Differences in the Severity of Alcohol Craving Between Euthymic Unipolar and Bipolar Patients

Background: To compare the severity of alcohol craving between euthymic patients with unipolar and bipolar disorders and comorbid alcohol use disorder (AUD) and to explore associations between craving severity and clinical and biological markers, including carbohydrate-deficient transferrin (CDT) and homocysteine, to better characterize diagnostic-specific patterns of dual diagnosis.

Methods: This cross-sectional study assessed 50 euthymic outpatients with comorbid AUD and either major depressive disorder (MDD) or bipolar disorder. Participants were evaluated using the Alcohol Use Disorder Identification Test (AUDIT), Visual Analog Scale (VAS) for craving, and blood biomarkers including homocysteine and CDT. Group differences and correlations between craving severity and clinical/biological variables were analyzed. Participants were consecutively recruited over a 12-month period, from June 2015 to May 2016.

Results: Patients with AUD and MDD reported significantly higher alcohol craving (VAS), AUDIT scores, and CDT levels than those with AUD and bipolar disorder. In both groups, alcohol craving positively correlated with AUDIT scores, CDT levels, and plasma homocysteine concentrations. No significant associations were found with sociodemographic variables.

Conclusions: Patients with AUD and MDD may represent a more severe clinical subtype of dual diagnosis. Elevated homocysteine may serve as a potential biomarker for craving intensity and mood instability. These findings support the need for integrated, personalized treatment approaches in dual-diagnosis populations.

Prim Care Companion CNS Disord 2026;28(2):25m04123.

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