Co-occurring Disorders: Mental Health and Alcohol Use

Alcohol use disorder (AUD) commonly co-occurs with other psychiatric disorders. AUD most frequently co-occurs with other substance use disorders, attention deficit hyperactivity disorder, major depressive disorder, and anxiety disorders, among others. The co-occurrence of AUD with psychiatric disorders significantly amplifies the risks associated with both conditions. Overlapping symptoms of both AUD and other psychiatric conditions exist and may precipitate or perpetuate the other. It is important to assess for and consider the directionality of comorbid conditions to inform diagnostic considerations and subsequent treatments. Although the pathophysiology of AUD with other psychiatric conditions is not well understood, theories exist to describe the underlying mechanisms of comorbidity, including the common liability pathway and the gateway hypothesis, each considering the interplay and directionality of genetic, environmental, epigenetic, and psychosocial factors. The dynamic interplay between the co-occurring disorders underscores the complexity of diagnosis and treatment. Importantly, the treatment of AUD comorbid with other psychiatric disorders should be integrated and simultaneous. Treatment approaches include both pharmacologic and psychotherapeutic interventions, which offer improved benefits when combined.