Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
10.4 Major clinical issues with somatoform disorders and alcohol use
Table of contents
- Acknowledgments
- Abbreviations
- Preface
- Introduction
- Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
1. Levels of evidence
2. Management of people with comorbidity of mental disorders and substance use- 3. The common drug groups
- 4. Tobacco
- 5. Depression and substance use
- 6. Anxiety disorders and substance use
- 7. Psychosis (schizophrenia and bipolar disorder) and substance use
- 8. Personality disorders and substance use
- 9. Eating disorders and substance use
- 10. Somatoform disorders and substance use
- 10.1 Somatoform disorders
- 10.2 Comorbidity with somatoform disorders
- 10.3 Major clinical issues with somatoform disorders and cannabis/ hallucinogen use
- 10.4 Major clinical issues with somatoform disorders and alcohol use
- 10.5 Major clinical issues with somatoform disorders and opioid use
- 10.6 Major clinical issues with somatoform disorders and stimulant (including methamphetamine) use
- 10.7 Major clinical issues with somatoform disorders and benzodiazepine use
- 10.8 Major clinical issues with somatoform disorders and inhalant/ solvent use
- 11. Gambling and substance use
- 12. Brain injury, mental disorders and substance use
- 13. Bibliography
- 14. Appendices
- Alcohol is one of the most commonly used substances by people with somatoform disorders.
- If alcohol consumption is hazardous or harmful, then the person should be counselled accordingly.
- Look for links between the patient’s symptomatology and alcohol use so that insight can be raised.
- Acamprosate and naltrexone are both effective in the management of alcohol dependence and maintaining abstinence.
10.4.1 Effects of alcohol on somatoform disorders
- Alcohol is one of the most commonly used substances by people with somatoform disorders(404, 415).
- People with somatoform disorders may self medicate with alcohol to mask pain or to reduce anxiety symptoms(379), as do people with organic physical pain and primary anxiety disorders.
- Alcohol use and intermittent withdrawal may result in exacerbation of a variety of physical symptoms particularly associated with anxiety(10, 18-23, 404).
10.4.2 Interactions between alcohol and therapeutic agents for somatoform disorders
- Benzodiazepines, opioids and antidepressants are metabolised by CYP 450 enzymes which may result in the inhibition or induction of each drug group. Therefore, individuals should be monitored closely to ensure they are receiving the appropriate therapeutic effect and not experiencing increased sedationx.
- Alcohol can exacerbate the sedative effects of any sedative agents (including tricyclic antidepressants and mirtazepine, benzodiazepines and opioids) used in the treatment of somatoform disorders. Alcohol toxicity and risk of overdose may occur through the inhibition of CYPs by sedative antidepressant involved in the metabolism of alcohol(133) or increase in sedation as a result of combinations of alcohol and benzodiazepines or opioidsx.
- Disulfiram and acamprosate used to treat alcohol dependence are unlikely to interact with antidepressants or with opioids if these are being usedx(229).
- Acamprosate and benzodiazepines do not appear to interact with one anotherx(230).
10.4.3 Management approaches to comorbid somatoform disorders and alcohol use
- Individuals with pain disorders may be taking benzodiazepines or opioids(377, 404).
- If alcohol consumption is hazardous or harmful, then the person should be counselled accordingly.
- Try to raise patient awareness of any links between their symptoms and their alcohol use.
- Somatoform disorders are best managed behaviourally and with cognitive therapy****(380-386).
- Alcohol intoxication will interfere with CBT and any structured problem solving or motivational therapy.
- Acamprosate and naltrexone are both effective in the management of alcohol dependence and maintaining abstinence****(141, 144, 235, 236).
- If the patient is taking opioid agonists for pain relief, the use of nalrexone to control alcohol consumption will block the therapeutic effect of opioid antagonistsxxx.
- Antidepressants may be required for comorbid depression and anxiety***(406, 407), with tricyclics being useful(377) for aiding chronic tension headaches and fibromyalgia.
