Drugs for the Treatment of Psychiatric Comorbidity in Alcoholics: Recent Developments

  • M. J. Bohn
  • D. Hersh
Part of the Handbook of Experimental Pharmacology book series (HEP, volume 114)


Alcoholism has long been associated with other psychiatric symptoms, including anxiety, depression, and hallucinations. Hippocrates advised that “wine drunk with an equal quantity of water puts away anxiety and terrors.” As distinct syndromes, coexisting psychiatric disorders are also common among alcoholics. Anxiety disorders, affective disorders, antisocial personality disorder (ASP), and drug use disorders are particularly prevalent comorbid disorders. These coexisting psychiatric conditions generally confer a poor prognosis following psychosocial treatment of the alcoholic (MCLELLAN et al. 1983a; ROUNSAVILLE et al. 1987; HELZER and PRYZBECK 1988).


Depressive Symptom Anxiety Disorder Generalize Anxiety Disorder Panic Disorder Lithium Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association (1987) Diagnostic and statistical manual for psychiatric disorders, 3rd edn, revised. American Psychiatric Association, Washington DCGoogle Scholar
  2. American Psychiatric Association (1993a) Practice guideline for major depressive disorder in adults. American Psychiatric Association, Washington DCGoogle Scholar
  3. American Psychiatric Association (1993b) DSM-IV draft criteria. American Psychiatric Association, Washington DCGoogle Scholar
  4. Aneshensel CS, Huba GJ (1983) Depression, alcohol use, and smoking over one year: a four-wave longitudinal causal model. J Abnorm Psychol 92:134–150PubMedCrossRefGoogle Scholar
  5. Babor TF, Hoffman M, Del Boca FK, Tennen H, Hesselbrock VM, Meyer RE (1992) Types of alcoholics I: evidence for an empirically derived typology based on indicators of vulnerability and severity. Arch Gen Psychiatry 49:599–608PubMedGoogle Scholar
  6. Ballenger JC, Post RM (1978) Kindling as a model for alcohol withdrawal syndromes. Br J Psychiatry 133:1–14PubMedCrossRefGoogle Scholar
  7. Beck AT, Ward CH, Mendelson M (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:461–471Google Scholar
  8. Black JL (1992) Obsessive-compulsive disorder: a clinical update. Mayo Clin Proc 67:266–275PubMedGoogle Scholar
  9. Bliding A (1978) The abuse potential of benzodiazepines with special reference to oxazepam. Acta Psychiatr Scand 24:111–116CrossRefGoogle Scholar
  10. Brown ME, Anton RF, Malcolm R, Ballenger JC (1990) Alcohol detoxification and withdrawal seizures: clinical support for a kindling hypothesis. Biol Psychiatry 23:507–514CrossRefGoogle Scholar
  11. Brown SA, Schuckit MA (1988) Changes in depression among abstinent alcoholics. J Stud Alcohol 49:412–417PubMedGoogle Scholar
  12. Brown SA, Irwin M, Schuckit MA (1991) Changes in anxiety among abstinent male alcoholics. J Stud Alcohol 52:55–61PubMedGoogle Scholar
  13. Bruno F (1989) Buspirone in the treatment of alcoholic patients. Psychopathology 22 [Suppl]:49–59PubMedCrossRefGoogle Scholar
  14. Bryant KJ, Rounsaville B, Spitzer RL, Williams JBW (1992) Reliability of dual diagnosis: substance dependence and psychiatric disorders. J Nerv Ment Dis 180:251–257PubMedCrossRefGoogle Scholar
  15. Buydens-Branchey L, Branchey MJ, Noumair D (1989) Age of alcoholism onset II. Relationship to susceptibility to serotonin precursor availability. Arch Gen Psychiatry 46:231–236PubMedGoogle Scholar
