Alcohol abuse and dependence are common disorders responsible for extensive morbidity and mortality. Epidemiologic research has shown that depressive disorders are frequently comorbid with alcohol use disorders and there is evidence from naturalistic studies that the presence of each inhibits recovery from the other. The recent award of a large NIMH contract, """"""""Sequenced Treatment Alternatives for Relief of Depression"""""""" (STAR*D), presents an unparalleled opportunity to study the treatment of depression comorbid with alcohol use disorders in a diverse sample, broadly representative of clinical practice. STAR*D will enroll 4,000 treatment-seeking patients with Major Depression in a range of settings at about 30 primary care and community-based psychiatric treatment settings across the U.S. to study their response to antidepressant treatment in a treatment effectiveness paradigm. The presence of a comorbid alcohol use disorder is not an exclusion from STAR*D and therefore such comorbid patients will be included in the study. We propose to study a consecutive series of 250 subjects in STAR*D with alcohol use disorders and to relate their response to antidepressant treatment to the course of their alcohol use disorder. STAR*D will include subjects with DSM-IV Alcohol Abuse and Alcohol Dependence, excluding only those with physical dependence sufficient to require detoxification. We shall screen all STAR*D subjects for alcohol use disorders, diagnose those who screen positive by structured interview, collect data on baseline alcohol and drug abuse, and study the effect of antidepressant treatment on alcohol use, controlling for the effects of any drug use that may be cormorbid. This study will provide unique data from a treatment effectiveness study to clarify the role of antidepressant treatment in patients comorbid for depression and alcohol use disorders who are treated in both primary care and community-based psychiatric settings.
