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PubMed1995

Prevalence and correlates of DSM-IV and ICD-10 alcohol dependence: 1990 US National Alcohol Survey.

This paper describes DSM-IV and ICD-10 alcohol dependence prevalence rates and sociodemographic and drinking correlates. The sample under analysis (n = 2058) constitutes a multicluster probability sample of the US adult household population. The study response rate is 71%. The prevalence rate for current (past 12 month) DSM-IV alcohol dependence is 3.9%, and for current ICD-10 it is 5.5%. Agreement between DSM-IV and ICD-10 on whether respondents are dependent or not is less than optimal (Kappa = 0.67). The predictors of ICD-10 alcohol dependence are the frequency of drinking five or more drinks on occasion and age (inverse relationship). For DSM-IV alcohol dependence the correlates are drinking five or more drinks on occasion, being unemployed and age (also an inverse relationship). Differences in results underline the importance of understanding the variations among DSM-IV and ICD-10 criteria for alcohol dependence and the implications of these differences for epidemiological research. The high prevalence of dependence among young men may be the result of recognizing consequences of episodic heavy drinking as signs of alcohol dependence.

Adolescent↗
PubMedDate not supplied

Clinical correlates of cigarette smoking and nicotine dependence in alcohol-dependent men and women. The Collaborative Study Group on the Genetics of Alcoholism.

This paper examines the clinical characteristics associated with tobacco use and nicotine dependence in a large sample of alcohol-dependent subjects. The goal was to determine if the characteristics of the alcohol use history were associated with the smoking status, even after controlling for additional characteristics, such as the antisocial personality disorder, other drug dependence and gender. As part of the Collaborative Study on the Genetics of Alcoholism, a semi-structured interview, including a detailed history of alcohol and tobacco use, was administered to 1005 alcohol-dependent men and women, made up of 658 (65.5%) current smokers, 167 (16.6%) former smokers, and 180 (17.9%) non-smokers. Among former smokers, 50.3%, and among current smokers, 72.8% had ever been nicotine-dependent (DSM-III-R). Current smokers and nicotine-dependent subjects had a greater severity of alcohol dependence, even as evaluated through logistic regression analyses in which gender and associated diagnoses were considered. The data also enabled us to study the relationships among depression, nicotine dependence, and alcohol dependence, with most of the correlation occurring for substance-induced, not independent, mood disorders.

Adult↗
PubMed2006

Precontemplated and impulsive suicide attempts among individuals with alcohol dependence.

OBJECTIVE: Alcohol dependence confers risk for suicidal behavior. Some suicide attempts are precontemplated, whereas other attempts are impulsive. The purpose of this study was to compare characteristics and correlates of impulsive and precontemplated suicide attempts. METHOD: Data were derived from analysis of The Collaborative Study on the Genetics of Alcoholism (COGA), which is a six-site family pedigree study of individuals in treatment for alcoholism (probands), relatives of probands, and control families. Subjects in the analysis were age 18 years or older with a diagnosis of current alcohol dependence according to the Diagnostic and Statistical Manual, Third Edition, Revised. Individuals reporting a lifetime history of one or more suicide attempts were divided into two strata: suicide attempters with a history of suicidal ideation that persisted for a week or more, conceptualized as attempters showing precontemplation (n=330), and suicide attempters without a history of persistent ideation, conceptualized as impulsive attempters (n=343). These groups were compared with subjects with no history of attempts (nonattempters; n=3115). RESULTS: Precontemplated acts were carried out with greater intent and were more likely to result in medical treatment. Dependence on illicit drugs and history of depression were more likely among attempters showing precontemplation. Impulsive attempts were more likely to be carried out by women and individuals with higher levels of alcohol-related aggression. CONCLUSIONS: Prevention of precontemplated suicide attempts by individuals with alcohol dependence should include a focus on recognition and treatment of depressive syndromes. Alcohol-related aggression was elevated among impulsive suicide attempters. Prevention efforts may include interventions targeting aggression.

Adolescent↗
PubMed2006

Identification of susceptibility loci for alcohol-related traits in the Irish Affected Sib Pair Study of Alcohol Dependence.

