Alcohol, Research & Health remains one of most readable and inexpensive professional journals in our field and has been a source for more than a few Research to Practice Columns, including this one. This time we focus on a few practical assessment implications gleaned from two recent comorbidity surveys. These very large studies added useful information to the developments of drug and alcohol disorders, prevalence rates, comorbidity, and risk factors.

First survey: alcohol and related conditions

A 2001-2002 survey from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (Stinson, Grant, Dawson, Ruan, Huang, & Saha, 2006), asked 43,093 people a set of questions concerning their alcohol and drug use. That information was correlated with variables such as sex, age, marital status, among others. Key findings revealed that individuals who reported both abuse of alcohol and drugs, and drug-only abuse were generally young males who had never married and who were of lower socioeconomic status. Individuals who fell into the alcohol-only group tended to be white, 30- to 64-years-old and of a higher socio-economic level.

Two additional findings from this survey were: individuals in the drug-only and comorbid (alcohol and drug) groups were more likely to have mood, or personality disorders (this drug-only group finding was consistent with previous studies); and the alcohol and drug group did not significantly increase the likelihood of mood, anxiety, or personality disorders above the levels found in the drug-only group. Surprisingly, the data did not indicate any correlation between the alcohol and drug combination and mood an anxiety disorders.

Try it: counseling suggestions

These survey results encourage one to pay close attention to his or her assessment process. This goes for first-time admissions or even long-term clients who have not been re-assessed for sometime. The initial assessment may confirm an anecdotal judgment of yours that says younger, never married folks who are unemployed tend to abuse alcohol and/or drugs, and that older white people tend to abuse alcohol.

Also, this information could prove beneficial in terms of properly assessing what combination of chemicals a client is really abusing. That doesn't you should jump to conclusions that a young, never married individual is a drug abuser. Rather, when you assess this type of individual and find it to correlate to your assessment, you can be more confident you are in the same ballpark as this data predicted.

Second survey: co-occuring substance use and mood, anxiety disorders.

This second research article focused on co-occurring substance use and mood and anxiety disorders (Grant, Stinson, Dawson, Chou, Dufour, Compton, Pickering, & Kaplan, 2006).

The main findings were that of all the associations between substance abuse and mental health disorders, the association that stands head and shoulders above the rest is the association between substance abuse and independent mood disorders (e.g., Major Depression, Dysthymia); and substance abuse and independent anxiety problems (e.g., Generalized Anxiety Disorder, Panic Disorder). This clearly implies that anyone who assesses or counsels addiction clients should automatically make it a habit to assess for mood and anxiety disorders.

Also, of this sample (using the same NESARC population as mentioned above), few had mood and anxiety disorders that were only substance-induced. This implies that treatment for mood and anxiety disorders should not be withheld from clients who are in remission from substance abuse based on the belief that any perceived mood and anxiety was due to intoxication or withdrawal. 

Try it: counseling suggestions

The above findings are huge. It means that the long-held belief that many mood or anxiety disorders would generally clear up once a client stopped drugs for awhile is not that accurate for a number of cases. Furthermore, it indicates that addiction counselors need to become familiar, if not proficient, with the dynamics and treatment elements of depression and anxiety. In turn, many addiction counselors will need to either attend continuing education programs or return to college to take the appropriate course work to learn how to recognize the symptoms of mood and anxiety disorders. More importantly, this level of education will teach counselors the evidence-based strategies and interventions to use with clients who exhibit these symptoms.

Becoming competent with this kind of knowledge is going to boost the ability of addiction counselors to have an impact on the potential for relapse, something our field constantly battles. Without this training, clients who have the independent mood and anxiety issues will go unattended, resulting in many needless bouts of relapse. 

Research you can do

These two articles are ideal for conducting a smaller version for your program needs. The rationale for conducting your mini surveys is primarily to determine if your service population fits the same findings that were assessed in NESARC sample. If they are, then there is the tendency to take the NESARC implications more seriously and conclude that the people you serve are similar in type and substance abuse potential. If not, then you may be onto something that says an exception(s) exists that needs to be further examined.

For an easy and simple survey, ask: what are the possible correlations between a sample of drug-only and alcohol and drug abuse subjects, given a set of variables such as age, gender, employment status, and socio-economic status. Assuming that your past assessment practices have collected the type of information you need, backtrack about 50 to 60 charts and gather the necessary information on a simple spreadsheet. Create columns for a drug-only abuse sample, then gender, age, employment, socio-economic status. Then create a separate spreadsheet for a drug and alcohol abuse sample and use the same variables; and a third spreadsheet for alcohol-only sample and the same variables.

Once the data is in the three spreadsheets, make an analysis. Simply eyeball the hash marks for all three spreadsheets, noting any standout difference between them (e.g., on one spreadsheet one column may show a high frequency count that is associated to another high frequency count column). If there is a standout difference, consider re-analyzing the data with central tendency and correlation procedures. A local college might well be interested in looking at your data and doing the statistical procedures for you.

As always, I remain interested in your results.

References

Grant, B.F., Stinson, F.S., Dawson, D.A., Chou, S.P., Dufour, M.C., Compton, W., Pickering, R.P. & Kaplan, K. (2006). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders. Alcohol, Research & Health, 29, 107-120.

Stinson, F.S., Grant, B.F., Dawson, D.A., Ruan, W.J., Huang, B. & Saha, T. (2006). Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States. Alcohol, Research & Health, 29, 2, 94-106.

This article is published in Counselor,The Magazine for Addiction Professionals, December 2006, v.7, n.6, pp.28-29.

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