Risk for alcohol use problems in severe mental illness: Interactions with sex and racial/ethnic minority status

Abstract

Background: Alcohol use disorder (AUD) is exceedingly common among individuals with bipolar disorder and schizophrenia. However, studies on alcohol use in psychiatric illness rely largely on population surveys with limited representation of severe mental illness (SMI); schizophrenia and bipolar disorder.

Methods: Using data from the Genomic Psychiatry Cohort (GPC) (Pato MT, 2013), associations of bipolar disorder and schizophrenia with alcohol use problems were examined in a diverse US based sample, considering the influence of self-described race (African Ancestry (AA), European Ancestry (EA), or Latinx Ancestry (LA)), sex, and tobacco use. Participants answered alcohol use problem items derived from the CAGE instrument, yielding a summed "probable" alcohol use disorder (pAUD) risk score.

Results: This study included 1952 individuals with bipolar disorder with psychosis (BDwP), 409 with bipolar disorder without psychosis (BD), 9218 with schizophrenia (SCZ), and 10,416 unaffected individuals. We found that SMI (BDwP, BD, SCZ) was associated with elevated AUD risk scores (B = 0.223, p < 0.001), an association which was strongest in females, particularly those of AA and LA, and in tobacco users. Schizophrenia was associated with the greatest increase in pAUD score (B = 0.141, p < 0.001). pAUD risk scores were increased among participants with bipolar disorder, with greater increases in BDwP (B = 0.125, p < 0.001) than in BD without psychosis (B = 0.027, p < 0.001).

Limitations: Limitations include reliance on self-report data, screening items for AUD, voluntary recruitment bias, and differences in race/sex distribution between groups, which were statistically adjusted for in analytic models.

Conclusions: SMI is associated with risk for AUD, particularly among females from racial minority groups, smokers, and those with psychotic disorders.

Keywords: Addiction; Bipolar disorder; Dual diagnosis; Psychosis; Schizophrenia; Substance use.

Figure 1.

Alcohol use disorder (AUD) score distribution by diagnosis This displays the distribution of AUD scores in participants with bipolar disorder (BD), bipolar disorder with psychosis (BDwP), schizophrenia (Scz), serious mental illness (SMI) and no severe mental illness (controls).

Figure 2.

Participants Endorsing Alcohol Use Problem Screening Items (%) Among SMI group Q14 was endorsed the highest (38.5%) followed by Q13 (29%), Q12 (27.7%), Q16 (27.2%), Q17 (25.7%) and Q15 (23.0%). When compared by each Dx Q14 was endorsed the most by BD with Psychosis (46.2%), BD without Psychosis (37%) and SZ (36.9%). Among controls Q14 was also endorsed the most (9.8%), followed by Q13 (7.9%), Q12 (6.6%), Q17 (5.7%), Q16 (4.8%) and Q15 (4.3%). Q12 More than 4/5 drinks/day Q13 Under influence of alcohol/accident/hurt Q14 More to drink than intended/calm nerves Q15 Wanted to quit/cut down Q16 People annoyed/criticize drinking Q17 Drink in morning [eye opener]

Figure 3.

Mean alcohol use disorder scores in males vs. females, by diagnosis. Abbreviations include BD (bipolar disorder), BDwP (bipolar disorder with psychosis), and SCZ (schizophrenia). Significant p<0.01 *, p<0.001 **, determined by independent samples t-test.