  16. Ciraulo DA, Alderson LM, Chapron DJ (1982) Imipramine disposition in alcoholics. J Clin Psychopharmacol 2:2–7PubMedCrossRefGoogle Scholar
  17. Ciraulo DA, Barnhill J, Boxenbaum HG (1985) Pharmacokinetic interaction of disulfiram and antidepressants. Am J Psychiatry 142:1373–1374PubMedGoogle Scholar
  18. Ciraulo DA, Barnhill JG, Jaffe JH (1988a) Clinical pharmacokinetics of imipramine and desipramine in alcoholics and normal volunteers. Clin Pharmacol Ther 43:509–518CrossRefGoogle Scholar
  19. Ciraulo DA, Barnhill J, Greenblatt DJ, Shader RE, Ciraulo AM, Tarmey MF, Molloy MA, Foti ME (1988b) Abuse liability and clinical pharmacokinetics of alprazolam in alcoholic men. J Clin Psychiatry 49:333–337PubMedGoogle Scholar
  20. Cooney NL, Kadden RM, Litt MD, Getter H (1991) Matching alcoholics to coping skills or interactional therapies: two-year follow-up results. J Consult Clin Psychol 59:598–601PubMedCrossRefGoogle Scholar
  21. Cornelius JR, Fisher BW, Salloum IM, Cornelius MD, Ehler JG (1992) Fluoxetine trial in depressed alcoholics. Alcohol Clin Exp Res 16:362Google Scholar
  22. Cottier LB, Compton WM, Mager D, Spitznagel EL, Janca A (1992) Posttraumatic stress disorder among substance users from the general population. Am J Psychiatry 149:664–670Google Scholar
  23. Dackis CA, Gold MS, Pottash ALC, Sweeney DR (1986) Evaluating depression in alcoholics. Psychiatry Res 17:105–109PubMedCrossRefGoogle Scholar
  24. de la Fuente J-R, Morse RM, Niven RG, Ilstrup DM (1989) A controlled study of lithium carbonate in the treatment of alcoholism. Mayo Clin Proc 64:177–180PubMedGoogle Scholar
  25. Dixon L, Haas G, Weiden P, Sweeney J, Frances A (1990) Acute effects of drug abuse in schizophrenic patients: clinical observations and patients’ self-reports. Schizophr Bull 16:69–79PubMedGoogle Scholar
  26. Dorus W, Kennedy J, Gibbons RD, Raavi SD (1987) Symptoms and diagnosis of depression in alcoholics. Alcohol Clin Exp Res 11:150–154PubMedCrossRefGoogle Scholar
  27. Dorus W, Ostrow DG, Anton R, Cushman P, Collins JF, Schaefer M, Charles HL, Desai P, Hayashida M, Malkernecker U, Willenbring M, Fiscella R, Sather MR (1989) Lithium treatment of depressed and nondepressed alcoholics. JAMA 262:1646–1652PubMedCrossRefGoogle Scholar
  28. Drake RE, Osher FC, Wallach MA (1989) Alcohol use and abuse in schizophrenia: a prospective community study. J Nerv Ment Dis 177:408–414CrossRefGoogle Scholar
  29. Drake RE, Osher FC, Noordsy DL (1990) Diagnosis of alcohol use disorders in schizophrenia. Schizophr Bull 16:57–67PubMedGoogle Scholar
  30. Drake RE, Wallach MA, Teague GB (1991) Housing instability and homelessness among rural schizophrenic patients. Am J Psychiatry 148:330–336PubMedGoogle Scholar
  31. Drake RE, McHugo GJ, Noordsy DL (1993) Treatment of alcoholism among schizophrenic outpatients: 4-year outcomes. Am J Psychiatry 150:328–329PubMedGoogle Scholar
  32. Elkin I, Shea T, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP, Fiester SJ, Parloff MB (1989) National Institute of Mental Health treatment of depression collaborative research program: general effectiveness of treatments. Arch Gen Psychiatry 46:971–982PubMedGoogle Scholar
  33. Fawcett J, Clark DC, Aagesen CA (1987) A double-blind, placebo-controlled trial of lithium carbonate therapy for alcoholism. Arch Gen Psychiatry 44:248–256Google Scholar
