Development of alcohol disorders: the role of clinical, psychological, environmental, genetic and neurobiological factors (WC2007-076)

Background

Starting date: 13/12/2007

Alcohol use disorders (AUD) are common and have enormous impact on both individuals and public health. Although effective treatment options are in place, the vast majority of AUD patients (>90%) do not receive appropriate treatment. To become more effective in preventing individual and societal consequences of AUD, knowledge about the key determining factors of AUD onset and course, and barriers in the provision of appropriate care are necessary.

Developmental trajectories of AUD are extremely complex. To study such trajectories, research should focus on a specific group or context in which the risk of AUD is substantially elevated. Adults with depression or anxiety symptoms or disorders represent such a group. Our own preliminary NESDA data (n=2000) indicate that the prevalence of DSM-IV alcohol dependence is 1.2% in healthy controls, but 7.7% in patients with depression or anxiety. Since 20-30% of the population has a depressive or anxiety disorder, AUD patients with depression or anxiety constitute 60-70% of all AUD patients.

Several proposed theories explain this co-occurrence through chronic intoxication, self-medication and shared genetic or environmental vulnerability. In NESDA, in 70% of the depressed or anxious patients the onset of AUD was during or after the onset of mood problems . These findings indicate that persons with anxiety or depression are at a strongly elevated risk to develop AUD and therefore constitute a unique high-risk population to examine mechanisms involved in AUD. With regard to opportunities to improve care it appears that concurrent anxiety or depression influences help-seeking behavior in a way that may facilitate effective treatment. Recent developments in health services have lead to a situation in which the majority of patients with anxiety or depression do come in for some form of treatment (in either primary care or specialized mental health).However, concurrent AUD, although very common, is rarely addressed. This may provide an excellent opportunity to improve the care of a large proportion of AUD patients.