Journal de recherche et de thérapie en toxicomanie

Abstrait

Lifetime Affective and Alcohol Use Disorder: Impact of Comorbidity on Current Functioning and Service Use in a Rural Population

Frances J Kay Lambkin, Kerry J Inder, Tonelle E Handley, Yun Ming Yong, Terry J Lewin and Brian J Kelly

Background: Depression and alcohol use problems frequently co-occur and significant barriers to service use for co-morbid mental health problems exist.

Purpose of the study: This study examines relationships between current functioning and lifetime treatment among people with an affective disorder (AD) and/or an alcohol use disorder (AUD) in a rural sample.

Methodology: A sub-sample of participants in the Australian Rural Mental Health Study with lifetime AD and/or AUD were assessed for current functioning using measures of psychological distress, alcohol use, and physical and psychological impairment, using multivariate logistic regression. Help seeking and perceived treatment effectiveness were examined across disorders.

Major findings: 234 participants (55% female) met criteria for a lifetime AD and/or AUD. A lifetime history of both disorders (24%) was associated with higher levels of current psychological distress, psychological and physical impairment than a lifetime history of AUD alone, and higher levels of risky current alcohol use than AD alone. Substantial delays in treatment seeking were detected (from 9-14 years). Those with AUD alone reported unacceptably low rates of treatment seeking (11%) compared with the other groups (76-78%). Those with comorbid AD+AUD reported the lowest endorsement of past perceived “effective treatment” for either condition. Effective treatment for depression was less likely to be reported by those with both AD and AUD.

Conclusion: Lifetime comorbid AD+AUD has a specific impact on current psychological and physical functioning that is not accounted for by age, gender, recent life events or chronic illness, highlighting the pressing need for better and more effective ways to offer assessment and treatment for these conditions. Rural participants more frequently accessed treatment for AD than AUD, representing an important opportunity to intervene early to better manage or prevent AUD and their associated burden. Technological solutions offer promise in this context as a way to address this need.