Chapter 7

Current Concepts in the Treatment of Depression in Alcohol-Dependent Patients

Patrick J. McGrath, M.D.

Edward V. Nunes, M.D.

Frederic M. Quitkin, M.D.


MEDICAL SIGNIFICANCE OF ALCOHOLISM

Because most psychiatric residencies limit training in the diagnosis and treatment of substance use disorders, psychiatrists may be insufficiently aware of the high rate and significant clinical impact of comorbidity of alcoholism and various psychiatric disorders, including depression. (In this chapter, alcoholism is used synonymously with alcohol dependence, as defined by DSM-IV. 1) Alcoholism is a leading cause of morbidity and mortality in developed and developing countries. Some statistics concerning alcoholism help to illustrate its enormous medical importance. If contributions to physical illness, suicide, homicide, and accidental death are considered, 26 alcoholism is the fourth leading cause of death in the United States. In multiple studies, alcoholism has been found to be associated with approximately 25% of the deaths by suicide 39 and more than 50% of fatal motor vehicle accidents. 33 Because many alcoholics die at younger ages than do nonalcoholics, more years of potential life are lost to alcoholism than to heart disease or cancer. 18 According to the World Health Organization, 40 alcohol use

This work was supported by grant AA 08030 and AA 09539 from the National Institute of Alcohol Abuse and Alcoholism and the Office of Mental Health of the State of New York.

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