Psychiatric Disorders

Psychiatric Disorders and their Relationship to

Alcohol and Drug Use Disorders
Shelia Chase

Wesleyan University
Coursera
October 4, 2015

Psychiatric Disorders

Abstract
The purpose of this literature review is to explore the relationship between psychiatric disorders
and alcohol and drug use disorders. Overtly focusing on the question, are psychiatric disorders
associated with alcohol and drug use disorders? The National Epidemiologic Survey of Drug
Use and Health Code Book from The National Epidemiologic Survey on Alcohol and Related
Conditions (NESARC) were reviewed to identify questions and variables that would measure the
selected topic. A second topic, genetic factors related to psychiatric disorders and alcohol and
drug use disorders was identified and used to review NESARC for questions and variables of
measurement. A literature review was then performed to determine research that has previously
been done on the selected topics.

Keyword: National Epidemiologic Survey on Alcohol and Related Conditions

(NESARC)

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The National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted a survey in
2001 and 2002, the National Epidemiologic Survey on Alcohol and Related Conditions
(NESARC), the largest comorbidity (simultaneous presence of two chronic diseases or
conditions in a patient) study ever conducted (Grant & Dawson, 2006). NESARC included
questions addressing present and past alcohol consumption, alcohol use disorders (AUDs),
utilization of alcohol treatment services, and tobacco and illicit drug use. NESARC also
contained questions from criteria set by the American Psychiatric Associations Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for the following psychiatric
disorders:

Five mood disorders (major depressive disorder, bipolar I and bipolar II disorders,

dysthymia, and hypomania).

Four anxiety disorders (panic with and without agoraphobia, social phobia, specific

phobia, and generalized anxiety).

Seven personality disorders (avoidant, dependent, obsessive-compulsive, paranoid,
schizoid, histrionic, and antisocial disorders).

NESARC studied the occurrence of more than one psychological disorder or substance use
disorder in the same person and collected demographic data on the people interviewed (Grant &
Dawson, 2006). Table 1.1 displays additional types of data collected by NESARC.

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Alcohol
Use

Tobacco
Use

Initiation of
Use

Initiation
of use

Consumpti
on patterns

Use of Other
Medications
and Drugs

Sedatives,
tranquilizers,
painkillers,
stimulants
Consumpt Marijuana
ion
patterns

Psycholo
gical
Disorder
s
Major
depressio
n

Family
Histor
y

Of
major
depress
ion
Of
persona
lity
disorde
rs

Circumstan
ces
surrounding
drinking

Conseque
nces of
tobacco
use

Cocaine,
hallucinogens,
inhalants,
heroin

Low
mood
(dysthymi
a)
Mania
and
hypomani
a

Beveragespecific
consumptio
n
Alcohol
experiences
Experience
s with
treatment
for alcohol
abuse and
dependence
Family
history of
alcoholism

Attempts
to stop
using
tobacco

Other meds
and drugs

Panic
disorders

Initiation of
use
Usage patterns

Social
phobia
Specific
phobias

Consequences
of use
- Physic
al and
mental
effects
- Signs
of
depend
ency
- Attemp
ts to
stop or
cut
down

Generaliz
ed
anxiety
disorder

Of
drug
use

Gamb
ling

Medical
Conditions/Victi
mization

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on use
Use of
treatment

Personalit
y
disorders

Family history
of substance
use and abuse

NESARC selected the household portion of the participants from the Census 2000 Group
Quarters Inventory. Individuals were then randomly selected from the group quarters. NESARC
oversampled young adults ages 18-24 at the household level at a rate of 2.25 to 1. NESARC also
oversampled Blacks and Hispanics increasing the representation of Black households from 12.3
% to 19.1 %. The survey consisted of two waves. Wave 1 was conducted from 2001 to 2002
while Wave 2 was conducted from 2004 to 2005. The sample consisted of civilian,
noninstitutionalized adults in the U.S. The selected sample resided in households, military
personnel living off base, and people in boarding or rooming houses, nontransient hotels and

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motels, shelters, facilities for housing workers, college quarters, and group homes (Grant &
Dawson, 2006).
Wave 2 NESARC was different from Wave 1 in the several ways. Wave 1 focused on the
participants lifetime up to the point of the interview while Wave 2 focused only on the period
since the Wave 1 interview. Wave 2 added questions for classifying several additional mental
disorders, including post-traumatic stress disorder; attention deficit-hyperactivity disorder; and
narcissistic, borderline, and schizotypal personality disorders. Wave 2 included questions
designed to measure sexual orientation, adverse childhood events (e.g., sexual abuse), childhood
and partner abuse (physical, sexual, and psychological), social integration, and acculturation.
Wave 2 also added numerous questions addressing perceived experiences of discrimination on
the basis of gender, race/ethnicity, disability, sexual orientation, and weight.

