Alcohol and Comorbid Medical Conditions

Alcohol use disorder (AUD) is a disease that may occur parallel with other medical or psychiatric diseases, which are then referred to as co-occurring or comorbid disorders.¹ Alcoholism and other diseases may be related in several ways:²

• Alcoholism and comorbid diseases may occur simultaneously by coincidence.
• AUD can worsen existing comorbid medical conditions or mental health issues.
• Substance abuse comorbidity may occur when people resort to substance abuse to alleviate the symptoms of their existing condition.
• Both alcoholism and a comorbid condition may be caused by a third condition.
• The symptoms of alcohol withdrawal may resemble those of other disorders.

What is Comorbidity?

Comorbidity is a medical term used to describe the condition where two or more illnesses are present in the same patient at the same time. It can appear in the form of co-occurring mental health disorders or physical illnesses, but it may also manifest as a combination of both.1

Comorbid disorders can develop simultaneously or one after another, but their co-occurrence does not necessarily mean that one is causing the other. Regardless of whether one is caused by another, co-occurring disorders often affect the gravity of each other’s symptoms and can make treatment outcomes less successful if one is neglected.22

Excessive use of alcohol can aggravate many existing physical illnesses, and it is also known to increase the risk of developing certain medical conditions. Health problems most commonly associated with alcohol consumption include neurological damage, gastrointestinal and cardiovascular disease.23

The connection between alcohol and comorbid mental health disorders occurs in one of three ways:24

1. Mental health disorders may contribute to alcohol abuse and addiction.
2. Alcohol use disorders can contribute to the development of mental illnesses and aggravate their symptoms.
3. Common risk factors, such as genetic predisposition and environmental influences, can contribute to the development of both mental illness and substance use and addiction.

Statistics of People with Alcohol Abuse and Comorbidity

Research has shown that comorbid mood disorders are a common occurrence among people who have an alcohol use disorder (AUD). In fact, a study examining the link between alcohol and comorbid mental health disorders shows that, among people who have alcohol abuse issues, as many as 12.3% also suffer from a major mood disorder.26

This percentage is even higher in those who have developed alcohol dependency, with 29.2% of people with alcohol dependency suffering from mood disorders, the most prevalent being various forms of depression and anxiety.26

Out of the people who are diagnosed with an AUD and a concurrent psychiatric disorder, 27.9% struggle with comorbid depression and alcohol dependence, while 36.9% have a comorbid anxiety disorder. Less frequently, but still notably, post traumatic stress disorder (PTSD) and bipolar disorder can co-occur with AUDs. As statistics show, 7.7% of alcohol dependent people also have PTSD, while 1.9% are bipolar.26

Medical comorbidities most commonly associated with chronic alcohol abuse include fatty liver, alcoholic hepatitis and cirrhosis. As research shows, fatty liver develops in as many as 90% to 100% of heavy drinkers, and approximately 30% of these patients test positive for alcoholic hepatitis on liver biopsy.27

Moreover, alcohol affects many other organs in the gastrointestinal tract, such as the stomach, the pancreas and the intestines. Heavy alcohol consumption is linked to approximately 30% of all acute pancreatitis cases in the US. Among those diagnosed with pancreatitis, 60% to 90% have a history of chronic alcohol consumption.27

Alcohol and Common Comorbid Medical Conditions

A person struggling with alcohol abuse may experience different comorbidity issues.

Liver Conditions

As the liver is the organ which metabolizes alcohol, it suffers the most significant tissue injury due to excessive drinking. Around 35% of heavy drinkers develop advanced liver disease. The common liver-related comorbid medical conditions are the following:³

• Steatosis (fatty liver), which is the earliest condition that happens in relation to heavy drinking and is very common. At least 90% of heavy drinkers show evidence of abnormal fat accumulation in their liver.
• Alcoholic hepatitis, which is an inflammatory liver injury that occurs in 10-35% problem drinkers.
• Alcoholic cirrhosis, which is excessive liver damage which can result in liver failure.

In contrast to the first two comorbid diseases, cirrhosis is not reversible with abstinence. It can only be stabilized.²

Pancreatitis

Alcohol abuse is one of the most common causes for both acute or chronic inflammation of the pancreas. This effect of alcohol on the pancreas typically occurs in patients after five years of excessive drinking. Pancreatitis increases the risk that a person will develop pancreatic cancer by 20 times. In addition, alcoholic pancreatitis can cause pancreatic diabetes, splenic vein thrombosis, and bile duct obstruction.⁴

Gastrointestinal Issues

When a person drinks excessively, the gastrointestinal tract does not have enough time to recover from the toxic effects of alcohol and its metabolites, which among other conditions results in:

• Alcohol bloat.⁵
• Increased risk of gastrointestinal cancer.⁶
• Alcohol-induced gastritis.⁷

