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

80 III. SUBSTANCES OF ABUSEness have a rate of alcohol dependence at approximately 21% and an alcoholabuse pattern of 18%. Non-substance-abusing patients with bipolar illnesshave a more favorable course of treatment than do those who are using alcoholor other drugs. For example, the patients with comorbid substance useand bipolar disorders have more frequent hospitalizations for mood symptoms,earlier onset of bipolar disorder, more rapid cycling, and a greater prevalenceof mixed mania. It is more common for bipolar disorder to precede alcoholism,although the reverse situation is certainly found. In either case, it is criticalthat the alcohol use disorder and the mood disorder be treated in a synchronousfashion, because failure to address one is likely to aggravate theoccurrence of the other.Anxiety DisordersCompared to depressive disorder, it is usually easier to determine whether ornot an anxiety disorder is independent of alcohol use. For example, posttraumaticstress disorder (PTSD) does require a specific traumatic event. Panicattacks are typically clearly recalled by individuals and are therefore easier toseparate from possible anxiety symptoms that have resulted from alcohol use,intoxication, or withdrawal. There is a strong comorbidity between alcohol usedisorders and anxiety disorders; nearly 37% of individuals with alcohol dependencehave met criteria for an anxiety disorder during the previous year. Generalizedanxiety disorder accounts for 11.6%, panic disorder for 3.9%, and PTSDfor 7.7%. Another way to appreciate these comorbidities is that the alcoholdependentperson is 4.6 times more likely to have generalized anxiety disorder,2.2 times more likely to have PTSD, and 1.7 times more likely to have panicdisorder than the non-alcoholic-dependent individual. The prevalence of socialanxiety disorder has been found to range from 2 to 13%, with the latter figuredetermined through the NCS. Typically, social anxiety disorder (social phobia)is present before the development of an alcohol use disorder, because individualswith social phobia are typically shy or behaviorally inhibited as small children.Conservative estimates of co-occurring social anxiety disorder and alcoholuse disorders indicate that 15% of people receiving alcoholism treatmenthave both disorders, and 20% of patients seeking treatment for social anxietydisorder also have a comorbid alcohol use disorder (Randall, Thomas, &Thevos, 2001). Generally, anxiety disorders develop prior to an alcohol use disorder,and alcohol is typically seen to achieve, at least briefly, tension reduction.SchizophreniaOther than nicotine, alcohol is the most commonly abused drug in patientswith schizophrenia. Schizophrenia occurs in about 1% of the population, butECA data revealed that 33.7% of people with schizophreniform disorder (same