COMORBID PSYCHIATRIC-DIAGNOSIS PREDICTS 3-YEAR OUTCOMES IN ALCOHOLICS- A POSTTREATMENT NATURAL-HISTORY STUDY

Objective: To examine the impact of three common comorbid disorders on a variety of outcomes 3 years after inpatient alcoholism treatment. M ethod: Using a prospective cohort design, we examined the frequency an d intensity of drinking, the severity of alcohol-related symptoms, glo bal alcohol-related outcome and severity of psychiatric symptoms in a group of 225 (74% male) alcoholics. At the index admission, patients w ere categorized as to the lifetime presence of major depression, antis ocial personality disorder (ASP) and drug abuse/dependence. Multiple l inear regression was used hierarchically to step in blocks of predicto rs in a logical sequence: (1) gender and age; (2) number of comorbid p sychiatric diagnoses and the presence or absence of the three individu al comorbid psychiatric disorders; and (3) the interaction between gen der and each of the three diagnostic groups. Results: Men showed great er intensity of drinking, more alcohol-related symptoms and poorer glo bal alcohol-related outcome. Younger patients also showed more alcohol -related symptoms. Although the number of comorbid diagnoses was corre lated with both the intensity of drinking and the severity of psychopa thology, each of the specific comorbid diagnoses accounted for unique variance in outcome. Comorbid drug abuse/dependence was associated wit h more drinking days and more alcohol-related symptoms. In contrast, t he presence of comorbid major depression was associated with lower int ensity of drinking. Finally, ASP was associated with poorer global alc ohol-related outcome. Conclusions: Outcomes 3 years after alcoholism t reatment are related to the presence of specific lifetime comorbid psy chiatric diagnoses. Since such disorders may positively influence the course of alcoholism, trials of clinical interventions that target the se disorders are warranted.