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Co-morbid anxiety disorders predict early relapse after inpatient alcohol treatment

Published online by Cambridge University Press:  15 April 2020

A.F.A. Schellekens ,
C.A.J. de Jong ,
J.K. Buitelaar  and
R.J. Verkes
A.F.A. Schellekens*
Affiliation:
Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands Nijmegen Institute for Science Practitioners in Addiction (NISPA) Radboud University Nijmegen, The Netherlands
C.A.J. de Jong
Affiliation:
Nijmegen Institute for Science Practitioners in Addiction (NISPA) Radboud University Nijmegen, The Netherlands
J.K. Buitelaar
Affiliation:
Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands Radboud University Nijmegen, The Netherlands
R.J. Verkes
Affiliation:
Department of Cognitive Neuroscience, University Medical Centre Radboud University Nijmegen, The Netherlands
*
*Corresponding author. E-mail address: a.f.a.schellekens@psy.umcn.nl (A.F.A. Schellekens).
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Abstract

Introduction:

Alcohol dependence and anxiety disorders often co-occur. Yet, the effect of co-morbid anxiety disorders on the alcohol relapse-risk after treatment is under debate. This study investigated the effect of co-morbid anxiety disorders on relapse rates in alcohol dependence. We hypothesized that co-morbid anxiety disorders would be particularly predictive for early relapse, but not late relapse.

Subjects and methods:

In a prospective design, male alcohol dependent patients (n = 189) were recruited from an inpatient detoxification clinic. Psychiatric diagnoses and personality traits were assessed using the Mini International Neuropsychiatric Interview for psychiatric disorders and the Temperament and Character Inventory. The addiction severity index was used to assess addiction severity and follow-up.

Results:

One year after detoxification, 81 patients (53%) relapsed and nine patients (7%) were deceased, due to alcohol related causes. Co-morbid anxiety disorder, marital status, addiction severity, in particular legal problems, and harm avoidance predicted relapse. Anxiety disorders specifically predicted early relapse.

Conclusion:

Alcohol dependence is a severe mental disorder, with high relapse rates and high mortality. Alcohol dependent patients with co-morbid anxiety disorders are particularly prone to relapse during the first three months of treatment. These patients may therefore require additional medical and psychological attention.

Keywords

Substance use disordersAnxietyMortalityTemperament and character inventoryTreatment
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 1 , January 2015 , pp. 128 - 136
Copyright
Copyright © European Psychiatric Association 2020

