The Intersection of Excessive Alcohol Use and Psychiatric Disorders

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According to a recent cross-sectional study¹ involving 2 million participants, people experiencing depression, anxiety disorder, or bulimia, are at heightened risk of excessive alcohol use.²

Unhealthy alcohol use and psychiatric disorders frequently co‐occur, but understanding how the levels of alcohol consumption affect those with psychiatric disorders might provide valuable insight to health care providers. The study sought to learn more about these relationships.

Researchers used alcohol screenings from Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery system, to collect data from a large, population‐based sample. More than 12 million alcohol screenings were conducted, which will help identify subgroups of patients with psychiatric disorders and co‐occurring unhealthy alcohol use.

Medical assistants asked 3 questions. One is a modified version of the National Institute on Alcohol Abuse and Alcoholism single‐item screening question used to determine whether the individual had drinking-heavy days: “How many times in the past 3 months have you had 5 or more drinks in a day?” The second and third are questions used to calculate average alcoholic drinks consumed per week: “On average, how many days per week do you have an alcoholic drink?” and “On a typical drinking day, how many drinks do you have?”

From these questions, patients were classified into 2 groups: low risk of alcohol abuse and unhealthy use. The unhealthy use class was further divided into subgroups: daily, where patients exceeded daily drinking limits; weekly, where patients exceeded weekly drinking limits; and both. Researchers then compared these answers to whether patients had a documented psychiatric disorder diagnosis, focusing on a list of 8 common psychiatric disorders: depression, bipolar disorder, anxiety disorder, obsessive compulsive disorder, schizophrenia, schizoaffective disorder, anorexia nervosa, and bulimia nervosa.

In the final sample of patients, it was found that the daily group was more likely to be male and aged 18 to 34 years old, while the weekly group was more likely to be female and aged 65 or older. The daily and weekly groups were more likely to have higher household incomes, greater than approximately $87,500. Those who reported no alcohol usage were more likely to be Asian, Native Hawaiian, or Pacific Islander. Those diagnosed with bipolar disorder or schizoaffective disorder were more likely to report no drinking, as well.

From this data pool, care management strategies for these patients can be formed, ideally for primary care settings. The findings support a need for screening for unhealthy alcohol use in primary care, which would help clinicians address alcohol problems early and help to prevent the onset of an alcohol use disorder.

References

1. Palzes VA, Parthasarathy S, Chi FW, Kline-Simon AH, et al. Associations Between Psychiatric Disorders and Alcohol Consumption Levels in an Adult Primary Care Population. Alcoholism: Clinical & Experimental Research. Wiley Periodicals LLC; 2020. https://onlinelibrary.wiley.com/doi/10.1111/acer.14477​

2. Research Society on Alcoholism. Patients with Depression, Anxiety, and Bulimia at Heightened Risk of Unhealthy Drinking and Associated Health Issues. News release. November 2, 2020. https://www.newswise.com/articles/patients-with-depression-anxiety-and-bulimia-at-heightened-risk-of-unhealthy-drinking-and-associated-health-issues​