Psychiatric comorbidity in long-term abstinent alcoholic individuals

A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples. In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholic individuals (LTAA; mean abstinence=6.3 years; n=52) compared with age and gender-comparable non-alcoholic controls (NC; n=48). We asked the following questions: (1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable with NC) and (2) can ongoing abstinence be maintained in the face of a current psychiatric disorder?

Lifetime and current (prior 12 months) psychiatric diagnoses were assessed in the mood, anxiety, and externalizing disorder domains using the computerized Diagnostic Interview Schedule (c-DIS).

Over 85% of LTAA had a lifetime psychiatric diagnosis, compared with 50% of NC. Long-term abstinent alcoholic individuals had a higher prevalence than NC of lifetime mood, anxiety, and externalizing disorder diagnoses. Long-term abstinent alcoholic individuals also had a greater prevalence than NC of current mood and anxiety diagnoses. Although LTAA had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than NC, no LTAA or NC had a current ASPD diagnosis. Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse.

Our results suggest that: (1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, (2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and (3) a current diagnosis of ASPD may not be compatible with long-term abstinence. The relatively low levels of antisocial behavior compared with preabstinence (as indicated by no LTAA meeting current criteria for ASPD) raises the question of whether the neurobiology underlying antisocial behavior is changed in abstinence, or brought under increased executive control, or both.