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References

Kessler, RC. The epidemiology of dual diagnosis. Biol Psychiatry 2004;56:730–737.CrossRefGoogle ScholarPubMed
Kessler, RC, Crum, RM, Warner, LA, Nelson, CB, Schulenberg, J, Anthony, JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997;54:313–321.CrossRefGoogle ScholarPubMed
Hasin, D, Kilcoyne, B. Comorbidity of psychiatric and substance use disorders in the United States: current issues and findings from the NESARC. Curr Opin Psychiatry 2012;25:165–171.CrossRefGoogle ScholarPubMed
Hasin, DS, Stinson, FS, Ogburn, E, Grant, BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. Arch Gen Psychiatry 2007;64:830–842.CrossRefGoogle ScholarPubMed
Robinson, J, Sareen, J, Cox, BJ, Bolton, J. Self-medication of anxiety disorders with alcohol and drugs: Results from a nationally representative sample. J Anxiety Disord 2009;23:38–45.CrossRefGoogle ScholarPubMed
Kushner, MG. Relationship between alcohol problems and anxiety disorders. Am J Psychiatry 1996;153:139–140.Google ScholarPubMed
Kushner, MG, Sher, KJ, Erickson, DJ. Prospective analysis of the relation between DSM-III anxiety disorders and alcohol use disorders. Am J Psychiatry 1999;156:723–732.Google ScholarPubMed
Johnston, AL, Thevos, AK, Randall, CL, Anton, RF. Increased severity of alcohol withdrawal in in-patient alcoholics with a co-existing anxiety diagnosis. Br J Addict 1991;86:719–725.CrossRefGoogle ScholarPubMed
Thevos, AK, Johnston, AL, Latham, PK, Randall, CL, Adinoff, B, Malcolm, R. Symptoms of anxiety in inpatient alcoholics with and without DSM-III-R anxiety diagnoses. Alcohol Clin Exp Res 1991;15:102–105.CrossRefGoogle ScholarPubMed
Terra, MB, Barros, HM, Stein, AT, Figueira, I, Jorge, MR, Palermo, LH, et al.Social anxiety disorder in 300 patients hospitalized for alcoholism in Brazil: high prevalence and undertreatment. Compr Psychiatry 2006;47:463–467.CrossRefGoogle ScholarPubMed
Driessen, M, Meier, S, Hill, A, Wetterling, T, Lange, W, Junghanns, K. The course of anxiety, depression and drinking behaviours after completed detoxification in alcoholics with and without comorbid anxiety and depressive disorders. Alcohol Alcohol 2001;36:249–255.CrossRefGoogle ScholarPubMed
Bradizza, CM, Stasiewicz, PR, Paas, ND. Relapse to alcohol and drug use among individuals diagnosed with co-occurring mental health and substance use disorders: a review. Clin Psychol Rev 2006;26:162–178.CrossRefGoogle Scholar
Marquenie, LA, Schade, A, van Balkom, AJ, Koeter, M, Frenken, S, van den Brink, W, et al.Comorbid phobic disorders do not influence outcome of alcohol dependence treatment. Results of a naturalistic follow-up study. Alcohol Alcohol 2006;41:168–173.CrossRefGoogle Scholar
Mann, K, Hintz, T, Jung, M. Does psychiatric comorbidity in alcohol-dependent patients affect treatment outcome?. Eur Arch Psychiatry Clin Neurosci 2004;254:172–181.CrossRefGoogle ScholarPubMed
Boschloo, L, Vogelzangs, N, van den, BW, Smit, JH, Beekman, AT, Penninx, BW. Predictors of the 2-year recurrence and persistence of alcohol dependence. Addiction 2012;107:1639–1640.CrossRefGoogle ScholarPubMed
Kushner, MG, Abrams, K, Thuras, P, Hanson, KL, Brekke, M, Sletten, S. Follow-up study of anxiety disorder and alcohol dependence in comorbid alcoholism treatment patients. Alcohol Clin Exp Res 2005;29:1432–1443.CrossRefGoogle ScholarPubMed
Fenton, MC, Keyes, K, Geier, T, Greenstein, E, Skodol, A, Krueger, B, et al.Psychiatric comorbidity and the persistence of drug use disorders in the United States. Addiction 2012;107:599–609.CrossRefGoogle ScholarPubMed
Xie, H, Drake, RE, McHugo, GJ, Xie, L, Mohandas, A. The 10-year course of remission, abstinence, and recovery in dual diagnosis. J Subst Abuse Treat 2010;39:132–140.CrossRefGoogle ScholarPubMed
Curran, GM, Booth, BM. Longitudinal changes in predictor profiles of abstinence from alcohol use among male veterans. Alcohol Clin Exp Res 1999;23:141–143.CrossRefGoogle ScholarPubMed
Charney, DA, Zikos, E, Gill, KJ. Early recovery from alcohol dependence: factors that promote or impede abstinence. J Subst Abuse Treat 2010;38:42–50.CrossRefGoogle ScholarPubMed
Bottlender, M, Soyka, M. Outpatient alcoholism treatment: predictors of outcome after 3 years. Drug Alcohol Depend 2005;80:83–89.CrossRefGoogle ScholarPubMed
