Indexing the ‘dark side of addiction’: substance-induced affective symptoms and alcohol use disorders

Abstract

Background and aims: The emergence of negative affective symptoms during the course of alcohol use disorders (AUDs) (e.g. ‘dark side’ symptoms) has been suggested theoretically; however, the description of their occurrence is limited. This study operationalized two negative affect symptoms and tested the strength of association between these phenotypes and (1) indicators of the clinical course of the severity of AUD, (2) comorbid Axis I psychiatric disorders, suicidal behaviors and trait neuroticism and (3) whether participants reported drinking to relieve the negative affective symptoms. Design: A retrospective cross-sectional study was used to evaluate associations, using logistic regression, between the two negative affective symptoms and clinical measures of AUD severity and progression as well as comorbidity with other psychiatric disorders and conditions, adjusted for demographic characteristics. Setting: US community-based studies. Participants: A total of 2568 individuals with AUDs obtained from larger population studies that targeted individuals of European American (n = 1663), Mexican American and American Indian (n = 905) ancestry. Measurements: Semi-Structured Assessment for the Genetics of Alcoholism was used to ascertain the two ‘dark side’ phenotypes, clinical diagnoses, the clinical course of AUD and associated symptoms. The two phenotypes were: (1) being anxious or depressed when trying to cut down or stop drinking and (2) experiencing disabling depression for more than 24 hours while drinking. Findings: Both phenotypes were found to be rare in mild and moderate use disorder and highly prevalent in severe AUDs. Having an independent anxiety or affective disorder and elevated scores on trait neuroticism were also associated significantly with the occurrence of both symptoms, as was alcohol ‘craving’, elevated treatment-seeking, suicidal behaviors and drinking to relieve the symptoms. Conclusions: Affective symptoms are common in severe alcohol use disorders are associated with a history of independent affective/anxiety disorders, neuroticism and suicidal behaviors; and may promote further heavy drinking.