COMORBIDITY DIAGNOSES IN ALCOHOL DEPENDENT PATIENTS: DIFFERENCES AND DILEMMAS

  • Maja Rus-Makovec Klinični oddelek za mentalno zdravje Psihiatrična klinika Enota za zdravljenje odvisnih od alkohola Poljanski nasip 58 1000 Ljubljana
  • Zdenka Čebašek-Travnik Klinični oddelek za mentalno zdravje Psihiatrična klinika Enota za zdravljenje odvisnih od alkohola Poljanski nasip 58 1000 Ljubljana
  • Mirjana Radovanovič Klinični oddelek za mentalno zdravje Psihiatrična klinika Enota za zdravljenje odvisnih od alkohola Poljanski nasip 58 1000 Ljubljana
  • Radica Ivančič Klinični oddelek za mentalno zdravje Psihiatrična klinika Enota za zdravljenje odvisnih od alkohola Poljanski nasip 58 1000 Ljubljana
  • Vida Tomšič Klinični oddelek za mentalno zdravje Psihiatrična klinika Enota za zdravljenje odvisnih od alkohola Poljanski nasip 58 1000 Ljubljana
Keywords: comorbidity, alcohol dependency, differences in diagnosis, treatment planning

Abstract

Background. In the presented study we followed the diagnostic procedures of comorbidity in alcohol dependent patients of in-patient treatment. The aim of the study was to evaluate the incidence of dual/triple diagnoses with alcohol dependent patients and to incorporate the diagnostic procedures in rutine work and in treatment planning.

Material and methods. We were following the basic parameters of treatment of 469 patients (366 male, 102 female) from July 1999 to July 2001. The diagnostic criteria according to ICD-10 were applied after at least four weeks of sobriety.

Results. The most frequent additional diagnoses found were nicotine dependency, depressive and personal disorders. Main gender differences were found in diagnosis of depressive disorders and in dependency or abuse of prescripted drugs. Comparison of our results with literature data showed the greatest differences in diagnoses of cognitive, depressive, anxious data and dependency of other psychoactive substances.

Conclusions. The comparison between the two time periods shows that stuff sensibility to diagnostic procedures of comorbidity states influences the frequency of diagnostic categories. The literature data review leads to impression of inconsistent diagnosing regarding the context and phylosophy of treatment context, stuff education and patient population.

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References

Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK. Comorbidity of mental disorders with alcohol and other drug abuse. Journal of the American Medical Association 1990; 264: 2511–8.

Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997; 54: 313–21.

Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ. The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am J Orthopsychiatry 1996; 66: 17– 31.

Ross HE. DSM-III-R alcohol abuse and dependence and psychiatric comorbidity in Ontario: results from the Mental Health Supplement to the Ontario Health Survey. Drug Alcohol Depend 1995; 39: 111–28.

Woody GE. The challenge of dual diagnosis. Alcohol Health & Research World 1996; 2: 76–80.

Woody GE, McLellan AT, Bedrick J. Dual diagnosis. In: Oldham JM, Riba MB eds. Review of Psychiatry, Vol. 14. Washington: American Psychiatric Press, 1995: 83–104.

Modesto-Lowe V, Kranzler HR. Diagnosis and treatment of alcohol-dependent patients with comorbid psychiatric disorders. Alcohol Res Health 1999; 23: 144–9.

World Health Organization. The ICD-10 Classification of mental and behavioural disorders. Diagnostic criteria for research. Geneva: WHO, 1993.

Molina JA, Bermeo F, del Ser T et al. Alcoholic cognitive deterioration and nutritional deficiences. Acta Neurol Scand 1994; 89: 384–90.

Caetano R, Weisner C. The association between DSM-III-R alcohol dependence, psychological distress and drug use. Addiction 1995; 90: 351–9.

Monti PM, Rohsenow DJ, Colby SM, Abrams DB. Smoking among alcoholics during and after treatment: Implications for models, treatment strategies, and policy. In: Fertig JB, Allen JP eds. Alcohol and tobacco: From basic science to clinical practice. Research Monograph 30. NIH Pub. No. 95–3931. Bethesda: National Institute on Alcohol Abuse and Alcoholism, 1995: 187–206.

Goodwin WD. Alcohol: Clinical aspects. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG eds. Substance abuse. 2nd ed. Baltimore: Williams & Wilkins, 1992: 144–51.

Cox BJ, Norton GR, Swinson RP, Endler NS. Substance abuse and panic – related anxiety: A critical review. Behavior Research and Therapy 1990; 28: 385–93.

Merikangas KR, Angst J. Comorbidity and social phobia: Evidence from clinical, epidemiologic and genetic studies. European Archives of Psychiatry and Clinical Neuroscience 1995; 244: 297–303.

Schuckit MA, Tipp JE, Anthenelli RM, Bucholz KK, Hesselbrock VM, Nurnberger JI Jr. Anorexia nervosa and bulimia nervosa in alcohol-dependent men and women and their relatives. Am J Psychiatry 1996; 153: 74–82.

Verheul R, van den Brik W, Hartgers C. Prevalence of personality disorders among alcoholics and drug addicts: An overview. European Addiction Research 1995; 1: 166–77.

Grant BF, Dufour MC, Harford TC. Epidemiology of alcoholic liver diseases. Seminars in Liver Disease 1988; 8: 12–25.

Trevisan LA, Boutros N, Petrakis IL, Krystal JH. Complications of alcohol withdrawal: Pathophysiological insights. Alcohol Health & Research World 1998; 22: 61–6.

Beghi E, Monticelli ML. Chronic symmetric symptomatic polyneuropathy in the elderly: a field screening investigation of risk factors for polyneuropathy in two Italian communities. Italian General Practitioner Study Group (IGPST). J Clin Epidemiol 1998; 51: 697–702.