Hingson, RW, Heeren, T, Winter, MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Arch Pediatr Adolesc Med 2006;160:739–746.CrossRefGoogle ScholarPubMed
Janowsky, DS, Boone, A, Morter, S, Howe, L. Personality and alcohol/substance-use disorder patient relapse and attendance at self-help group meetings. Alcohol Alcohol 1999;34:359–369.CrossRefGoogle ScholarPubMed
Sellman, JD, Mulder, RT, Sullivan, PF, Joyce, PR. Low persistence predicts relapse in alcohol dependence following treatment. J Stud Alcohol 1997;58:257–263.CrossRefGoogle ScholarPubMed
Meszaros, K, Lenzinger, E, Hornik, K, Fureder, T, Willinger, U, Fischer, G, et al.The Tridimensional Personality Questionnaire as a predictor of relapse in detoxified alcohol dependents. The European Fluvoxamine in Alcoholism Study Group. Alcohol Clin Exp Res 1999;23:483–486.CrossRefGoogle ScholarPubMed
Arnau, MM, Mondon, S, Santacreu, JJ. Using the temperament and character inventory (TCI) to predict outcome after inpatient detoxification during 100 days of outpatient treatment. Alcohol Alcohol 2008;43:583–588.CrossRefGoogle ScholarPubMed
Muller, SE, Weijers, HG, Boning, J, Wiesbeck, GA. Personality traits predict treatment outcome in alcohol-dependent patients. Neuropsychobiology 2008;57:159–164.CrossRefGoogle ScholarPubMed
Schuckit, MA, Monteiro, MG. Alcoholism, anxiety and depression. Br J Addict 1988;83:1373–1380.CrossRefGoogle ScholarPubMed
Cordovil De Sousa, UM, Luminet, O, Cortesi, M, Constant, E, Derely, M, De, TP. Distinct effects of protracted withdrawal on affect, craving, selective attention and executive functions among alcohol-dependent patients. Alcohol Alcohol 2010;45:241–246.CrossRefGoogle Scholar
McLellan, AT, Kushner, H, Metzger, D, Peters, R, Smith, I, Grissom, G, et al.The fifth edition of the addiction severity index. J Subst Abuse Treat 1992;9:199–213.CrossRefGoogle ScholarPubMed
Lehman, AF, Myers, CP, Dixon, LB, Johnson, JL. Detection of substance use disorders among psychiatric inpatients. J Nerv Ment Dis 1996;184:228–233.CrossRefGoogle ScholarPubMed
Rikoon, SH, Cacciola, JS, Carise, D, Alterman, AI, McLellan, AT. Predicting DSM-IV dependence diagnoses from addiction severity index composite scores. J Subst Abuse Treat 2006;31:17–24.CrossRefGoogle ScholarPubMed
Makela, K. Studies of the reliability and validity of the addiction severity index. Addiction 2004;99:398–410.CrossRefGoogle ScholarPubMed
Leonhard, C, Mulvey, K, Gastfriend, DR, Shwartz, M. The addiction severity index: a field study of internal consistency and validity. J Subst Abuse Treat 2000;18:129–135.CrossRefGoogle ScholarPubMed
Zanis, DA, McLellan, AT, Corse, S. Is the addiction severity index a reliable and valid assessment instrument among clients with severe and persistent mental illness and substance abuse disorders?. Community Ment Health J 1997;33:213–227.CrossRefGoogle ScholarPubMed
de Jong, CA, Willems, JC, Schippers, GM, Hendriks, VM. The addiction severity index: reliability and validity in a Dutch alcoholic population. Int J Addict 1995;30:605–616.CrossRefGoogle Scholar
Hendriks, VM, Kaplan, CD, van, LJ, Geerlings, P. The addiction severity index: reliability and validity in a Dutch addict population. J Subst Abuse Treat 1989;6:133–141.CrossRefGoogle Scholar
McLellan, AT, Luborsky, L, Cacciola, J, Griffith, J, Evans, F, Barr, HL, et al.New data from the addiction severity index. Reliability and validity in three centers. J Nerv Ment Dis 1985;173:412–423.CrossRefGoogle ScholarPubMed
Kosten, TR, Rounsaville, BJ, Kleber, HD. Concurrent validity of the addiction severity index. J Nerv Ment Dis 1983;171:606–610.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al.The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(Suppl 20):22–33.Google ScholarPubMed
Kooij, SJJ, Boonstra, MA, Swinkels, SH, Bekker, EM, de, NI, Buitelaar, JK. Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. J Atten Disord 2008;11:445–458.CrossRefGoogle Scholar
Kumar, G, Faden, J, Steer, RA. Screening for attention-deficit/hyperactivity disorder in adult inpatients with psychiatric disorders. Psychol Rep 2011;108:815–824.CrossRefGoogle ScholarPubMed
