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

78 III. SUBSTANCES OF ABUSEstudy. In both male and female alcoholics, the combinations of elevated GGTand MCV identified 90% of alcoholic patients (Skinner, 1981). Other teststhat may be elevated are triglycerides, serum alkaline phosphates, serum bilirubin,and uric acid.A relatively new test with clinical utility is carbohydrate-deficient transferrin(CDT). Consuming more than 60 grams (5 drinks) of alcohol per day willincrease CDT. Normal CDT levels can be expected to return after 2–4 weeks ofabstinence (Allen & Anthnelli, 2003).COMORBIDITYThe Epidemiologic Catchment Area (ECA) study that involved 20,000adults in the general public determined that 7.3% had an alcohol use disorderwithin the 12 months prior to the interview (Regier et al., 1993). TheNational Comorbidity Survey (NCS) involved a sample of over 8,000 individuals,ages 15–54 years, in the noninstitutionalized civilian population ofthe United States. The 1-year prevalence rates for any alcohol use disorder(i.e., either abuse or dependence) was 9.9%. Alcohol abuse was found in2.5% of the population within the previous 12 months, and alcohol dependencein 7.2% of the sample within the past 12 months (Kessler et al., 1994).More recently, these statistics have been revised to address the issue of clinicalsignificance (Narrow, Rae, Robins, & Regier, 2002). Clinical significancewas assessed by determining whether a physician or other professional wastold about the symptoms, whether medicine was taken more than once forthe symptoms, or whether the symptoms interfered a lot with one’s life oractivities. When these aspects of clinical significance were factored in, theprevalence rates for any alcohol use disorder went from 9.9% of the sample to6.5% in the sample in the NCS and from 7.3% of the sample to 7.2% of thesample in the ECA study.For each psychiatric disorder assessed in these epidemiological studies, theprevalence rates of psychiatric disorders were higher among people diagnosedwith alcohol dependence or alcohol abuse. Furthermore, those with alcoholdependence were more likely to have a psychiatric disorder than those diagnosedwith alcohol abuse.In the NCS study, the median age for onset of a comorbid psychiatric disorderpreceded the median age of onset for all addictive disorders by about 10years. The majority of individuals who had both a psychiatric disorder and anaddictive disorder reported that they had experienced the symptoms of the psychiatricdisorder before the addictive disorder started. One exception to thisorder of onset was that nearly 72% of alcohol-abusing males reported that theiralcohol abuse preceded the onset of a mood disorder (Petrakis, Gonzales,Rosenheck, & Krystal, 2002).