BACKGROUND: Alcoholism is a phenotypically and probably genetically heterogeneous condition. Thus, one strategy for finding genes influencing liability to alcoholism is to study the components of alcoholism, which may be more directly related to the underlying pathophysiology than is clinical diagnosis. The goal of this study was to identify genomic regions containing susceptibility loci for alcohol-related traits. METHODS: A 4-cM dense whole-genome linkage study was conducted in the Irish Affected Sib Pair Study of Alcohol Dependence. Probands, affected siblings, and parents were evaluated by structured interview. Variance component linkage analysis was applied to data from 485 families for 5 measures: initial sensitivity and tolerance (based on scales from the self-report of the effects of ethanol; maximum drinks within 24 hours, an empirically derived factor score based on withdrawal symptoms, and age at onset of alcohol dependence. RESULTS: Evidence for linkage (p<0.005) was found on 9 chromosomes. For age at onset, 2 regions were found on chromosome 9 (highest Lod=2.3, p=0.0005). For initial level of response to alcohol, suggestive regions were on chromosomes 1 and 11 (highest Lod=2.9, p=0.0001 on chromosome 11), while those for tolerance signals were on chromosomes 1, 6, and 22. Maximum drinking was associated with regions on chromosomes 12 and 18. For withdrawal symptoms, the highest peak was on chromosome 2 (Lod=2.2, p=0.0007). CONCLUSIONS: Using quantitative measures of components of alcohol dependence, we identified several regions of the genome that may contain susceptibility loci for specific alcohol-related traits and merit additional study.

Adult↗
PubMedDate not supplied

Vigilance in recovering cocaine-dependent and alcohol-dependent patients: a prospective study.

Electroencephalographic activity and psychomotor performance were evaluated in 11 cocaine-dependent and 4 alcohol-dependent patients, after 1, 3, and 12 weeks of verified abstinence, and 15 non-drug-dependent age-matched controls, while they performed a 30-min signal-detection task. The task consisted of lower and higher pitched tones, 100 msec in duration, occurring in randomized order at a rate of 1 every 2 seconds. Subjects were asked to press a response key whenever they detected the less frequent (p = 0.3), higher pitched tone. Over the course of the 30 min task, subjects responded less frequently and more slowly to the higher pitched tone. Also, the amount of slow wave (i.e., alpha) activity in their EEGs increased. There were no differences among the groups with respect to the rate or magnitude of these time-related decrements in performance and electroencephalographic arousal. The only dependent variable which differentiated groups was reaction time, averaged across the duration of the task. Overall, the cocaine dependent group responded 80-100 msec slower than the other groups. In the context of other findings, this finding of increased reaction time among recovering cocaine dependent patients is interpreted as reflecting an effect of previous cocaine use on neural processes involved in the programming and/or execution of motor responses.

Adult↗
PubMed2004

The role of drinking restraint in alcohol dependence: validation of the temptation and restraint inventory in an alcohol dependent sample.

OBJECTIVE: The Temptation and Restraint Inventory (TRI) is commonly used to measure drinking restraint in relation to problem drinking behavior. However, as yet the TRI has not been validated in a clinical group with alcohol dependence. METHOD: Male (n = 111) and female (n = 57) inpatients with DSM-IV diagnosed alcohol dependence completed the TRI and measures of problem drinking severity, including the Alcohol Dependence Scale and the quantity, frequency and week total of alcohol consumed. RESULTS: The factor structure of the TRI was replicated in the alcohol dependent sample. Cognitive Emotional Pre-occupation (CEP), one of the two higher order factors of the TRI, demonstrated sound predictive power toward all dependence severity indices. The other higher order factor, Cognitive Behavioral Control (CBC), was related to frequency of drinking. There was limited support for the CEP/CBC interactional model of drinking restraint. CONCLUSIONS: Although the construct validity of the TRI was sound, the measure appears more useful in understanding the development, maintenance and severity of alcohol-related problems in nondependent drinkers. The TRI may show promise in detecting either continuous drinking or heavy episodic type dependent drinkers.

Adult↗
PubMed2006

Alcoholics Anonymous and other 12-step programmes for alcohol dependence.

