This revised R01 application is in response to the Program Announcement (PA-07-071) for "Secondary Analysis of Existing Alcohol Epidemiology Data". The overall goals for this application are to assess patterns of alcohol use disorders (AUD) with comorbid anxiety and mood conditions, to examine whether transition to alcohol dependence is altered by the presence of specific psychiatric disorders and symptoms, and if these patterns differ among gender and race-ethnicity subgroups. Although prior population-based and clinical studies have provided evidence for the comorbid occurrence of alcohol and with both mood and anxiety disorders, there have been little assessment of patterns of these co-occurrences, their relationship with transition to alcohol dependence, and whether these patterns differ for specific subgroups of the population. Using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) dataset, we propose to 1) assess the comorbid prevalence, incidence and strength of association of AUD with anxiety symptoms and disorders (panic, social phobia, specific phobia and generalized anxiety disorder), and 2) mood symptoms and disorders (major depression, dysthymia, mania, and hypomania). In addition, using data from the National Longitudinal Alcohol Epidemiologic Survey (NLAES), 3) we aim to assess whether prevalence and comorbid trends of alcohol abuse and dependence with major depression have changed during the intervals between the NLAES (1991-92), and with wave 1 (2001-02) and wave 2 NESARC (2004-05). Using survival analyses, 4) we intend to assess whether age of (a) onset of AUD, (b) first symptom of excessive alcohol use, and (c) alcohol use initiation varies by presence and type of anxiety and mood condition. Using latent class analysis, 5) we also aim to examine the relationship of anxiety and mood disorders with patterns of excessive alcohol use symptoms, and using latent transition analyses to 6) assess patterns of transition to alcohol dependence. In addition, 7) for each specific aim, we will examine the bidirectional assessment of these associations. The proposed analyses should further our understanding of the comorbid patterns and relationships of alcohol, anxiety and mood symptoms and disorders. Assessment of patterns of these comorbid conditions potentially will improve our ability to identify high risk groups which may provide targets for early prevention and intervention efforts. Alcohol, mood and anxiety disorders together constitute some of the largest groups of mental and substance use conditions worldwide. Yet, the ability to examine the relationship of these conditions in a population-based sample (reducing potential selection biases), providing DSM-IV diagnostic criteria, within a sample large enough to assess potentially diverse associations among gender and race-ethnicity subgroups until now has been quite limited. The proposed analyses should fill in many gaps in our understanding of these co-occurring conditions.

Public Health Relevance

Anxiety and mood problems are among the most common mental health disorders worldwide. These problems may increase the chance that other conditions occur such as addictions to alcohol. Using information gathered from one of the largest surveys to evaluate the presence of these symptoms among residents of the United States, we will study these relationships by different groups, in order to help understand if some individuals are more or less vulnerable to these conditions. This study aims to evaluate the complex relationships that may be occurring between mood, anxiety and drinking behavior with the hope that understanding these relationships better will help us identify improved methods for preventing and intervening with these conditions.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Study Section
Behavioral Genetics and Epidemiology Study Section (BGES)
Program Officer
Ruffin, Beverly
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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Crum, Rosa M; Mojtabai, Ramin; Sareen, Jitender (2014) Does self-medication predict the persistence or rather the recurrence of alcohol dependence?--reply. JAMA Psychiatry 71:205-6
Kaufmann, Christopher N; Chen, Lian-Yu; Crum, Rosa M et al. (2014) Treatment seeking and barriers to treatment for alcohol use in persons with alcohol use disorders and comorbid mood or anxiety disorders. Soc Psychiatry Psychiatr Epidemiol 49:1489-99
Mojtabai, Ramin; Chen, Lian-Yu; Kaufmann, Christopher N et al. (2014) Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders. J Subst Abuse Treat 46:268-73
Alvanzo, Anika A H; Storr, Carla L; Mojtabai, Ramin et al. (2014) Gender and race/ethnicity differences for initiation of alcohol-related service use among persons with alcohol dependence. Drug Alcohol Depend 140:48-55
Chen, Lian-Yu; Crum, Rosa M; Martins, Silvia S et al. (2013) Service use and barriers to mental health care among adults with major depression and comorbid substance dependence. Psychiatr Serv 64:863-70
Crum, Rosa M; La Flair, Lareina; Storr, Carla L et al. (2013) Reports of drinking to self-medicate anxiety symptoms: longitudinal assessment for subgroups of individuals with alcohol dependence. Depress Anxiety 30:174-83
Crum, Rosa M; Mojtabai, Ramin; Lazareck, Samuel et al. (2013) A prospective assessment of reports of drinking to self-medicate mood symptoms with the incidence and persistence of alcohol dependence. JAMA Psychiatry 70:718-26
Chen, Lian-Yu; Strain, Eric C; Crum, Rosa M et al. (2013) Gender differences in substance abuse treatment and barriers to care among persons with substance use disorders with and without comorbid major depression. J Addict Med 7:325-34
Mojtabai, Ramin; Crum, Rosa M (2013) Cigarette smoking and onset of mood and anxiety disorders. Am J Public Health 103:1656-65
Pacek, Lauren R; Martins, Silvia S; Crum, Rosa M (2013) The bidirectional relationships between alcohol, cannabis, co-occurring alcohol and cannabis use disorders with major depressive disorder: results from a national sample. J Affect Disord 148:188-95

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