Prevalence of comorbid alcohol disorder and consumption in medically ill and depressed patients.

OBJECTIVE

To estimate the extent to which alcohol disorder co-occurs in patients with major medical and psychiatric conditions.

DESIGN

Observational study.

SETTING

Offices of general medical providers and mental health specialists in three US cities.

PATIENTS

Adult patients (N = 2296) with hypertension, diabetes, heart disease (congestive heart failure or myocardial infarction), and/or current depressive disorder or subthreshold depressive symptoms.

MAIN OUTCOME MEASURES

Current and lifetime alcohol disorder, alcohol consumption, current problem drinking, perceived need for help for alcohol or other drug problems, and unmet need.

METHODS

Comparisons of the prevalence of alcohol comorbidity in medically ill nondepressed patients of general medical providers and in depressed patients of both provider types.

RESULTS

Patients with chronic medical problems or depression had similar levels of lifetime alcohol disorder (14% to 19%) and current alcohol problems (18% to 29%), but depressed patients were more likely to report needing help for problems with alcohol or drugs. Current alcohol disorder was more prevalent among depressed patients in mental health specialty practices than in general medical practices. Many patients who perceived a need for care for alcohol and other drug problems reported that this need was unmet (37% to 84%).

CONCLUSIONS

Clinicians who treat patients with major medical and psychiatric conditions need to be prepared to identify and treat comorbid alcohol disorder.