Wetterling T, Veltrup C, Driessen M, John U. Drinking pattern and alcoholrelated medical disorders. Alcohol and Alcoholism 1999; 34: 330–6.

Meyer RE. Prospects for a rational pharmacotherapy of alcoholism. J Clin Psych 1989; 50: 403–12.

Schuckit MA. Genetic and clinical implications of alcoholism and affective disorder. Am J Psych 1986; 143: 140–7.

Taylor RC, Harris NA, Singleton EG, Moolchan ET, Heishman SJ. Tobacco craving: intensity-related effects of imagery scripts in drug abusers. Exp Clin Psychopharmacol 2000; 8: 75–87.

Magura S, Rosenblum A. Modulating effect of alcohol use on cocaine use. Addict Behav 2000; 25: 117–22.

Lilenfeld LR, Kaye WH. The link between alcoholism and eating disorders. Alcohol Health & Research World 1996; 2: 94–9.

Ziedonis DM, Fisher W. Motivation based assessment and treatment of substance abuse in patients with schizophrenia. Directions in Psychiatry 1996; 16: 1–8.

Daghestani AN, Elenz E, Crayton JW. Pathological gambling in hospitalized substance abusing veterans. J Clin Psychiatry 1996; 57: 360–3.

Specker SM, Carlson GA, Edmonson KM, Johnson PE, Marcotte M. Psychopathology in pathological gamblers seeking treatment. Journal of Gambling Studies 1996; 12: 67–81.

Blume SB. Pathologic gambling. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG eds. Substance abuse. A comprehensive textbook. 3rd ed. Baltimore: Williams and Wilkins, 1997: 330–6.

Horner MD, Waid LR, Johnson DE, Latham PK, Anton RF. The relationship of cognitive functioning to amount of recent and lifetime alcohol consumption in outpatient alcoholics. Addict Behav 1999; 24: 449–53.

Koob GF. Neurobiology of addiction. Toward the development of new therapies. Ann NY Acad Sci 2000; 909: 170–85.

Dackis CA, Gold SM. Psychiatric hospitals for treatment of dual diagnosis. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG eds. Substance abuse – a comprehensive textbook. Baltimore: Williams and Wilkins, 1992: 467–85.

Kushner MG, Sher KJ, Beltman BD. The relationship between alcohol problems and anxiety disorders. Am J Psychiatry 1991; 147: 685–95.

Schuckit MA, Tipp JE, Bucholz KK, Nurnberger JI Jr., Hesselbrock VM, Crowe RR, Kramer J. The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls. Addiction 1997; 92:1289–304.

Compton WM 3rd, Cottler LB, Phelps DL, Ben Abdallah A, Spitznagel EL. Psychiatric disorders among drug dependent subjects: are they primary or secondary? Am J Addict 2000; 9: 126–34.

George DT, Zerby A, Noble S, Nutt DJ. Panic attacks and alcohol withdrawal: Can subjects differentiate the symptoms? Biological Psychiatry 1988; 24: 240–3.

Simoni-Wastila L. The use of abusable prescription drugs: The role of gender, Journal of Women’s Health and Gender-based Medicine 2000; 9: 289–97.

Alaja R, Seppa K, Sillanaukee P, Tienari P, Huyse FJ, Herzog T, Malt UF, Lobo Psychiatric referrals associated with substance use disorders: prevalence and gender differences. European Consultation-Liaison Workgroup. Alcohol Clin Exp Res 1997; 21: 620–6.

Vittadini G, Buonocore M, Colli G, Terzi M, Fonte R, Biscaldi G. Alcoholic polyneuropathy: a clinical and epidemiological study. Alcohol and Alcoholism 2001; 36: 393–400.

Vaillant G. An alternative to psychotherapy. In: The international handbook of addiction behavior. London and New York: Tavistock/Routledge, 1991: 236–9.

Levy M. Psychotherapy with dual diagnosis patients: working with denial. J Subst Abuse Treat 1993; 10: 499–504.

Bordwine Beeder A, Millman RB. Patients with psychopathology. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG eds. Substance abuse. A comprehensive textbook. 3rd ed. Baltimore: Williams and Wilkins, 1997: 551–63.

Miller NS. Psychiatric comorbidity: occurence and treatment. Alcohol Health and Research World 1994; 18: 261–4.

Wu LT, Kouzis AC, Leaf PJ. Influence of comorbid alcohol and psychiatric disorders on utilization of mental health services in the national comorbidity survey. Am J Psychiatry 1999; 156: 1230–6.

Čebašek-Travnik Z, Užmah A, Svetina P, Simonič A, Števanec M, Borko B. Evalvacija hospitalnega zdravljenja odvisnosti od alkohola; primerjalna študija vseh šestih centrov v Republiki Sloveniji. In: Čebašek-Travnik Z, Radovanovič M eds. Medicina odvisnosti. Zbornik prispevkov 1. slovenske konference o medicini odvisnosti (Ljubljana: oktober 1996). Ljubljana: Republiški strokovni kolegij za psihiatrijo, Delovna skupina za odvisnost od alkohola, 1997: 131–45.

Goodwin DW, Gabrielli WF. Alcohol: Clinical aspects. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG eds. Substance abuse. A comprehensive textbook. 3rd ed. Baltimore: Williams and Wilkins, 1997: 142–8.

How to Cite
1.
Rus-Makovec M, Čebašek-Travnik Z, Radovanovič M, Ivančič R, Tomšič V. COMORBIDITY DIAGNOSES IN ALCOHOL DEPENDENT PATIENTS: DIFFERENCES AND DILEMMAS. ZdravVestn [Internet]. 1 [cited 23Aug.2019];71(11). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/1644
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Professional Article