  34. Geller B, Cooper TB, Watts HE, Cosby CM, Fox LW (1992) Early findings from a pharmacokinetically designed, double-blind, placebo-controlled study of lithium for adolescents with comorbid bipolar and substance dependence disorders. Prog Neuropsychopharmacol Biol Psychiatry 16:281–299PubMedCrossRefGoogle Scholar
  35. George DT, Nutt DJ, Dwyer BA, Linnoila M (1988) Alcoholism and panic disorders: is the comorbidity more than coincidence? Acta Psychiatr Scand 81:97–107CrossRefGoogle Scholar
  36. Goodwin FK, Jamison KR (1990) Manic depressive illness. Oxford University Press, New YorkGoogle Scholar
  37. Grant BF, Hasin DS, Harford TC (1989) Screening for major depression among alcoholics: an application of receiver operating characteristic analysis. Drug Alcohol Depend 23:123–131PubMedCrossRefGoogle Scholar
  38. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62PubMedCrossRefGoogle Scholar
  39. Hatsukami D, Pickens RW (1982) Post-treatment depression in an alcohol and drug abuse population. Am J Psychiatry 139:1563–1566PubMedGoogle Scholar
  40. Heizer JE, Pryzbeck TR (1988) The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. J Stud Alcohol 49:219–224Google Scholar
  41. Henriksson MM, Aro HM, Marttunen MJ, Heikkinen ME, Isometsa ET, Kuoppasalmi KI, Lonnqvist JK (1993) Mental disorders and comorbidity in suicide. Am J Psychiatry 150:935–940PubMedGoogle Scholar
  42. Hesselbrock MN, Meyer RE, Keener J J (1985) Psychopathology in hospitalized alcoholics. Arch Gen Psychiatry 42:1050–1055PubMedGoogle Scholar
  43. Jaffe JH (1987) Alcoholism and affective disturbance: current drugs and current shortcomings. In: Edwards G, Littleton J (eds) Pharmacologic treatments for alcoholism. Methuen, New York, pp 463–490Google Scholar
  44. Jaffe JH, Ciraulo DA (1986) Alcoholism and depression. In: Meyer RE (ed) Psychopathology and addictive disease. Guilford, New York, pp 293–320Google Scholar
  45. Jefferson JW, Greist JH, Ackerman DL, Carroll JA (1987) Lithium encyclopedia for clinical practice, 2nd edn. American Psychiatric Press, Washington DCGoogle Scholar
  46. Judd, LL, Huey LY (1984) Lithium antagonizes ethanol intoxication in alcoholics. Am J Psychiatry 141:1517–1521PubMedGoogle Scholar
  47. Keeler MH, Taylor I, Miller WC (1979) Are all recently detoxified alcoholics depressed? Am J Psychiatry 136:586–588PubMedGoogle Scholar
  48. Kissin B (1975) The use of psychoactive drugs in the long-term treatment of chronic alcoholics. Ann NY Acad Sci 252:385–395PubMedCrossRefGoogle Scholar
  49. Kranzler HR, Meyer RE (1989) An open trial of buspirone in alcoholics. J Clin Psychopharmacol 9:379–380PubMedCrossRefGoogle Scholar
  50. Kranzler HR, Del Boca FK, Korner P, Brown J (1990) Fluvoxamine is poorly tolerated by alcoholics. In: Naranjo CA, Sellers EM (eds) Novel pharmacological interventions for alcoholism. Springer, Berlin Heidelberg New York, pp 304–308Google Scholar
  51. Kranzler HR, Burleson JA, Del Boca FK, Babor TF, Korner P, Brown J, Bohn MJ (unpublished manuscript) Placebo-controlled trial of buspirone as an adjunct to relapse prevention in anxious alcoholicsGoogle Scholar
  52. Kupfer DJ, Frank E, Perel JM, Cornes C, Mailinger AG, Thase ME, McEachran AB, Grochocinski VJ (1992) Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry 49:769–773PubMedGoogle Scholar
  53. Liebowitz MR, Gorman JM, Fyer AJ, Campeas R, Levin AP, Sandberg D, Hollander E, Papp L, Goetz D (1988) Pharmacotherapy of social phobia: an interim report of a placebo-controlled comparison of phenelzine and atenolol. J Clin Psychiatry 49:252–257PubMedGoogle Scholar
