Citation

Ehlers CL, Gilder DA, Gizer IR, Wilhelmsen K. Addiction 2019; 114(1): 139-149.

Affiliation

Departments of Genetics and Neurology, University of North Carolina at Chapel Hill, 120 Mason Farm Rd, Chapel Hill, NC, 27599.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1111/add.14431

PMID

30153346

Abstract

BACKGROUND AND AIMS: The emergence of negative affective symptoms over the course of alcohol use disorders (AUDs) (e.g. "dark side symptoms") has been suggested theoretically,; however, the description of their occurrence is limited. This study operationalized two negative affect symptoms and tested the strength of association between these phenotypes and 1) indicators of the clinical course of the severity of AUD, 2) comorbid Axis I psychiatric disorders, suicidal behaviors, and trait neuroticism, and 3) whether participants reported drinking to relieve the negative affective symptoms.

DESIGN: A retrospective cross-sectional study was used to evaluate associations, using logistic regression, between the two negative affective symptoms and clinical measures of AUD severity and progression as well as comorbidity with other psychiatric disorders and conditions, adjusted for demographic characteristics. SETTING: U.S. community based studies. PARTICIPANTS: 2,568 individuals with AUDs obtained from larger population studies that targeted individuals of European (n=1663), Mexican and American Indian (n=905) ancestry. MEASUREMENTS: Semi-Structured Assessment for the Genetics of Alcoholism was used to ascertain: the 2 "dark side" phenotypes, clinical diagnoses, the clinical course of AUD, and associated symptoms. The two phenotypes were: 1) being anxious or depressed when trying to cut down or stop drinking and 2) experiencing disabling depression for more than 24 hours while drinking.

FINDINGS: Both phenotypes were found to be rare in mild and moderate use disorder and highly prevalent (>60%) in severe AUDs. Having an independent anxiety or affective disorder and elevated scores on trait neuroticism were also significantly associated with the occurrence of both symptoms, as was alcohol "craving", elevated treatment seeking, suicidal behaviors and drinking to relieve the symptoms (all adjusted p<0.01, ORs range= 1.5-22).

CONCLUSIONS: Affective symptoms are common in severe alcohol use disorders; are associated with a history of independent affective/anxiety disorders, neuroticism, and suicidal behaviors; and may promote further heavy drinking.

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Language: en

Keywords

Affective disorders; Alcohol use disorders; American Indians; Anxiety disorders; Mexican Americans; comorbidity