A network approach to modeling comorbid internalizing and alcohol use disorders

Area of Science:

• Psychiatry
• Clinical Psychology
• Behavioral Science

Background:

• Internalizing disorders frequently co-occur with alcohol use disorder (AUD), complicating treatment.
• The "vicious cycle" model posits drinking to cope (DTC) as a central link in this comorbidity.
• Existing interventions show success, but the precise role of DTC in maintaining comorbidity requires further evidence.

Purpose of the Study:

• To investigate the role of drinking to cope (DTC) in the comorbidity of internalizing disorders and AUD using network analysis.
• To examine the associations between internalizing symptoms, alcohol craving, drinking behavior, DTC, and other relevant variables.

Main Methods:

• Network analysis was applied to data from 362 individuals with comorbid anxiety and AUD at the start of residential treatment.
• Associations between internalizing symptoms, drinking elements, DTC, perceived stress, and coping self-efficacy were mapped.
• Model simulations were conducted to assess the unique contribution of DTC to the observed relationships.

Main Results:

• Internalizing symptoms and drinking behaviors showed weak direct associations but were strongly linked via DTC and perceived stress.
• Drinking to cope (DTC) emerged as the most central element in the network, connecting various symptoms and behaviors.
• Statistical simulations confirmed that DTC accounted for all associations between internalizing and drinking elements, unlike any other variable.

Conclusions:

• Drinking to cope (DTC) acts as a "keystone" process, maintaining the comorbidity between internalizing disorders and AUD.
• Targeting DTC directly may be essential for effectively treating individuals with comorbid internalizing disorders and AUD.