Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany

Alcohol & Alcoholism Vol. 36, No. 3, pp. 219–223, 2001 COMORBID ANXIETY AND AFFECTIVE DISORDER IN ALCOHOL-DEPENDENT PATIENTS SEEKING TREATMENT: THE FIRST MULTICENTRE STUDY IN GERMANY U. SCHNEIDER*, A. ALTMANN1, M. BAUMANN2, J. BERNZEN3, B. BERTZ4, U. BIMBER5, T. BROESE6, A. BROOCKS3, W. BURTSCHEIDT7, K. F. CIMANDER8, P. DEGKWITZ9, M. DRIESSEN3, H. EHRENREICH1, E. FISCHBACH10, H. FOLKERTS11, H. FRANK11, D. GURTH12, U. HAVEMANN-REINECKE1, W. HEBER13, J. HEUER10, A. HINGSAMMER14, S. JACOBS1, H. KRAMPE1, W. LANGE10, T. LAY6, M. LEIMBACH11, M. R. LEMKE15, M. LEWEKE7, A. MANGHOLZ1, W. MASSING16, R. MEYENBERG14, J. PORZIG1, T. QUATTERT17, C. REDNER7, G. RITZEL17, J. D. ROLLNIK, R. SAUVAGEOLL5, D. SCHLÄFKE6, G. SCHMID6, H. SCHRÖDER18, U. SCHWICHTENBERG19, D. SCHWOON9, J. SEIFERT, I. SICKELMANN, C. F. SIEVEKING20, C. SPIESS21, H. H. STIEGEMANN17, R. STRACKE12, H. D. STRAETGEN22, P. SUBKOWSKI23, R. THOMASIUS9, H. TRETZEL4, L. J. VERNER, J. VITENS24, T. WAGNER1, S. WEIRICH6, I. WEISS14, T. WENDORFF15, T. WETTERLING2, B. WIESE and J. WITTFOOT10 Medizinische Hochschule Hannover, 1Georg-August Universität, Göttingen, 2Johann-Wolfgang-Goethe Universität, Frankfurt, 3Medizinische Universität, Lübeck, 4Klinikum der Hansestadt Stralsund, 5Zentrum für Soziale Psychiatrie, Bad Emstal, 6Klinik für Psychiatrie und Psychotherapie der Universität Rostock, 7Psychiatrische Klinik der Heinrich Heine Universität, Düsseldorf, 8Zentrum für Drogenkranke, Hannover, 9Universitätskrankenhaus, Hamburg, 10 Gilead, Psychiatrische Klinik, Bielefeld, 11Reinhard-Nieter Krankenhaus, Wilhelmshaven, 12Klinikum Nord, Hamburg, 13Nds. Landeskrankenhaus, Göttingen, 14Klinik für Psychiatrie und Psychotherapie III des Zentralkrankenhauses Bremen Ost/Universität Oldenburg, 15Christian-Albrechts Universität, Kiel, 16Tagesklinik Königstraße, Hannover, 17Nds. Landeskrankenhaus, Hildesheim, 18Klinik für Psychiatrie und Psychotherapie, Langenhagen, 19 Nds. Landeskrankenhaus, Osnabrück, 20Paracelsus-Wiehengebirgsklink, Bad Essen, 21Charite, Berlin, 22Fachklinik Holstein, Lübeck, 23 Paracelsus Berghof-klinik, Bad Essen, 24Nds. Landeskrankenhaus Wehnen, Bad Zwischenahn, Germany (Received 10 July 2000; in revised form 10 November 2000; accepted 10 December 2000) Abstract — The goals of this study were to describe demographic variables, drinking history, and the 6-month prevalence of Axis I comorbidity among alcohol-dependent subjects in Germany. The variables: amount of alcohol consumption, age at onset of the first alcohol consumed, age at onset of daily alcohol consumption, age at onset of withdrawal symptoms and number of detoxifications were related to the different comorbid disorders and gender. In this study, 556 patients from 25 alcohol treatment centres were enrolled between 1 January 1999 and 30 April 1999. After a minimum of 10 days of sobriety patients who fulfilled ICD-10 and DSM-IV criteria of alcohol dependence were interviewed for data collection using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule) and a standardized psychosocial interview. The 6-month prevalence of comorbid Axis I disorders was 53.1%. Among the patients with comorbidity, affective and anxiety disorders were most frequent. Comorbid stress disorder was associated with an early start of drinking, an early beginning of withdrawal symptoms, highest number of detoxifications, and the highest amount of alcohol consumed. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid disorder. The data do not answer the question of the pathogenesis of comorbid disorders and alcoholism, but indicate that stress disorders in alcoholic patients and anxiety disorders in female alcoholics influence the course and severity of alcoholism. INTRODUCTION alcohol-dependent patients (Driessen et al., 1998). This multicentre study, which is the largest in sample size yet undertaken in Germany, aimed to close that gap. The CART (Classification and Regression Trees) procedure was used for data analysis. Two main issues were addressed by the study: (1) to investigate the current (6 months) prevalence of psychiatric comorbidity in alcohol-dependent patients in 25 treatment centres; (2) to analyse the relation of comorbid disorders and gender on alcohol-related variables. While many alcohol treatment units exclusively focus on alcohol problems, psychiatric comorbidity may be underestimated both diagnostically and therapeutically. Although the impact of co-occurring disorders remains controversial (Schuckit, 1985; Bean-Bayog, 1988) it is reasonably clear that alcohol-dependent individuals who meet diagnostic criteria for one or more comorbid psychiatric disorders differ from those without comorbidity in many clinically relevant ways. Among alcohol-abusing and alcohol-dependent patients, prevalence rates for psychiatric comorbidity of between 57% and 84% have been reported (Powell et al., 1987; Regier et al., 1990; Wittchen et al., 1992). Depressive disorders as well as anxiety disorders were found very frequently (Arolt and Driessen, 1996; Schuckit et al., 1997; Berglund and Ojehagen, 1998; Swendsen et al., 1998; Tondo et al., 1999). The amount of pure alcohol consumed is higher in Germany than in most other European countries. However, there is a paucity of data concerning psychiatric comorbidity in SUBJECTS AND METHODS The Multicentre Study of Psychiatric Comorbidity in Alcoholics (MUPCA) is a retrospective study that enrolled 556 patients from 25 centres between 1 January 1999 and 30 April 1999. These 25 centres cover a population of 7 250 000 inhabitants, representing ~10% of the population of Germany, and they treat anually about 15 285 patients with alcoholrelated disorders. Only those patients who fulfilled ICD-10 (World Health Organization, 1992) and DSM-IV (American Psychiatric Association, 1994) criteria of alcohol dependence were included in this study. Patients with additional substance misuse or dependence were excluded. *Author to whom correspondence should be addressed at: Medical School Hannover, Department of Clinical Psychiatry and Psychotherapy, OE 7110, 30625 Hannover, Germany. 219 © 2001 Medical Council on Alcoholism 220 U. SCHNEIDER et al. The patients were interviewed face to face after a minimum of 10 days and a maximum of 28 days of sobriety and when withdrawal symptoms could no longer be observed by clinical means. The patients were selected consecutively. The MiniDIPS (Markgraf, 1994) and a standardized psychosocial interview were applied. The DIPS represents the German version of the Anxiety Disorders Interview Schedule (Di Nardo and Barlow, 1988). The Mini-DIPS is the short form of this structured interview according to DSM-IV and ICD-10 criteria for current (6 months) comorbidity and covers the following disorders: anxiety, affective, somatization, obsessive–compulsive, post-traumatic stress, acute stress, dissociative, and eating disorders (F30–F50). (...truncated)