that participants' history of opiate addiction did improve prediction of first-degree relatives' alcohol-related problems, except for participants' brothers. Additional familial risks for alcoholism were seen among siblings of drug abusers who also reported abuse of or dependence on alcohol even after controlling for relatives' ages. Furthermore, parental prevalence of alcohol-related problems were greater when participants had opiate addiction in addition to cocaine addiction. This seems to indicate that opiate addiction in addition to cocaine addiction has particularly strong inheritance patterns. In contrast, parental prevalence of drug-related problems was not greater when participants had alcohol addiction in addition to cocaine addiction. Thus, the cross-substance parent-child familial risk is limited to the dually diagnosed illicit drug.     

Increase in Alcohol-Related Hospitalizations in Finland 1969–1975

Alcohol consumption increased 2.2-fold in Finland in 1968-1974. Have alcohol-related diseases become at the same time more common? This was studied by scrutinizing hospitalizations with alcoholism, alcohol psychosis, alcohol poisoning, liver cirrhosis and pancreatitis as the principal diagnosis. During the years 1969–1975, the male admission rate for alcohol psychosis increased 2.1-fold, the rate for pancreatitis increased 2-fold, that for alcoholism increased 1.7-fold and that for liver cirrhosis increased 1.2-fold. At the same time, the increases in female admission rates were 2.4-fold for alcoholism, 2.3-fold for alcohol psychosis, 1.9-fold for alcohol poisoning and 1.4-foldfor pancreatitis. The increase in admission rates seemed to be closely associated with the increase in alcohol consumption.     

Alcohol abuse in the critically ill patient

Alcohol abuse and dependence disorders are common in the 10% of hospitalised patients who need admission to the intensive care unit (ICU), but these disorders are often undiagnosed. The systemic effects from the excessive use of alcohol increase susceptibility to, or directly cause various important disorders in the critically ill. Early recognition of alcohol abuse and dependence is necessary and should prompt consideration of several alcohol-specific diagnoses that have important prognostic and therapeutic implications for these patients. We discuss the use of screening tests to improve the identification of alcohol abuse and dependence disorders, the epidemiology and pathogenesis of important alcohol-related disorders, differences in the presentation of several common alcohol-related diagnoses in the ICU, and important alcohol-specific therapies.     

Surprisingly high prevalence of anxiety and depression in chronic breathing disorders

STUDY OBJECTIVES: The objectives of this study were to assess the prevalence, screening, and recognition of depression and anxiety in persons with chronic breathing disorders, including COPD. DESIGN: Cross-sectional study. SETTING: The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC). PARTICIPANTS: A large sample of 1,334 persons with chronic breathing disorder diagnoses who received care at the MEDVAMC. MEASUREMENTS: The prevalence of anxiety and depression was measured in a large sample of persons with a chronic breathing disorder diagnosis who received care at the MEDVAMC, using the Primary Care Evaluation of Mental Disorders (PRIME-MD) screening questions. The positive predictive value of the PRIME-MD questions was then determined. The prevalence of anxiety and depressive diagnoses in patients determined to have COPD was then measured, using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). RESULTS: Of patients screened with the PRIME-MD, 80% screened positive for depression, anxiety, or both. The predictive value of a positive phone screen for either depression or anxiety was estimated to be 80%. In the subsample of patients who had COPD and received a diagnosis using the SCID, 65% received an anxiety and/or depressive disorder diagnosis. Of those patients, only 31% were receiving treatment for depression and/or anxiety. CONCLUSIONS: It is troubling that a mere 31% of COPD patients with depression or anxiety are being treated, particularly given their high prevalence in this population. Practical screening instruments may help increase the recognition of anxiety and depression in medical patients, as suggested by the excellent positive predictive value of the PRIME-MD in our study.     

Underdiagnosis of alcohol dependence in psychiatric inpatients.

Alcoholism is prevalent among psychiatric inpatients, and accurately diagnosing alcohol problems is a critical step in treatment planning. The authors diagnosed alcohol dependence in 35 psychiatric inpatients by blind review of interview protocols and hospital records. They then examined the frequency with which admitting and attending clinicians diagnosed alcohol abuse and dependence in these patients. Alcoholism was underdiagnosed; 24% of the clinicians' diagnoses included no alcoholism diagnosis, 39% were alcohol abuse, and only 37% were alcohol dependence. Underdiagnosis was strongly associated with the presence of a comorbid psychosis, as well as with patients' denial of alcoholism and with less severe alcoholism. The authors discuss the patient and clinician variables which may contribute to underdiagnosing alcoholism and recommend educational and administrative measures to improve clinicians' diagnostic sensitivity.     