BACKGROUND: Alcoholics Anonymous (AA) is an international organization of recovering alcoholics that offers emotional support through self-help groups and a model of abstinence for people recovering from alcohol dependence, using a 12-step approach. Although it is the most common, AA is not the only 12-step intervention available there are other 12-step approaches (labelled Twelve Step Facilitation (TSF)). OBJECTIVES: To assess the effectiveness of AA or TSF programmes compared to other psychosocial interventions in reducing alcohol intake, achieving abstinence, maintaining abstinence, improving the quality of life of affected people and their families, and reducing alcohol associated accidents and health problems. SEARCH STRATEGY: We searched the Specialized Register of Trials of the Cochrane Group on Drugs and Alcohol, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE from 1966, EMBASE from 1980, CINAHL from 1982, PsychINFO from 1967. Searches were updated in February 2005. We also inspected lists of references for relevant studies. SELECTION CRITERIA: Studies involving adults (<18) of both genders with alcohol dependence attending on a voluntary or coerced basis AA or TSF programmes comparing no treatment, other psychological interventions, 12-step variants. DATA COLLECTION AND ANALYSIS: One reviewer (MF) assessed studies for inclusion and extracted data using a pre-defined data extraction form. Studies were evaluated for methodological quality and discussed by all reviewers. MAIN RESULTS: Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence. AUTHORS' CONCLUSIONS: No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.

Adult↗
PubMed2001

Association between suicide attempts and 5-HTTLPR-S-allele in alcohol-dependent and control subjects: further evidence from a German alcohol-dependent inpatient sample.

BACKGROUND: Genetically-mediated alterations in serotonergic transmission have been implicated in both the pathogenesis of alcoholism and suicidal behavior. Thus, the identification of vulnerability genes could uncover pathophysiological links for both syndromes. A significant association between suicide attempts and the 5-HTT promoter polymorphisms (5-HTTLPR) S-allele has been reported in a sample of French alcohol-dependent subjects, and this paper evaluates this phenomenon in a German sample. METHODS: One hundred and sixty-three patients meeting DSM-IV criteria for alcohol dependence and 117 healthy controls were investigated. Blood samples were taken to genotype the 5-HTTLPR by using polymerase chain reaction (PCR) of lymphocyte DNA. RESULTS: 5-HTTLPR-S alleles were seen more frequently in suicidal compared to nonsuicidal alcohol-dependent subjects. Furthermore, significant effects from suicide attempts on the number of S-alleles were found. CONCLUSIONS: The results are consistent with an association between the 5-HTTLPR-S-allele and suicide attempts in alcohol-dependent subjects.

Adult↗
PubMed2005

Hormone responses to social stress in abstinent alcohol-dependent subjects and social drinkers with no history of alcohol dependence.

BACKGROUND: Previous studies have described blunted stress hormone responses after pharmacological activation of the hypothalamic-pituitary-adrenal (HPA) axis in sober alcoholics. The aim of the present study was to compare ACTH, cortisol, and prolactin responses to a psychological stressor in abstinent alcohol-dependent subjects matched to healthy control subjects. METHODS: Individuals who met DSM-IV diagnostic criteria for a history of alcohol dependence but not for other axis I disorders were included in the study (n = 18; mean duration of abstinence +/- SEM, 3.5 +/- 5.7 years). Social drinkers (n = 23) served as control subjects. The sober alcohol-dependent and control subjects were matched for demographic measures including levels of stress symptoms. All subjects underwent the Trier Social Stress Test (TSST), a laboratory-based psychological stressor. Prestress and poststress plasma ACTH, cortisol, and prolactin levels, as well as a self-report measure of anxiety (State-Trait Anxiety Inventory), were obtained. RESULTS: Nondepressed, abstinent alcoholics and control subjects did not differ with regard to age, racial composition, or baseline or poststress ratings of anxiety. Whereas ACTH and cortisol levels increased in response to the TSST, prolactin levels did not. Stress hormone response curves for the three hormones did not differ between the alcoholics and control subjects. CONCLUSIONS: When matched for levels of stress, a laboratory-based psychological stress test did not induce differential hormone response curves for abstinent alcoholics and control subjects.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

[Description of patients diagnosed with "alcohol dependence syndrome" and "alcohol abuse" according to the C.I.E.-9a criteria of the W.H.O. at a psychiatric hospitalization service].