  54. Liebson I, Bigelow G, Flamer R (1973) Alcoholism among methadone patients: a specific treatment method. Am J Psychiatry 130:483–485PubMedGoogle Scholar
  55. Litt MD, Babor TF, Del Boca FK, Kadden RM, Cooney NL, Getter H (1992) Types of alcoholics: application of an empirically derived typology to treatment matching. Arch Gen Psychiatry 49:609–614PubMedGoogle Scholar
  56. Lowinsohn JH, Ruiz P, Millman RB, Langrod JG (1992) Substance abuse: a comprehensive textbook, 2nd edn. Williams and Wilkins, BaltimoreGoogle Scholar
  57. Malcolm R, Anton RF, Randall CL, Johnston A, Brady K, Thevos A (1993) A placebo-controlled trial of buspirone in anxious inpatient alcoholics. Alcohol Clin Exp Res 16:1007–1014CrossRefGoogle Scholar
  58. Manuzza S, Fyer AJ, Martin LY, Gallops MS, Endicott J, Gorman J, Liebowitz MR, Klein DF (1989) Reliability of anxiety assessment. I. Diagnostic agreement. Arch Gen Psychiatry 46:1093–1101Google Scholar
  59. Marks IM (1987) Fears, phobias, and rituals: panic, anxiety, and their disorders. Oxford University Press, New YorkGoogle Scholar
  60. Mason BJ, Kocsis JH (1991) Desipramine treatment of alcoholism. Psychopharmacol Bull 27:155–161PubMedGoogle Scholar
  61. McLellan AT, Luborsky L, Woody GE, O’Brien CP, Druley KA (1983a) Predicting response to alcohol and drug abuse treatments: role of psychiatric severity. Arch Gen Psychiatry 40:620–625PubMedGoogle Scholar
  62. McLellan, AT, Woody GE, Luborsky L, O’Brien CP, Druley KA (1983b) Increased effectiveness of substance abuse treatment: a prospective study of patient-treatment “matching”. J Nerv Ment Dis 171:597–605CrossRefGoogle Scholar
  63. Mueser KT, Bellack AS, Blanchard JJ (1992) Comorbidity of schizophrenia and substance abuse: implications for treatment. J Consult Clin Psychol 60:845–856PubMedCrossRefGoogle Scholar
  64. Murphy GE (1992) Suicide in alcoholism. Oxford University Press, New YorkGoogle Scholar
  65. Nakamura MM, Overall JE, Hollister LE, Radcliffe E (1983) Factors affecting outcome of depressive symptoms in alcoholics. Alcohol Clin Exp Res 7:188–193PubMedCrossRefGoogle Scholar
  66. Nathan PE, Titler NA, Lowenstein LM, Solomon P, Rossi AM (1970) Behavioral analysis of chronic alcoholism: interaction of alcohol and human contact. Arch Gen Psychiatry 22:419–430PubMedGoogle Scholar
  67. Noordsy DL, Drake RE, Teague GB (1991) Subjective experiences related to alcohol use among schizophrenics. J Nerv Ment Dis 179:410–414CrossRefGoogle Scholar
  68. Nunes EV, McGrath PJ, Quitkin FM, Stewart JP, Harrison W, Tricamo E, Ocepek-Welikson K (1993) Imipramine treatment of alcoholism with comorbid depresión. Am J Psychiatry 150:963–965PubMedGoogle Scholar
  69. Post RM, Trimble MR, Pippinger C (1989) Clinical use of anticonvulsants in psychiatric disorders. Demos, New YorkGoogle Scholar
  70. Robins LN, Regier DA (1990) Psychiatric disorders in America. Free Press, New YorkGoogle Scholar
  71. Robins LN, Cottier L, Keating S (1989) NIMH Diagnostic Interview Schedule, Version III, Revised. Washington University Department of Psychiatry, St LouisGoogle Scholar
  72. Ross HE, Glaser FB, Germanson T (1988) The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Arch Gen Psychiatry 45:1023–1031PubMedGoogle Scholar
  73. Rounsaville BJ, Dolinsky ZS, Babor TF, Meyer RE (1987) Psychopathology as a predictor of treatment outcome in alcoholics. Arch Gen Psychiatry 44:505–513PubMedGoogle Scholar
