Kranzler H R, Del Boca F K, Rounsaville B J
Department of Psychiatry, University of Connecticut Health Center, Farmington 06030-2103, USA.
J Stud Alcohol. 1996 Nov;57(6):619-26. doi: 10.15288/jsa.1996.57.619.
To examine the impact of three common comorbid disorders on a variety of outcomes 3 years after inpatient alcoholism treatment.
Using a prospective cohort design, we examined the frequency and intensity of drinking, the severity of alcohol-related symptoms, global alcohol-related outcome and severity of psychiatric symptoms in a group of 225 (74% male) alcoholics. At the index admission, patients were categorized as to the lifetime presence of major depression, antisocial personality disorder (ASP) and drug abuse/dependence. Multiple linear regression was used hierarchically to step in blocks of predictors in a logical sequence: (1) gender and age; (2) number of comorbid psychiatric diagnoses and the presence or absence of the three individual comorbid psychiatric disorders; and (3) the interaction between gender and each of the three diagnostic groups.
Men showed greater intensity of drinking, more alcohol-related symptoms and poorer global alcohol-related outcome. Younger patients also showed more alcohol-related symptoms. Although the number of comorbid diagnoses was correlated with both the intensity of drinking and the severity of psychopathology, each of the specific comorbid diagnoses accounted for unique variance in outcome. Comorbid drug abuse/dependence was associated with more drinking days and more alcohol-related symptoms. In contrast, the presence of comorbid major depression was associated with lower intensity of drinking. Finally, ASP was associated with poorer global alcohol-related outcome.
Outcomes 3 years after alcoholism treatment are related to the presence of specific lifetime comorbid psychiatric diagnoses. Since such disorders may positively influence the course of alcoholism, trials of clinical interventions that target these disorders are warranted.
探讨三种常见共病障碍对住院酒精中毒治疗3年后各种结局的影响。
采用前瞻性队列设计，我们对一组225名（74%为男性）酒精中毒患者的饮酒频率和强度、酒精相关症状的严重程度、总体酒精相关结局以及精神症状的严重程度进行了研究。在首次入院时，患者根据是否存在重度抑郁症、反社会人格障碍（ASP）和药物滥用/依赖进行分类。采用多元线性回归按逻辑顺序分层逐步纳入预测因素块：（1）性别和年龄；（2）共病精神科诊断的数量以及三种个体共病精神科障碍的有无；（3）性别与三个诊断组中每组之间的相互作用。
男性饮酒强度更大，酒精相关症状更多，总体酒精相关结局更差。年轻患者也表现出更多酒精相关症状。虽然共病诊断的数量与饮酒强度和精神病理学严重程度均相关，但每种特定的共病诊断在结局中都占独特的方差。共病药物滥用/依赖与饮酒天数增加和更多酒精相关症状有关。相比之下，共病重度抑郁症与饮酒强度较低有关。最后，ASP与总体酒精相关结局较差有关。
酒精中毒治疗3年后的结局与特定的终生共病精神科诊断的存在有关。由于这些障碍可能对酒精中毒病程产生积极影响，因此有必要对针对这些障碍的临床干预进行试验。