The authors make an introduction where they describe several problems found in the alcoholic diseases researches. The most important of them are related to the "alcoholic case" concept. After this the authors report several epidemiological facts about the alcoholic diseases and disorders in Castilla-León and Madrid. Then a retrospective analysis of inpatients psychiatric records from the Psychiatry Department of Valladolid's University Hospital between 1980 to 1984 (N = 1.259) is made. 252 (20.01%) of them suffered an alcoholic disorders, following the I.C.D.-9th criteria psychoses alcoholic were 102 (8.10%) and they were excluded. However "Alcohol dependence" with 128 cases (10.17%) and "Alcohol Abuse Syndromes" with 22 cases (1.75%) were studied deeply, being 150 cases--120 males (80%) and 30 females (20%)--evaluated. Every diagnostic group was analysed in a distinct way through 41 epidemiological, clinical, diagnostic and medical care variables. These two groups and their differences and similarities between them are reported. The main profile is a male patient, 43 years old, married, urban life, blue collar worker, unskilled work, primary studies, bad economic level, marriage and working maladapted, clinical admitted through the Emergency Service, with an alcoholism 24 years old and intake of 234 grs. alcohol/day, with former treatment of minor tranquilizers (B.D.Z.) and at last is readmitted by alcoholic disease of disorder or a different psychiatric disease or disorders (I.C.D.-9.a or D.S.M.-III) in a 37.5% and 16.41% respectively.

Alcoholism↗
PubMed2000

Before-discharge intervention method in the treatment of alcohol dependence.

BACKGROUND: Alcoholics have the fundamental problem of denying dependence on alcohol and minimizing their alcohol-related problems. Therapeutic interventions often fail to help alcoholics become aware of their drinking problem and remain in long-range treatment programs, which is a prerequisite for recovery from alcohol dependence. METHODS: Inpatients were assigned to either group 1 or 2 depending on which day of the week they were admitted to the hospital. A newly developed structured intervention method (Before-Discharge Intervention Method, or BDIM) was employed with select (nonrandomized) hospitalized alcoholics in group 1 and their family members before the patients were discharged from the hospital. None of the patients in group 2 received the BDIM. With this intervention method, the alcoholic's family members delivered to him or her verbal messages that conveyed concern about the alcoholic's problem drinking, their observations of the alcoholic's past episodes of drinking problems, and wishes and support for abstinence. Unless patients died during hospitalization or would not be able to attend the hospital follow-up clinic and local self-help groups (Danshukai) after discharge, outcome evaluations were carried out on all patients in groups 1 and 2 during two calendar months, 3 months after the last BDIM patient left the hospital. Outcome measures included patient's and family members' attendance at hospital outpatient follow-up sessions and self-help group meetings, and patient's abstinence. RESULTS: Family members' attendance at hospital follow-up sessions and/or self-help group meetings was significantly higher in group 1 than in group 2. Among the three subgroups of discharged patients in either group 1 or 2-that is, those who lived with their spouse, those who lived with someone other than their spouse, and those who lived alone-only those in group 1 who lived with their spouse did significantly better than their counterparts in group 2 in three treatment outcome measures. However, patients' maintenance of abstinence was significantly better only when they and their family members both attended hospital outpatient follow-up sessions and/or self-help group meetings. We noted no other statistically significant difference between groups 1 and 2 in any of the other two subgroups of discharged or patients in any of the three treatment outcome variables. Irrespective of the BDIM, patients who lived alone did significantly more poorly than either those who lived with their spouse or those who lived with someone other than their spouse in terms of attendance at hospital follow-up sessions and local self-help group meetings and abstinence. CONCLUSIONS: This intervention method can help the alcoholic face the reality of his or her drinking problems and alcohol dependence and thus remain longer in long-range rehabilitation programs, which is a prerequisite for successful recovery from alcohol dependence.

Adult↗
PubMedDate not supplied

[Alcohol dependence treatment with naltrexone: safety assessment. Observation study group of alcoholic dependence].