Gastritis is the inflammation of the stomach lining, which may result in stomach aches from alcohol, vomiting, diarrhea, heartburn, ulcers, bacterial infections, and bleeding. When the lining of the intestines that filters alcohol is damaged, more toxins are allowed to pass into the bloodstream and cause more damage to other organs.⁸

Cardiovascular Issues

While low to moderate alcohol consumption, optimally in the form of red wine before or during a meal, is proved to be good for the heart, excessive drinking has adverse cardiovascular effects that include high blood pressure, cardiomyopathy, irregular heart beat, heart failure, or stroke.⁹ Cardiovascular alcohol-related comorbidity issues are a clear example of how the dose makes the poison or the remedy.¹⁰

Diabetes

Diabetes mellitus can appear as a complication of AUD. Chronic and heavy alcohol consumption is a risk factor for the development of type 2 diabetes.¹¹ In addition, as alcohol interferes with blood sugar control in people who are already suffering from diabetes, heavy alcohol consumption can worsen the comorbidities associated with diabetes and result in severe health consequences.¹²

HIV/AIDS

Alcohol abuse can contribute to the spread of HIV infection as intoxication often causes people to engage in risky sexual or drug abuse behavior that can get them infected with HIV.¹³

In addition, alcohol has a negative impact on the treatment of HIV patients: the comorbid disorders such as liver disease can accelerate the progression of HIV. Moreover, HIV patients are required to follow a strict medication regimen and this is difficult to accomplish if they are struggling with AUD.¹³

Chronic pain

Alcohol often helps relieve pain. However, if people start drinking excessively to alleviate chronic pain, then they put themselves at risk of developing AUD. Moreover, if a person is already taking painkillers, there is a risk of harmful drug-alcohol interactions and even overdose in case of opioid medications.¹⁴

What Are Chronic Comorbid Conditions?

Chronic comorbid conditions refer to co-occurring health problems with long-term consequences happening in the same patient at the same time. These can refer to multiple chronic physical illnesses or different combinations of physical and mental disorders happening at the same time. 

With a prolonged consumption of alcohol, heavy drinkers become more likely to develop a variety of chronic diseases and psychological disorders, including:28

• Digestive problems, liver disease, elevated blood pressure, heart disease and stroke.
• Various types of cancer, such as mouth, throat, voice box and esophageal cancer; liver, colon and rectal cancer and even breast cancer.
• Weakened immune response to various diseases, making an individual more prone to sickness.
• Cognitive impairment, difficulties in learning and memorizing, including dementia.
• Psychological disorders, such as depression and anxiety.
• Difficulties adapting to the social environment, such as having job-related problems and family issues.
• Alcohol use disorders (AUDs) or alcohol dependence.

Which Mental Disorder is Most Commonly Comorbid with Alcoholism? 

It’s important to note that alcohol has a powerful effect on people’s moods. Mood disturbances are among the most common psychiatric complaints among patients who seek treatment for AUDs, affecting approximately 80% of alcoholics at some point in their drinking careers.27

Mood disturbances cannot always be classified as mental disorders, as they do not always meet the criteria of severity for this classification. However, these mood-altering properties of alcohol make alcoholism closely interlinked with some more severe psychological disorders.25, 27

According to the National Institute of Health, the psychiatric disorders most commonly related to alcohol consumption are depression, anxiety and bipolar disorder. These mental disorders may occur in a patient independently of AUDs, may be the underlying cause of AUD, but may also be induced by alcohol consumption.22, 27

It’s important to note that alcohol can induce symptoms of depression, anxiety, and mimic other psychiatric disorders during intoxication, but even more so in the withdrawal phase. To diminish the possibility of relapse and ensure a patient is on the path to recovery, it’s absolutely crucial to have patients undergo a medically assisted detoxification program.27

Mental Health Comorbidities and Alcoholism

There are three possible connections between mental health issues and substance use disorders, which can explain their high level of comorbidity:¹⁵

• Some common genetic factors put people at an increased risk of developing mental health conditions and substance use disorders..
• Mental health disorders are proven to be risk factors for substance use disorders. People sometimes use alcohol to self-medicate and relieve symptoms of mental diseases. This effect is rather short, while in the long run, alcohol abuse makes the mental health condition even worse.
• Substance abuse can damage certain brain structures that are also disrupted in mental disorders such as anxiety, mood disorders, or schizophrenia. Substance abuse can therefore trigger the development of these diseases.

When it comes to specific psychiatric comorbid conditions connected with alcohol abuse, it has been shown that:¹⁶

• About 30-40% of individuals struggling with alcohol abuse experience depression.
• Among manic patients, 50-60% abuse alcohol or other drugs.
• 19.4% of people diagnosed with AUD also suffer from an anxiety disorder.
• The percentage of individuals suffering from post-traumatic stress disorder (PTSD) who abuse alcohol is higher than the percentage of individuals who do not have PTSD.¹⁷
• 24% of people with obsessive-compulsive disorder meet the criteria for AUD.¹⁸

How Is Comorbid Disorder Treated? 