Review of Literature
Comorbidity
Research suggests that treatment for a comorbid (one or more disorders coexisting with
another disorder) mood or anxiety disorder shouldnt be withheld from individuals with
substance use disorders (Grant, Stinson, Dawson, Chou, Dufour, Compton, Pickering, & Kaplan,
2004). According to Grant, et al., 2004 national epidemiologic surveys and numerous clinical
studies consistently indicate that substance use disorders and mood and anxiety disorders have

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strong associations when considered on a lifetime basis. Research suggests that substance use
disorders and mood and anxiety disorders that develop outside of intoxication and withdrawal
are among the most prevalent psychiatric disorders in the U.S. According to research, it has been
difficult to accurately treat patients with substance abuse disorders for personality disorders since
intoxication and withdrawal can cause similar behaviors. If there were a strong association
between mood and anxiety disorders and substance use disorders then a more holistic approach
to treatment would be optimal.
Mental disorder comorbidity is highly predominant and has been linked to serious
negative health consequences (Robinson, Sareen, Cox & Bolton, 2011). The causes of the
comorbidity are poorly understood and are the focus of current research. A study by Robinson et
al., 2011 researches a cause for the development of comorbidity. The study looks into selfmedication and its relationship to the development and persistence of comorbid substance use
and anxiety disorders. The study concluded that self-medication in anxiety disorders confers
substantial risk of incident substance use disorders while self-medication in substance use
disorders was associated with incident social phobia (Robinson et al., 2011). This study shows
that there are several pathways to comorbidity and different points of intervention in the
treatment. Thus, supporting the importance of revised treatment of those suffering from
psychological disorders and substance abuse disorders.
Another study on the comorbidity of severe psychotic disorders with substance abuse
shows that individuals with severe psychotic disorders have increased risks for smoking, heavy
alcohol use, heavy marijuana use and recreational drug use (Hartz et al., 2014). It was found that
smoking, alcohol and other substance use was dramatically higher than recent estimates of
substance use in mild mental illness cases. This study also showed the strongest associations

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between severe psychotic illness and substance use were with cigarette use. This is of
importance because most of the mortality seen in severe psychiatric illness is due to smokingrelated disorders. Another study on posttraumatic stress disorder and drug use did not support
the hypothesis that exposure to traumatic events increases the risk for substance use disorders
(Breslau, Davis & Schultz, 2003). The study did show a modest increase in risk for nicotine
dependence. Also, there were differences found between males and females who experienced
trauma. In women who were exposed to trauma with and without posttraumatic stress disorder
an increased risk for alcohol abuse and dependence was found.
A study on the co-occurrence of 12-month alcohol and drug use disorders and personality
disorders from NESARC suggest that comorbidity of personality disorders with alcohol and drug
use disorders is pervasive in the U.S. (Grant et al., 2004). Among the individuals with an alcohol
use disorder, 28.6% had at least one personality disorder. While 47.7% of those individuals with
a drug use disorder had at least one personality disorder. 16.4% of individuals with at least one
personality disorder had an alcohol use disorder and 6.5% had a drug use disorder. The study
showed that both alcohol use disorders and drug use disorders was most strongly related to
antisocial, histrionic, and dependent personality disorders. This study also showed significant
differences between male and females in comorbidity. Associations between obsessivecompulsive, histrionic, schizoid, and antisocial personality disorders and specific alcohol and
drug use disorders were significantly stronger among women than men (Grant et. al., 2004). The
association between dependent personality disorder and drug dependence was significantly
greater among men than women.
There has been an increasing amount of research on comorbidity of psychiatric disorders
and alcohol and drug abuse disorders. Studies have shown a significant association between

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psychiatric disorders and substance abuse disorders. Studies have also shown differences
between males and females in respect to personality disorders and substance abuse disorders.
Researchers suggest that there is need for more research on the underlying causes of these
comorbid disorders in order to advance the treatment of them.