  74. Sandoz M, Vandel S, Vandel B, Bonin B, Allers G, Volmot R (1983) Biotransformation of amitriptyline in alcoholic depressive patients. J Clin Pharmacol 24:615–621CrossRefGoogle Scholar
  75. Schottenfeld RS, O’Malley SS, Smith L, Rounsaville BJ, Jaffe JH (1989) Limitation and potential hazards of MAOIs for the treatment of depressive symptoms in abstinent alcoholics. Am J Drug Alcohol Abuse 15:339–344PubMedCrossRefGoogle Scholar
  76. Schuckit M (1979) Alcoholism and affective disorder: diagnostic confusion. In Goodwin DW, Erickson CK (eds) Alcoholism and affective disorders. Spectrum, New York, pp 9–19Google Scholar
  77. Schuckit MA, Winokur G (1972) A short-term follow-up of women alcoholics. Dis Nerv Syst 33:672–678Google Scholar
  78. Schuckit MA, Irwin M, Brown SA (1990) History of anxiety symptoms among 171 primary alcoholics. J Stud Alcohol 51:34–41PubMedGoogle Scholar
  79. Soni SD, Brownlee M (1991) Alcohol abuse in chronic schizoprenics: implications for management in the community. Acta Psychiatr Scand 84:272–276PubMedCrossRefGoogle Scholar
  80. Spitzer RL, Williams JBW, Gibbon M, First MB (1992) The Structured Clinical Interview for DSM-III-R (SCID). I. History, rationale, and description. Arch Gen Psychiatry 49:624–629PubMedGoogle Scholar
  81. Tamerin JS, Mendelson JH (1969) The psychodynamics of chronic inebriation: observations of alcoholics during the process of drinking in an experimental group setting. Am J Psychiatry 125:58–71Google Scholar
  82. Test MA, Wallisch LS, Allness DJ, Ripp K (1989) Substance use in young adults with schizophrenic disorders. Schizophr Bull 15:465–476PubMedGoogle Scholar
  83. Tollefson GD, Montague-Clouse J, Tollefson SL (1992) Treatment of comorbid generalized anxiety in a recently detoxified alcoholic population with a selective serotonergic drug (buspirone). J Clin Psychopharmacol 12:19–26PubMedCrossRefGoogle Scholar
  84. Tyrer SP, Peat MA, Minty PSB (1990) The effect of alcohol on lithium kinetics. Lithium 1:163–168Google Scholar
  85. Von Knorring A-L, Bohman M, Von Knorring L (1985) Platelet MAO-activity as a biological marker in subgroups of alcoholism. Acta Psychiatr Scand 72:51–58CrossRefGoogle Scholar
  86. Weiss RD, Mirin SM, Griffin ML (1992) Methodological considerations in the diagnosis of coexisting psychiatric disorders in substance abusers. Br J Addict 87:179–187CrossRefGoogle Scholar
  87. Westermeyer J (1992) Schizophrenia and substance abuse. In: Tasman A, Riba M (eds) Annual review of psychiatry, vol 11. American Psychiatric Press, Washington DC, pp 379–40Google Scholar
  88. Woods JH, Katz JL, Winger G (1987) Abuse liability of benzodiazepines. Pharmacol Rev 39:254–413Google Scholar
  89. World Health Organization (1990a) International classification of diseases - 10, chapter V: mental and behavioural disorders: diagnostic criteria for research. World Health Organization, GenevaGoogle Scholar
  90. World Health Organization (1990b) Composite international diagnostic interview, core Version 1.0 World Health Organization, GenevaGoogle Scholar
  91. Zimmerman M, Coryell W (1986) Reliability of follow-up assessments of depressed inpatients. Arch Gen Psychiatry 43:468–470PubMedGoogle Scholar
  92. Zung WWK (1965) A self-rating depression scale. Arch Gen Psychiatry 12:63–70PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • M. J. Bohn
  • D. Hersh

There are no affiliations available

Personalised recommendations