PCSS-MAUD Webinar: When Psychiatric Disorders Co-occur with Alcohol Use Disorder-Slides

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The webinar examines the prevalence, assessment, and treatment of psychiatric disorders that co-occur with alcohol use disorder (AUD). Depression, anxiety, trauma-related disorders, and other substance use disorders are common among people with AUD. Among people with psychiatric disorders, AUD is especially prevalent in bipolar disorder, affecting just under half.<br /><br />Treatment can be hindered by fragmented services, under-reporting, missed or misdiagnosed conditions, active symptoms, limited insight, and difficulties engaging in care. Assessment should consider whether symptoms occur during intoxication or withdrawal, or persist independently. Symptoms that begin with heavy drinking and resolve with abstinence may be substance-induced; symptoms that predate heavy use or continue during sobriety may indicate an independent disorder. Screening tools such as the PHQ-9, GAD-7, PC-PTSD-5, and C-SSRS can support assessment, with diagnostic interviews used for further evaluation.<br /><br />Care should be individualized, starting with assessment of the appropriate level of care and potentially using motivational interviewing, brief advice, office-based treatment, or specialty referral. FDA-approved AUD medications include naltrexone, acamprosate, and disulfiram. The presentation notes that these can be used in patients with psychiatric comorbidity, while emphasizing that medication choice should account for safety, symptoms, and patient preference. Medications for depression, anxiety, or PTSD may treat those conditions but generally do not reduce alcohol consumption on their own.<br /><br />Behavioral approaches include AUD-focused therapies, trauma-focused PTSD treatments such as prolonged exposure and cognitive processing therapy, and integrated approaches such as Seeking Safety. Evidence reviewed from more than 36 trials suggests that AUD pharmacotherapy and trauma-focused behavioral interventions can improve both alcohol-use and PTSD symptoms; combining these approaches may offer particular benefit. Social connectedness, family and peer support, and practical factors such as access to substances, time, and money also matter.

Keywords

alcohol use disorder

psychiatric comorbidity

depression

anxiety disorders

PTSD

bipolar disorder

screening tools

naltrexone

trauma-focused therapy

integrated treatment