Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

5. Alcohol 79Drug Abuse–DependenceA common comorbidity associated with alcohol use disorders is co-occurringdrug use disorders. In 2001, the National Household Survey on Drug Abusefound that among teenagers who binge drink, two-thirds were also abusingdrugs. In contrast, one in 20 teenagers who did not drink abused drugs. Drawingupon the ECA and NCS data, it has been determined that one in five individualswith an alcohol use disorder will also have a drug use disorder. A breakdownof the NCS data indicates that those with either alcohol abuse or alcoholdependence in 40% of cases have either drug abuse or drug dependence.The more serious the drug use disorder, the more likely it is that alcoholabuse–dependence will be found. For example, the ECA data indicate that if nodrug problem exists, the rate of alcohol abuse–dependence is 11% (compared to13% for the total population). When tetrahydrocannabinol abuse–dependenceis present, the prevalence of alcohol abuse–dependence rises to 36%. The ratesof alcohol abuse–dependence rise even further with amphetamines (62%),opioids (67%), barbiturates (71%), and cocaine (84%) (Helzer & Pryzbeck,1988).An additional drug use comorbidity associated with drinking is that oftobacco dependence. Smoking rates among alcoholics are estimated to be ashigh as 90%, with approximately 70% of alcoholics smoking heavily, that is, atleast one pack of cigarettes per day. Smokers who are dependent on nicotinehave an approximately three times greater risk of becoming alcohol-dependentthan nonsmokers (National Institute on Alcohol Abuse and Alcoholism,1998). It is well known that the smoking rate in the general population hasgradually declined over past decades, but the smoking rates among those withalcohol dependence have remained persistently high (Hays et al., 1999).Mood DisordersWhen corrected for clinical significance (Narrow et al., 2002) 1-year majordepression prevalence rates are approximately 5%. Women are twice as likely asmen to experience major depression. Major depression will be found nearly fourtimes more commonly in individuals with alcohol dependence compared to thenon-alcohol-dependent population. Those with a diagnosis of alcohol abuse(rather than alcohol dependence) have only a slight increased risk of majordepression compared to the general population. There is a strong sex differencein order of onset. For example, in males, alcoholism precedes depression in 78%of cases, whereas for women, the reverse is true (i.e., depression precedes alcoholdependence in about 66% of cases) (Helzer & Pryzbeck, 1988).Bipolar disorder and alcohol use disorders have a strong association.Bipolar I patients have alcohol dependence in approximately 31% of cases,and another 15% meet criteria for alcohol abuse. Patients with bipolar II ill-