Di Sclafani Victoria, Finn Peter, Fein George
Neurobehavioral Research Inc., Corte Madera, California 94925, USA.
Alcohol Clin Exp Res. 2007 May;31(5):795-803. doi: 10.1111/j.1530-0277.2007.00361.x. Epub 2007 Mar 22.
A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples. In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholic individuals (LTAA; mean abstinence=6.3 years; n=52) compared with age and gender-comparable non-alcoholic controls (NC; n=48). We asked the following questions: (1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable with NC) and (2) can ongoing abstinence be maintained in the face of a current psychiatric disorder?
Lifetime and current (prior 12 months) psychiatric diagnoses were assessed in the mood, anxiety, and externalizing disorder domains using the computerized Diagnostic Interview Schedule (c-DIS).
Over 85% of LTAA had a lifetime psychiatric diagnosis, compared with 50% of NC. Long-term abstinent alcoholic individuals had a higher prevalence than NC of lifetime mood, anxiety, and externalizing disorder diagnoses. Long-term abstinent alcoholic individuals also had a greater prevalence than NC of current mood and anxiety diagnoses. Although LTAA had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than NC, no LTAA or NC had a current ASPD diagnosis. Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse.
Our results suggest that: (1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, (2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and (3) a current diagnosis of ASPD may not be compatible with long-term abstinence. The relatively low levels of antisocial behavior compared with preabstinence (as indicated by no LTAA meeting current criteria for ASPD) raises the question of whether the neurobiology underlying antisocial behavior is changed in abstinence, or brought under increased executive control, or both.
在社区和治疗样本中，酒精使用障碍患者共病精神障碍的患病率都很高，治疗样本中的共病率更高。在本研究中，我们比较了长期戒酒的酗酒者（LTAA；平均戒酒时间 = 6.3 年；n = 52）与年龄和性别匹配的非酗酒对照者（NC；n = 48）的终生及当前精神疾病诊断情况。我们提出了以下问题：（1）一个人要实现长期戒酒，是否必须相对精神健康（即与 NC 相当），以及（2）面对当前的精神疾病，能否维持持续戒酒状态？
使用计算机化诊断访谈表（c - DIS）评估情绪、焦虑和外化性障碍领域的终生及当前（过去 12 个月）精神疾病诊断情况。
超过 85% 的 LTAA 有终生精神疾病诊断，而 NC 为 50%。长期戒酒的酗酒者终生情绪、焦虑和外化性障碍诊断的患病率高于 NC。长期戒酒的酗酒者当前情绪和焦虑诊断的患病率也高于 NC。虽然 LTAA 终生反社会人格障碍（ASPD）的患病率高于 NC，但没有 LTAA 或 NC 当前被诊断为 ASPD。最后，戒酒持续时间与终生或当前精神疾病诊断之间没有关联，这与精神疾病诊断对复发影响不大一致。
我们的结果表明：（1）存在终生精神疾病诊断并不妨碍实现长期戒酒，（2）在当前存在情绪或焦虑障碍的情况下可以维持戒酒状态，以及（3）当前诊断为 ASPD 可能与长期戒酒不相容。与戒酒前相比，反社会行为水平相对较低（如没有 LTAA 符合当前 ASPD 标准所示），这就提出了一个问题，即反社会行为背后的神经生物学机制在戒酒过程中是发生了变化，还是受到了更强的执行控制，或者两者兼而有之。