Axis I and Axis II Comorbidity in Alcohol Dependence and the Two Types of Alcoholism

Background: Although high prevalence rates of psychiatric comorbidity were reported in alcoholism, there is a lack of studies covering the whole spectrum of DSM Axes I and II disorders. The relation of comorbid psychopathology and Cloninger's and Babor's types of alcoholism still remained unclear. Methods: Psychiatric comorbidity in 250 hospitalized alcohol-dependent patients without additional substance-related disorders was assessed by the Composite International Diagnostic Interview and the International Personality Disorder Examination. Information about the course and severity of alcoholism was obtained from several sources. Results: Additional Axis I disorders only were found in 24.0%, Axis II disorders only in 16.4%, and concurrent Axis I and Axis II disorders in 17.2% (total comorbidity rate: 57.6%). Two clusters of alcohol dependence were found that substantially overlap with Cloninger's and Babor's types of alcoholism. The majority of type A subjects were found to be either not comorbid at all, or to be Axis I comorbid only. Type B, on the other hand, was preferably associated with personality disorders (mainly Clusters A and B) and dimensional scores of personality pathology (schizoid, schizotypal, all Cluster B, and passive-aggressive). Conclusions: The entire spectrum of personality pathology should be assessed in the comorbidity research of alcoholism. The two types of alcoholism differ on a variety of alcohol-related and comorbid personality characteristics, but further research is needed to clarify the underlying psychological and biological associations.     

Underdiagnosis of Alcohol Dependence in Psychiatric Inpatients

Abstract

Alcoholism is prevalent among psychiatric inpatients, and accurately diagnosing alcohol prob lems is a critical step in treatment planning. The authors diagnosed alcohol dependence in 35 psychiatric inpatients by blind review of interview protocols and hospital records. They then examined the frequency with which admitting and attending clinicians diagnosed alcohol abuse and dependence in these patients. Alcoholism was underdiagnosed; 24% of the clinicians' diagnoses included no alcoholism diagnosis, 39% were alcohol abuse, and only 37% were alcohol dependence. Underdiagnosis was strongly associated with the presence of a comorbid psychosis, as well as with patients' denial of alcoholism and with less severe alcoholism. The authors discuss the patient and clinician variables which may contribute to underdiagnosing alcoholism and recommend educational and administrative measures to improve clinicians' diagnostic sensitivity.     

Alcoholism and aging. 2. Alcoholic dementia or alcoholic cognitive impairment?

Chronic alcohol consumption results in considerable damage to many of the body's organs, and particularly to the brain. Beyond the confusional state occurring with acute intoxication or withdrawal, alcohol abuse is responsible of a constellation of neuropsychiatric syndromes including cognitive dysfunction, Wernicke-Korsakoff Syndrome, alcoholic cerebellar degeneration, Marchiafava-Bignami disease and alcohol-related dementia, ARD. ARD would account for nearly 20% of all admissions to state mental hospitals in the United-States. According to the DSM-IV, ARD is defined by a dementia associated with alcohol abuse. However, the concept of a dementia directly related to the neurotoxicity of alcohol for brain neurons is still a matter of debate. Several hypotheses have been proposed to explain the mechanisms of cognitive deficits related to chronic alcohol intoxication. This paper presents the epidemiological, neuropathological, neurochemical and clinical data on ARD. Alcoholism is responsible for cognitive deficits of various severity, which could be reversible or not with alcohol abstinence, but can also participate to the cognitive impairment related to other pathologies, such as Alzheimer disease. On account of this review, it is suggested that the term alcohol-related cognitive impairment should be more convenient than that of ARD, more restrictive and more confusing. Presently, there are no established treatment for alcohol-related cognitive impairment. Alcohol abstinence is a most important step. Psychosocial interventions are essential to support the patients in the daily life.     

Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011

Individuals with HIV infection are living substantially longer on antiretroviral therapy, but hospitalization rates continue to be relatively high. We do not know how overall or diagnosis-specific hospitalization rates compare between HIV-infected and uninfected individuals or what conditions may drive hospitalization trends. Hospitalization rates among United States Veterans were calculated and stratified by HIV serostatus and principal diagnosis disease category. Because alcohol-related diagnoses (ARD) appeared to have a disproportional effect, we further stratified our calculations by ARD history. A multivariable Cox proportional hazards model was fitted to assess the relative risk of hospitalization controlling for demographic and other comorbidity variables. From 1997 to 2011, 46,428 HIV-infected and 93,997 uninfected patients were followed for 1,497,536 person-years. Overall hospitalization rates decreased among HIV-infected and uninfected patients. However, cardiovascular and renal insufficiency admissions increased for all groups while gastrointestinal and liver, endocrine, neurologic, and non-AIDS cancer admissions increased among those with an alcohol-related diagnosis. After multivariable adjustment, HIV-infected individuals with an ARD had the highest risk of hospitalization (hazard ratio 3.24, 95 % CI 3.00, 3.49) compared to those free of HIV infection and without an ARD. Still, HIV alone also conferred increased risk (HR 2.08, 95 % CI 2.04, 2.13). While decreasing overall, risk of all-cause hospitalization remains higher among HIV-infected than uninfected individuals and is strongly influenced by the presence of an ARD.     

Alcoholism and Occupations: A Review and Analysis of 104 Occupations

A review of the many attempts to establish an association between occupations and alcoholism reveals that most do not deal with data about clinically defined alcoholism but instead use data about cirrhosis mortality, self-reported alcohol problems, and frequent and heavy drinking. The present study establishes an association between occupations and diagnoses of Alcohol Dependence Disorder and Alcohol Abuse Disorder, using data from a large population-based household interview study. Statistical adjustment using logistic methods reveals that apparent associations between occupations and alcohol-related disorders previously reported in the literature are due to characteristics of those employed in various occupations. The prevalence of alcohol dependence and abuse in two high risk industries, construction and transportation, is confirmed. More than one in four construction laborers and one in five skilled construction trades workers received a DIS/DSM-III diagnosis related to alcohol abuse. In the transportation industry one in six heavy truck drivers and material movers received an alcohol diagnosis. Analyses of the data from individuals currently employed and not employed in their occupation reveals reduction in risk for those who leave some occupations and increased risk for those who leave other occupations. Evidence is presented that employment in some occupations may be protective for Alcohol Dependence. The findings support the view that occupation may be associated with Alcohol Dependence and Alcohol Abuse independent of demographic variations. Previously proposed explanatory models for associations between occupations and alcohol problems are called into question because they do not take into account the demographic characteristics and employment status of workers.     

The adult children of alcoholics in a psychiatric population

The issues confronting adult children of alcoholics (ACOA) are well publicized but their empirical basis remains limited. The screening of 250 consecutive psychiatric admissions to a general hospital revealed a significant prevalence of ACOAs across diagnoses. Compared to the other patients, the ACOA group was younger but with no other socioeconomic difference. The diagnoses of substance abuse and phobic disorders were more frequent. The group was psychiatrically hospitalized at an earlier age. The impact of an ACOA status varied with the parental biological relation and gender, and with the premorbid antecedents of parental alcoholism.     

Alcohol consumption and related problems among primary health care patients: WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption—I

This WHO collaborative project is the first phase of a programme of work aimed at developing techniques for early identification and treatment of persons with hazardous and harmful alcohol consumption. The aim of the present study was to determine the prevalence of hazardous and harmful alcohol use among patients attending primary health care facilities in several countries, and to examine the correlates of drinking behaviour and alcohol-related problems in these culturally diverse populations. The broader purpose was to determine whether there was justification for developing alcohol screening instruments for cross-national use. One thousand, eight hundred and eighty-eight subjects in Australia, Bulgaria, Kenya, Mexico, Norway and the USA underwent a comprehensive assessment of their medical history, alcohol intake, drinking practices, and any physical or psychosocial problems related to alcohol. After non-drinkers and known alcoholics had been excluded, 18% of subjects had a hazardous level of alcohol intake and 23% had experienced at least one alcohol-related problem in the previous year. Intrascale reliability coefficients were uniformly high for the drinking behaviour (dependence) and adverse psychological reactions scales, and moderately high for the alcohol-related problems scales. There were strong correlations between the various alcohol-specific scales, and between these scales and measures of alcohol intake. Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems. These findings strengthen the case for developing international screening instruments for hazardous and harmful alcohol consumption.     

