Psychiatric disorders among at-risk consumers of alcohol in the general population

Objective: At-risk consumption of alcohol has increasingly become the focus of primary and secondary prevention efforts. Little is known about the co-occurrence of psychiatric disorders with at-risk drinking. We examined patterns of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) lifetime co-occurrence of psychiatric disorders in individuals in the general population with at-risk consumption of alcohol, alcohol abuse, alcohol dependence and moderate drinking/abstention, considering potential gender differences. Method: Cross-sectional data of a representative general population-based study were analyzed. Based on DSM-IV criteria, participants aged 18-64 (N = 4,074; 2,045 men) were diagnosed using a standardized computer-assisted version of the Munich Composite International Diagnostic Interview (M-CIDI). Nonpsychotic Axis-I lifetime diagnoses were examined. At-risk consumption of alcohol was defined as an average of more than 20 g (0.71 oz) pure alcohol consumption per day for women and 30 g (1.06 oz) for men, with alcohol abuse or alcohol dependence excluded. Results: Almost 9% of participants were identified as at-risk drinkers. Prevalence rates for at-risk drinkers were 16.9% for affective, 18.1% for anxiety and 17.8% for somatoform disorders. Compared with moderate drinkers/abstainers, atrisk drinkers showed a twofold increased risk of having a psychiatric disorder. Subjects with alcohol abuse showed a comparable level of risk and individuals with alcohol dependence showed an even greater risk. Female at-risk drinkers were twice as likely to have a psychiatric disorder as their male counterparts. The odds ratios for psychiatric disorders in at-risk drinkers compared with moderate drinkers/abstainers, however, did not differ in men and women. Conclusions: Rates of psychiatric co-occurrence among at-risk drinkers were considerably elevated when compared with moderate drinkers/abstainers. These findings underline the relevance of at-risk consumption of alcohol and represent an important challenge to public health efforts regarding screening of psychiatric disorders and referral to appropriate treatment services.