OBJECTIVES: The security the naltrexone treatment in alcohol dependence was evaluated by clinic follow-up (tolerance and secondary effects) and analitic follow-up (transaminases and another biological assessment). MATERIAL AND METHODS: This is an one open study, not controlled, prospective and multicentric treatment of the alcoholism of Spain. 42 centres recruited alcoholic patients who were treated with 50 mg of naltrexone with pursuit of 6 months. RESULTS: 234 patient were selected, 173 concluded the study. The more frequent secondary effects were: astenia (16%), nausea (11.6%), sleepiness (8%), and insomnia (7%). The majority of patients tolerated well the treatment with naltrexone. Only 5 (3%) patients were dropped out of the study by intolerance to naltrexone. GOT, GPT, GGT levels decreased during the six months of treatment. CONCLUSIONS: The naltrexone treatment in alcoholic dependent is well tolerated. The secondary effects are infrequent and only in 3% of them the treatment were interrupted.

Adult↗
PubMedDate not supplied

Substitution of chlordiazepoxide for ethanol in alcohol-dependent mice.

Alcohol dependence was induced in C57BL/6J mice by administration of a liquid diet containing ethanol. These mice showed alcohol withdrawal signs when the alcohol diet was withdrawn. However, when the alcohol diet was substituted with three liquid diets containing different amounts of chlordiazepoxide (CDP; 0.4, 1 and 2 mg/ml), the alcohol withdrawal signs were fully suppressed by CDP. The CDP diet administration was continued for 14-24 days. At termination of the diet treatment, the mice showed CDP withdrawal signs. Similar signs, but much more short-lived, can be precipitated by injection of the benzodiazepine receptor antagonist, RO-15-1788. The results are consistent with the hypothesis that alcohol-dependent mice are cross-dependent on CDP. This report constitutes the first experimental demonstration of cross-dependence between ethanol and CDP. The reverse phenomenon, namely, CDP-dependent mice being cross-dependent on ethanol, remains to be investigated.

Animals↗
PubMedDate not supplied

Persistence predicts latency to relapse following inpatient treatment for alcohol dependence.

Male alcoholics (N = 85) were followed for 6 months after inpatient treatment for alcohol dependence. Latency to relapse was predicted by two related persistence measures (the RD2 Persistence scale and the Orderliness/Persistence factor scale of the Tridimensional Personality Questionnaire, TPQ) as well as by job status at the time of admission to treatment, a history of vagrancy or public intoxication, amount of prior substance abuse treatment and the number of criteria met for a diagnosis of Antisocial Personality Disorder. Persistence predicted relapse latency even when the other predictors were used as covariates, supporting the hypothesis that normal-range personality variables may enhance the prediction of clinical outcome. Further, the relations between TPQ scales and antisocial behavior as well as the severity of alcohol dependence were examined.

Adult↗
PubMed1995

Cycles of alcohol dependence: frequency-domain analyses of daily drinking logs for matched alcohol-dependent and nondependent subjects.

OBJECTIVE: This study was undertaken to evaluate possible differences in the patterns of daily alcohol use, in terms of periodicity or rhythmicity of consumption, between alcohol-dependent and nondependent drinkers otherwise matched on the basis of quantity and frequency of alcohol use. METHOD: Frequency-domain time-series analysis was applied to daily drinking logs of six alcohol-dependent and six nondependent male subjects matched for consumption quantity and frequency who had participated in a larger 112-day study of alcohol consumption patterns using an innovative touch-tone telephone method of daily self-report. Spectral analysis partitioned variance in the drinking logs among statistically independent frequency cycles of relatively heavier and lighter drinking. The percentage of variance accounted for by fast (< 4 days), medium (7 +/- 3 days) and slow (> 10 days) cycle periods was compared for diagnostic group differences. RESULTS: Effective matching precluded consumption quantity, frequency or variability differences between the groups. Spectral analysis of the time-series data revealed group differences in the rhythmicity, or cyclical characteristics, of the drinking logs. The drinking logs of alcohol-dependent subjects exhibited more pronounced weekly cycles, whereas drinking logs of nondependent subjects fluctuated over longer periods. CONCLUSIONS: Temporal patterns of regular alcohol use may be an important behavioral variable influencing the seriousness of consequences associated with drinking, which may partly elucidate the relatively weak relationship between dependence symptomatology and consumption quantity-frequency.