Alcohol abuse and dependence in Latinos living in the United States: validation of the CAGE (4M) questions

BACKGROUND: Brief alcoholism screening questionnaires have not been adequately studied in the rapidly growing Latino population living in the United States. OBJECTIVE: To assess (1) the prevalence of alcoholism and (2) the performance of 2 alcohol screening instruments in Latinos. SUBJECTS AND METHODS: We performed a cross-sectional interview study in an urban teaching hospital-based primary care practice. Consecutive self-identified Latino subjects provided informed consent. All subjects were interviewed in English or Spanish using 2 alcoholism screening tools, the CAGE (or the Spanish version, the 4M), and the Alcohol Use Disorders Identification Test, and a criterion standard for the diagnosis of alcohol abuse and dependence, the Composite International Diagnostic Interview. RESULTS: Of 210 subjects interviewed, 36% had a lifetime diagnosis of alcohol abuse or dependence by the criterion standard. Thirty-one percent were currently drinking hazardous amounts of alcohol. A CAGE (4M) score of 1 or more was 92% sensitive and 74% specific, and a score of 2 or more was 80% sensitive and 93% specific for a lifetime diagnosis of alcohol abuse or dependency. CAGE (4M) scores of 0, 2, 3, and 4 were associated with likelihood ratios (0.1, 4.8, 18.5, and 36.8, respectively) that resulted in substantial changes from pretest (36%) to posttest probability (to 6%, 73%, 91%, and 95%, respectively) of a diagnosis of alcohol abuse or dependency. At the standard cutoff point, the Alcohol Use Disorders Identification Test detected only 51% of subjects with alcohol disorders. CONCLUSIONS: In Latinos in primary care settings, alcohol abuse and dependence are common and the CAGE (4M) is a brief, valid, screening tool for detecting alcohol use disorders.     

Co-morbid medical and psychiatric illness and substance abuse in HCV-infected and uninfected veterans

Comorbidities may affect the decision to treat chronic hepatitis C virus (HCV) infection. We undertook this study to determine the prevalence of these conditions in the HCV-infected persons compared with HCV-uninfected controls. Demographic and comorbidity data were retrieved for HCV-infected and -uninfected subjects from the VA National Patient Care Database using ICD-9 codes. Logistic regression was used to determine the odds of comorbid conditions in the HCV-infected subjects. HCV-uninfected controls were identified matched on age, race/ethnicity and sex. We identified 126 926 HCV-infected subjects and 126 926 controls. The HCV-infected subjects had a higher prevalence of diabetes, anaemia, hypertension, chronic obstructive pulmonary disease (COPD)/asthma, cirrhosis, hepatitis B and cancer, but had a lower prevalence of coronary artery disease and stroke. The prevalence of all psychiatric comorbidities and substance abuse was higher in the HCV-infected subjects. In the HCV-infected persons, the odds of being diagnosed with congestive heart failure, diabetes, anaemia, hypertension, COPD/asthma, cirrhosis, hepatitis B and cancer were higher, but lower for coronary artery disease and stroke. After adjusting for alcohol and drug abuse and dependence, the odds of psychiatric illness were not higher in the HCV-infected persons. The prevalence and patterns of comorbidities in HCV-infected veterans are different from those in HCV-uninfected controls. The association between HCV and psychiatric diagnoses is at least partly attributable to alcohol and drug abuse and dependence. These factors should be taken into account when evaluating patients for treatment and designing new intervention strategies.     

Utilization of residential alcoholism treatment in bipolar disorder

Despite the high prevalence rate of comorbid alcohol dependence and bipolar disorder, little is known about how many bipolar patients are actively engaged in addiction treatment or the alcohol consumption characteristics of this group. This retrospective study reviewed the medical records from patients with alcohol dependence admitted to residential treatment at our institution (n = 588). The analyses focused on alcoholism severity measures and discharge clinical diagnoses. Patients with alcoholism + bipolar disorder compromised only 5% of the total study group. The number of drinking years was lower for patients with alcoholism + bipolar disorder (23.1 ± 17.7) than for those with alcoholism + depression (26.8 ± 13.9) or alcoholism alone (28.1 ± 13.2). A trend of higher mean lifetime maximum daily drinks was observed for patients with alcoholism + bipolar disorder; this was because of the significantly higher maximum drinks for women with bipolar disorder (21.0 ± 11.5) than for women in other diagnostic groups. Despite high rates of comorbidity in community-based studies, this retrospective study suggests that patients with bipolar disorder are not highly represented in residential alcoholism addiction treatment. Future studies are encouraged to better understand utilization rates of addiction treatment among patients with bipolar disorder and to identify clinical correlates that predispose bipolar women to high-dose drinking.