The most effective way to treat people with alcoholism and comorbid health conditions is to approach treatment in an all-encompassing way. Integrated approaches have a higher likelihood of positive outcomes than the treatment of each condition separately.24

If all comorbid conditions are not taken into consideration, positive treatment outcomes may be more difficult to achieve. For example, patients with comorbid psychiatric disorders are more likely to drop out of treatment than those who struggle with addiction only.24

Effective treatment for comorbid disorders may sometimes require integrated services from treatment clinics and other relevant organizations that provide their supportive services. This mainly refers to addressing patients’ issues with physical health, vocational skills, legal problems and homelessness.24

Many of the physical comorbidities that come with alcohol abuse can be stabilized and reversed if the patient stops consuming alcohol. 26 However, treatment for mental health comorbidities is more complex and often consists of a combination of medicated and behavioral therapy.24

Some behavioral treatment options that have proven to be effective in comorbid mental disorders and SUDs, such as comorbid alcohol and depression include:24

• Cognitive Behavioral Therapy (CBT): CBT alters harmful beliefs and maladaptive behaviors though therapy, and has proven to be effective in treating individuals with substance abuse disorders and comorbid mental health issues.

• Dialectical Behavior Therapy (DBT): DBT’s primary goal is to reduce self-destructive behaviors, many of which are connected to alcohol abuse and co-occurring mental health issues. 

• Assertive Community Treatment (ACT) : ACT programs are an effective integrated behavioral treatment approach for more severe mental disorders such (e.g. schizophrenia) and concurrent substance use disorders. 

• Therapeutic Communities (TCs): TCs are a form of long-term residential treatment for substance use disorders. They aim to “resocialize” the recovering individual, and are especially appropriate for those with co-occurring disorders that involve problems with justice, vocational issues, social neglect and homelessness.

• Integrated Group Therapy (IGT): IGT is a treatment aimed at patients suffering from bipolar disorder and substance abuse disorders. It is commonly used in combination with medication and focuses on helping patients understand the connection between their co-existing mental health issues and substance abuse.
• Seeking Safety (SS): Seeking Safety is designed to treat trauma-related problems (including PTSD) and substance use disorder simultaneously. Patients get to learn behaviors that help them cope with trauma and SUDs.

How Does Comorbidity Affect the Quality of Life? 

The quality of life can be defined as “the patient’s subjective perception of the impact of his or her disease and its treatment on their daily life, physical, psychological and social functioning and well-being”.29

Research into the topic has revealed that the quality of life in treatment-seeking patients is significantly negatively impacted by their AUD and comorbid disorders. Patients with comorbid disorders often experience cognitive impairment, disturbances in their sleep patterns and mood disorders, which are all seen as negative contributors to the quality of life.29

A study examining the relation between severe alcohol abuse and quality of life measured how much patients felt their alcoholism impacted 7 different life domains: daily activities, relationships, living conditions, negative emotions, self-esteem, control and sleep. It revealed that alcoholism has caused people to miss out on everyday activities with family and friends, negatively interfered with their relationships, affected their housing situation, worsened their self-esteem, caused negative emotions and overall contributed to feelings of personal dissatisfaction.29

Where to Find Help for Alcohol & Comorbid Diseases

If a situation with comorbid disorders is particularly complicated, planned professional interventions of family and friends may not be sufficient to help the person who is suffering from alcohol addiction. In such cases, professional treatment may be necessary to help the person detox safely. When a person who is struggling with AUD has some mental health and medical comorbidities, it is very important that they find a treatment facility and a program that can appropriately recognize and address these issues at the same time.

American Addiction Centers is well equipped to treat alcohol addiction alongside both physical comorbidities and co-occurring mental disorders. Some patients with more severe conditions may need 24/7 inpatient care, especially in cases when there is a high risk that the symptoms of comorbid disorders may worsen during the stage of detoxification, i.e. alcohol withdrawal.¹⁹ After this supervised detox, treatment users can proceed with medication-assisted treatment, which means that in addition to behavioral therapy, FDA-approved medications are prescribed to help patients overcome alcohol cravings and remain sober in the long run.²⁰The process of admission into treatment usually starts by calling a helpline that provides guidance and support for treatment seekers. American Addiction Centers offers such a helpline 24/7 to people who want to acknowledge their issue with alcohol, find the best way to overcome it, or identify the best treatment option for their loved one. Treatment navigators can immediately check the availability of treatment centers, payment options and insurance coverage, so the patient can start their treatment as soon as possible.