Adult↗
PubMed2000

Substance dependence, family history of alcohol dependence and neuropsychological functioning in adolescence.

AIMS: It was hypothesized that adolescent substance dependence moderates the relationship between family history of alcohol dependence and neuropsychological functioning. DESIGN: This study compared the neuropsychological functioning of non-abusing and alcohol and drug-dependent adolescents with and without a family history of alcohol dependence using hierarchical multiple regressions and general factorial analyses. SETTING: Substance-dependent adolescents were recruited and tested in inpatient alcohol and drug abuse treatment programs after 3 weeks of abstinence. A matched sample of non-abusing adolescents was recruited from the same San Diego-area communities. PARTICIPANTS: Substance-dependent adolescents (n = 101) met DSM-III-R criteria for dependence on alcohol and at least one other substance. Non-abusing adolescents (n = 50) had no substance use disorders. Groups were comparable on socio-economic status. Participants were 44% female, ages 13-18, and had no serious head injuries or neurological disorders. MEASUREMENTS: Information was gathered on demographics, family history, substance involvement, and conduct disorder behaviors and adolescents were administered neuropsychological tests covering language, visuospatial, verbal memory, attention and executive functioning domains. FINDINGS: The hypothesis was supported for language and attention tests. Substance involvement interacted with family history of alcohol dependence to predict language and attention functioning. Family history negative non-abusers performed better than the other adolescents. CONCLUSIONS: The pattern of results suggests that family history of alcohol dependence and adolescent substance use are separate risk factors for poorer neuropsychological performance in youth.

Adolescent↗
PubMed2006

Cortisol concentrations, stress-coping styles after withdrawal and long-term abstinence in alcohol dependence.

Alcohol-dependent patients face a substantial risk of relapse after detoxification. A major risk factor for relapse is stress which is reflected biologically by various physiological changes that include an activation of the hypothalamic-pituitary-adrenal (HPA) axis and release of glucocorticoids. The prospective study examined cortisol concentrations and stress-coping styles in relation to abstinence 1 year following discharge from treatment. Cortisol concentrations were measured in the plasma of 46 alcohol-dependent patients (12 women) on initial presentation for treatment (day 1), and again in plasma and in cerebrospinal fluid (CSF) after 6 weeks of abstinence (day 40). These results were compared with those of 26 age- and sex-matched, healthy control subjects. After withdrawal, the patients completed a comprehensive baseline assessment including a stress-coping questionnaire (Stressverarbeitungsfragebogen SVF120) and were monitored for 1 year after discharge. Negative stress-coping styles (e.g. flight, resignation) positively correlated with higher cortisol concentration in plasma and in CSF after withdrawal (day 40). Compared with relapsers after 1 year, abstainers had significantly lower levels for cortisol in CSF, whereas the stress-coping styles did not differ between abstainers and relapsers in this sample. These findings suggest that relatively stable personality traits like stress-coping styles have no measurable influence on abstinence. The lower cortisol concentration in CSF as an indicator for HPA axis functioning is associated with long-term abstinence in detoxified alcoholics.

Adaptation, Psychological↗
PubMed1988

Pattern of psychiatric morbidity and alcohol dependence in patients with alcoholic liver disease.

Fifty-six male patients with alcoholic liver disease were evaluated for the presence and severity of alcohol dependence and psychiatric illness using a severity of alcohol dependence questionnaire and research diagnostic criteria, respectively. Forty-three (76.7%) patients were found to be dependent; 26 (46.4%) moderately, and 17 (30.3%) severely. Patients with alcoholic hepatitis were significantly (P less than 0.05) more often found to be dependent than patients with alcoholic cirrhosis. Psychiatric morbidity was observed in 42 (75%) of the patients with alcoholic liver disease and 15 (26.7%) of the nonalcoholic cirrhotics. The difference was highly significant (P less than 0.01). The commonest disorders in patients with alcoholic liver disease were neuroses (33.0%), followed by affective disorders (26.8%). It was, however, not possible to ascertain whether psychiatric disorders antedated alcoholism or were secondary to it. Detection of moderate to severe dependence on alcohol and psychiatric morbidity in about three-fourths of the patients with alcoholic liver disease warrants an increased awareness and a multidisciplinary approach for the management of these patients.

Adult↗