Alcohol Use Disorder Criteria Exhibit Different Comorbidity Patterns.
BACKGROUND AND AIMS
Alcohol use disorder is comorbid with numerous other forms of psychopathology, including externalizing disorders (e.g., conduct disorder) and, to a lesser extent, internalizing conditions (e.g., depression, anxiety). Much of the time, overlap among alcohol use disorder and other conditions is explored at the disorder-level, assuming that criteria are co-equal indicators of other psychopathology even though alcohol use disorder criteria span numerous varied domains. Emerging evidence suggests that there are symptom clusters within the construct of alcohol use disorder that relate differentially with important external criteria, including psychopathology and allied personality traits (e.g., impulsivity, novelty seeking). The present study mapped individual alcohol use disorder criteria onto internalizing and externalizing dimensions. Design and participants We used multivariate and factor analytic modeling and data from 2 large nationally representative samples of past year drinkers (ns = 25,604; 19,454).


SETTING
USA MEASUREMENTS: Psychopathology was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, yielding alcohol use disorder criteria, internalizing diagnoses (i.e., major depressive disorder, dysthymia, social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder), and externalizing diagnoses and symptoms (i.e., antisocial personality disorder, conduct disorder, and 3 impulsivity items drawn from borderline personality disorder criteria). Alcohol consumption was assessed in terms of past-year drinking frequency, usual amount of alcohol consumed on drinking days, binge drinking frequency, intoxication frequency, and maximum number of drinks in a 24-hour period.


FINDINGS
Four different patterns emerged. First, several alcohol use disorder criteria were relatively weakly associated with externalizing and internalizing. Second, withdrawal was associated with internalizing, but this association was not specific to distress. Third, there was a general lack of specificity between alcohol use disorder criteria and narrower forms of internalizing, despite what might be predicted by modern models of addiction. Fourth, recurrent use in hazardous situations reflected higher degrees of externalizing and lower internalizing liability.


CONCLUSIONS
Different symptom combinations appear to yield differential expressions of alcohol use disorder that are disorder-specific, or reflect broader tendencies toward externalizing, internalizing, or both.