Clear Comorbidities of Alcohol Dependence

cont. from

Although alcohol is the survey's centerpiece, the data show its use and abuse are not independent of other problems. "Alcohol dependence is very highly co-morbid with drug use and mental disorders," says Grant. "We're trying to understand what the comorbidities mean."

For example, NESARC shows that not only do one out of 12 Americans abuse alcohol, but nearly one out of 10 adults appear to have a substance-use disorder (alcohol or drug or both). That overlap is consistent with some psychologists' concept of an "addictive personality."

Further analyses revealed that about one out of five Americans with substance abuse disorders had mood or anxiety disorders during that time. When the researchers reversed the question, they found that the same proportion of people with mood or anxiety disorders also had substance-use disorders.

Because people who sought treatment for mental disorders often had co-existing substance-use disorders and vice versa, NIAAA Director Ting-Kai Li, MD, said in an early report that to ensure comprehensive treatment, professionals should assess for and treat both substance-use and mental disorders at the same time. Untreated problems can lead to substance-use relapse and other bad outcomes.

For prevention, researchers can use new statistical techniques such as categorical or continuous latent trait modeling to determine whether NESARC data are consistent with the emerging "latent trait" model, in which researchers theorize that single stable factor underlies a common predisposition to poor mental health and substance abuse. Scientists might finally pin down risk factors for substance abuse and the odds of developing mental or physical disorders relative to that abuse, which would help clinicians advise patients (and health promotion experts tell the general public) how heavy drinking might put them at higher risk for, for example, liver disease or major depression.

Psychologists welcome

To promote research using NESARC data, NIAAA has sent fliers about the database to every department of psychology, psychiatry and epidemiology in the United States. Grant, who reviews many of the resulting papers, says that many doctoral students are writing dissertations on the data.

The NESARC Web site includes the data itself (scrubbed clean of any identifiers), data notes, a code book that covers every variable and its frequency, an overview of methodology and the entire questionnaire. A data reference manual will be posted this spring. The data sets are formatted so they can be analyzed by popular statistical software such as SAS and SPSS and accompanying programs that adjust for the complex design features of the NESARC.

NESARC can clear a path to multidisciplinary research as well, says Goldman. Its large data sample could help experts to define possible at-risk phenotypes and behavioral expressions of underlying genotypes–information that could ultimately lead to treatments of underlying vulnerabilities to alcohol abuse, substance abuse and mental disorders. To share in these exciting discoveries, Goldman urges psychologists to cross disciplinary lines and collaborate on what he calls "the next generation of progress."

next: Overview of Alcohol Abuse and Dependence

top . pages 1 2 . send to friend . addictions site map

Reviewed: 03/2006