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Neuropsychology Review

, Volume 25, Issue 4, pp 456–475 | Cite as

Psychiatric Comorbidity in Alcohol Dependence

  • George Fein
Review

Abstract

We review our clinical studies of psychiatric comorbidity in short-term and long-term abstinent and in treatment naïve alcoholics (STAA, LTAA and TNA). TNA ypically have less severe alcoholism than treated abstinent samples and evidence less severe psychiatric disturbance. Lifetime psychiatric diagnoses are the norm for STAA and LTAA but not for TNA. Individuals with alcohol and drug use disorders show greater antisocial personality disturbance, but do not show differences in the mood or anxiety domains or in borderline personality disorder (BPD) symptoms. The studies show that alcoholics can achieve and maintain abstinence in the face of ongoing mood, anxiety, or BPD problems. By contrast, for ASPD, LTAA essentially stop current antisocial behaviors in all seven domains of antisocial behaviors. We believe that ongoing antisocial behavior is not consistent with maintaining abstinence, and that LTAA modify their antisocial behavior despite continued elevated social deviance proneness and antisocial dispositionality. Abstinent individuals without lifetime psychiatric disorders and TNA show more (subdiagnostic threshold) psychiatric symptoms and abnormal psychological measures than non-alcoholic controls in the mood, anxiety, BPD, and antisocial domains. In summary, our studies show that although LTAA have achieved multi-year abstinence, they still report significant psychological distress compared to NAC. We believe this distress may negatively affect their quality of life. This suggests the importance of developing effective care models to address comorbid mental health problems in LTAA. We also show that antisocial personality disorder symptoms decline to the levels seen in normal controls, and that excluding individuals from research with a psychiatric diagnosis does not control for subdiagnostic psychiatric differences between alcoholics and controls.

Keywords

Alcoholism Psychiatric comorbidity 

Notes

Acknowledgments

This work was supported by the National Institutes for Health Grants 3R01AA016944-02S1, 5R01AA013659, 5R01AA016944, and 5R01AA11311

Compliance with Ethical Standards

Funding

This work was supported by the National Institutes for Health Grants 3R01AA016944-02S1, 5R01AA013659, 5R01AA016944, and 5R01AA11311.

Disclosures

George Fein is President and CEO of Neurobehavioral Research, Inc.

Conflict of Interest

George Fein is President and CEO of Neurobehavioral Research, Inc. There is no conflict of interest in the writing of this review.

Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the studies summarized in this review.

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© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Neurobehavioral Research, Inc.WailukuUSA
  2. 2.Department of MedicineUniversity of HawaiiHonoluluUSA
  3. 3.Department of PsychologyUniversity of HawaiiHonoluluUSA

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