de Azevedo Marques, JM, Zuardi, AW. Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil. Gen Hosp Psychiatry 2008;30:303–310.CrossRefGoogle ScholarPubMed
Rossi, A, Alberio, R, Porta, A, Sandri, M, Tansella, M, Amaddeo, F. The reliability of the Mini-International Neuropsychiatric Interview – Italian version. J Clin Psychopharmacol 2004;24:561–563.CrossRefGoogle ScholarPubMed
Cloninger, CR, Svrakic, DM, Przybeck, TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993;50:975–990.CrossRefGoogle ScholarPubMed
Goncalves, DM, Cloninger, CR. Validation and normative studies of the Brazilian Portuguese and American versions of the temperament and character inventory – revised (TCI-R). J Affect Disord 2010;124:126–133.CrossRefGoogle Scholar
Martinotti, G, Mandelli, L, Di, NM, Serretti, A, Fossati, A, Borroni, S, et al.Psychometric characteristic of the Italian version of the Temperament and Character Inventory – revised, personality, psychopathology, and attachment styles. Compr Psychiatry 2008;49:514–522.CrossRefGoogle ScholarPubMed
Preiss, M, Kucharova, J, Novak, T, Stepankova, H. The temperament and character inventory-revised (TCI-R): a psychometric characteristics of the Czech version. Psychiatr Danub 2007;19:27–34.Google ScholarPubMed
Fossati, A, Cloninger, CR, Villa, D, Borroni, S, Grazioli, F, Giarolli, L, et al.Reliability and validity of the Italian version of the temperament and character inventory-revised in an outpatient sample. Compr Psychiatry 2007;48:380–387.CrossRefGoogle Scholar
Hansenne, M, Delhez, M, Cloninger, CR. Psychometric properties of the temperament and character inventory-revised (TCI-R) in a Belgian sample. J Pers Assess 2005;85:40–49.CrossRefGoogle Scholar
Pelissolo, A, Mallet, L, Baleyte, JM, Michel, G, Cloninger, CR, Allilaire, JF, et al.The Temperament and Character Inventory-Revised (TCI-R): psychometric characteristics of the French version. Acta Psychiatr Scand 2005;112:126–133.CrossRefGoogle ScholarPubMed
Potgieter, A. Science, practice and patient needs: the work of the Plinius Maior Society. Alcohol Alcohol 2000;35:16–24.CrossRefGoogle ScholarPubMed
Potgieter, AS, Deckers, F, Geerlings, P. Craving and relapse measurement in alcoholism. Alcohol Alcohol 1999;34:254–260.CrossRefGoogle ScholarPubMed
Fureman, B, Parikh, G, Bragg, A, McLellan, ATAddiction Severity Index, Fifth edition with preface, a guide to training and supervising ASI interviews based on the past ten years. 5 Pennsylvania: The University of Pennsylvania/veterans administration, Center for studies of addiction; 1990 Ref Type: Serial (Book, Monograph).Google Scholar
Stoffelmayr, BE, Mavis, BE, Kasim, RM. The longitudinal stability of the addiction severity index. J Subst Abuse Treat 1994;11:373–378.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BOMplus User's Guide (6th edition). 6. Los Angeles 2010 Ref Type: Serial (Book, Monograph).Google Scholar
Dawson, DA, Goldstein, RB, Grant, BF. Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up. Alcohol Clin Exp Res 2007;31:2036–2045.CrossRefGoogle ScholarPubMed
Timko, C Predictors of 16-year mortality among individuals initiating help-seeking for an alcoholic use disorder; 2006.CrossRefGoogle Scholar
Johnson, JE Predictors of 5-year mortality following inpatient/residential group treatment for substance use disorders; 2005CrossRefGoogle Scholar
Martinotti, G, Nicola, MD, Reina, D, Andreoli, S, Foca, F, Cunniff, A, et al.Alcohol protracted withdrawal syndrome: the role of anhedonia. Subst Use Misuse 2008;43:271–284.CrossRefGoogle ScholarPubMed
Moos, RH, Moos, BSRates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction 2006;101:212–222.CrossRefGoogle ScholarPubMed
McGuinness, TM, Fogger, SAHyper-anxiety in early sobriety: psychopharmacological treatment strategies. J Psychosoc Nurs Ment Health Serv 2006;44:22–27.CrossRefGoogle ScholarPubMed
Trevisan, LA, Boutros, N, Petrakis, IL, Krystal, JHComplications of alcohol withdrawal: pathophysiological insights. Alcohol Health Res World 1998;22:61–66.Google ScholarPubMed
Kliethermes, CLAnxiety-like behaviors following chronic ethanol exposure. Neurosci Biobehav Rev 2005;28:837–850.CrossRefGoogle ScholarPubMed
Schade, A, Marquenie, LA, van Balkom, AJ, Koeter, MW, de Beurs, E, van den Brink, W, et al.The effectiveness of anxiety treatment on alcohol-dependent patients with a comorbid phobic disorder: a randomized controlled trial. Alcohol Clin Exp Res 2005;29:794–800.CrossRefGoogle ScholarPubMed