Genetic Risks
Research suggests that by mapping psychiatric disorders, new classification of disorders
and treatment can occur (Blanco et. al, 2013). Research shows disorders that are closer to each
other are more likely to share liabilities than those further apart and that disorders can develop
through multiple etiologic paths (Blanco et. al., 2013). According to Blanco et al., (2013) the
risk for nicotine dependence may be high in individuals with a propensity toward externalization,
but it may also be increased in individuals with some internalizing disorders such as depression.
Also, it is suggested that several dimensions may have to be affected before a full-blown disorder
occurs. Another study on the shared genetic risk of major depression, alcohol dependence, and
marijuana dependence shows that in men, genetic effects on risk of antisocial personality
disorder are a major determinant of risk of substance dependence (Fu et. al., 2002). Research
suggests that due to the strong relationship between antisocial personality disorder and major
depression, failure to treat antisocial personality disorder may have led to major depression and
inheritance of alcohol dependence and marijuana dependence (Fu et. al., 2002).
Research has shown genetic relationships between personality disorders and substance
abuse disorders. Research has also shown differences in genetic effects between personality
disorders and substance abuse disorders among men and women. Understanding these genetic

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risks for personality disorders and substance abuse disorders can further our understanding of
how to treat them.

Family Studies (environmental effects, genetic-environmental

interactions and genetic effects)
According to a study on families of alcohol dependence, alcohol dependence tends to
cumulate within families (Nurnberger et. al., 2004). The study showed that rates of substance
dependence increased in relatives of alcohol dependent probands (first person in the family to
seek treatment) for cocaine, marijuana, opiates, sedatives, stimulates, and tobacco. Familial
aggregation was also seen for panic disorder, obsessive-compulsive disorder, posttraumatic stress
disorder, and major depression. The study concluded that the risk of alcohol dependence in
relatives of probands compared with controls was increased about 2-fold (Nurnberger et. al.,
2004). According to Nurnberger et al (2004) the aggregation of antisocial personality disorder,
drug dependence, anxiety disorders, and mood disorders suggests common mechanisms for the
disorders and alcohol dependence within some families. The study showed certain psychiatric
disorders to be more prevalent in persons with alcohol dependence compared with controls; child
conduct disorder, antisocial personality disorder, depression and anxiety disorders. According to
Nurnberger et al (2004) many disorders cluster in families with an alcohol-dependent proband,
alcohol dependence, other forms of substance dependence, antisocial personality disorder,
several anxiety disorders, major depression, and dysthymia.
Another study on the relationship of family to personality disorders and substance abuse
disorders concluded that there is a consistent association between family history and the presence
of four disorder types; depression, anxiety disorder, alcohol dependence, and drug dependence

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(Milne et al 2009). Researchers suggest that family history should be used to determine
patients treatment and for selecting cases for genetic studies.

Conclusion
The variables of comorbidity, genetic risks and family studies discussed in this paper all
show varying relationships between psychiatric disorders and alcohol and drug use disorders.
Trends in comorbidity have been identified throughout numerous studies. Significant
relationships have been found to exist between alcohol and drug use disorders and certain
psychiatric disorders. Furthermore, gender differences have been found to exist in relation to
personality disorders and alcohol and drug use disorders. Associations between obsessivecompulsive, histrionic, schizoid, and antisocial personality disorders and specific alcohol and
drug use disorders were significantly stronger among women than men (Grant et al 2004). The
association between dependent personality disorder and drug dependence was significantly
greater among men than women. Research has shown that genetic risks and family studies
suggest strong associations between psychiatric disorders and alcohol and drug use disorders
within families. According to Nurnberger et al (2004) many disorders cluster in families with an
alcohol-dependent proband, alcohol dependence, other forms of substance dependence, antisocial
personality disorder, several anxiety disorders, major depression, and dysthymia. Analysis of the
variables and their relationship to the topic of interest, psychiatric disorders and alcohol and drug
abuse disorders will further our understanding and improve treatment for these individuals and
families.

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References
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Grant B, Stinson F, Dawson D, Chou S, Ruan J, Pickering P. (2004). Co-occurrence of
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