Enoch, MAThe role of GABA(A) receptors in the development of alcoholism. Pharmacol Biochem Behav 2008;90:95–104.CrossRefGoogle ScholarPubMed
Glockner-Rist, A, Lemenager, T, Mann, KReward and relief craving tendencies in patients with alcohol use disorders: results from the PREDICT study. Addict Behav 2013;38:1532–1540.CrossRefGoogle ScholarPubMed
Crum, RM, La, FL, Storr, CL, Green, KM, Stuart, EA, Alvanzo, AA, et al.Reports of drinking to self-medicate anxiety symptoms: longitudinal assessment for subgroups of individuals with alcohol dependence. Depress Anxiety 2013;30:174–183.CrossRefGoogle ScholarPubMed
Lazareck, S, Robinson, JA, Crum, RM, Mojtabai, R, Sareen, J, Bolton, JMA longitudinal investigation of the role of self-medication in the development of comorbid mood and drug use disorders: findings from the National Epidemiologic Survey on alcohol and related conditions (NESARC). J Clin Psychiatry 73 2012 e588–e593.CrossRefGoogle Scholar
Durazzo, TC, Rothlind, JC, Gazdzinski, S, Meyerhoff, DJThe relationships of sociodemographic factors, medical, psychiatric, and substance-misuse co-morbidities to neurocognition in short-term abstinent alcohol-dependent individuals. Alcohol 2008;42:439–449.CrossRefGoogle ScholarPubMed
Mann, K, Schafer, DR, Langle, G, Ackermann, K, Croissant, BThe long-term course of alcoholism, 5, 10 and 16 years after treatment. Addiction 2005;100:797–805.CrossRefGoogle ScholarPubMed
Hopley, AA, Brunelle, CPersonality mediators of psychopathy and substance dependence in male offenders. Addict Behav 2012;37:947–955.CrossRefGoogle ScholarPubMed
Thylstrup, B, Hesse, MThe impulsive lifestyle counseling program for antisocial behavior in outpatient substance abuse treatment. Int J Offender Ther Comp Criminol 2011Google ScholarPubMed
Wahlund, K, Kristiansson, MOffender characteristics in lethal violence with special reference to antisocial and autistic personality traits. J Interpers Violence 2006;21:1081–1091.CrossRefGoogle ScholarPubMed
Walitzer, KS, Dearing, RLGender differences in alcohol and substance use relapse. Clin Psychol Rev 2006;26:128–148.CrossRefGoogle ScholarPubMed
Hasin, D, Fenton, MC, Skodol, A, Krueger, R, Keyes, K, Geier, T, et al.Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders. Arch Gen Psychiatry 2011;68:1158–1167.CrossRefGoogle ScholarPubMed
Hasin, D, Paykin, A, Endicott, JCourse of DSM-IV alcohol dependence in a community sample: effects of parental history and binge drinking. Alcohol Clin Exp Res 2001;25:411–414.CrossRefGoogle Scholar
de Bruijn, C, van den Brink, W, de Graaf, R, Vollebergh, WAThe three-year course of alcohol use disorders in the general population: DSM-IV, ICD-10 and the craving withdrawal model. Addiction 2006;101:385–392.CrossRefGoogle ScholarPubMed
Moos, RH, Moos, BSTreated and untreated alcohol-use disorders: course and predictors of remission and relapse. Eval Rev 2007;31:564–584.CrossRefGoogle ScholarPubMed
Amorim, P, Lecrubier, Y, Weiller, E, Hergueta, T, Sheehan, DDSM-IH-R psychotic disorders: procedural validity of the Mini International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI. Eur Psychiatry 1998;13:26–34.CrossRefGoogle ScholarPubMed
van Vliet, I, de Beurs, EThe MINI-International Neuropsychiatric Interview. A brief structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric disorders. Tijdschr Psychiatr 2007;49:393–397.Google ScholarPubMed
Wetterling, T, Junghanns, KPsychopathology of alcoholics during withdrawal and early abstinence. Eur Psychiatry 2000;15:483–488.CrossRefGoogle ScholarPubMed
Kushner, MG, Abrams, K, Borchardt, CThe relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings. Clin Psychol Rev 2000;20:149–171.CrossRefGoogle ScholarPubMed
Cosci, F, Schruers, KR, Abrams, K, Griez, EJAlcohol use disorders and panic disorder: a review of the evidence of a direct relationship. J Clin Psychiatry 2007;68:874–880.CrossRefGoogle ScholarPubMed
Oei, TP, Loveday, WAManagement of co-morbid anxiety and alcohol disorders: parallel treatment of disorders. Drug Alcohol Rev 1997;16:261–274.CrossRefGoogle ScholarPubMed
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