Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
Alcohol (ethanol) is one of the most commonly used and misused substances. It is a depressant drug that slows down body reactions and general brain function. Alcohol is readily available and its excessive consumption has become part of Australian culture.
In Australia, the 12 month prevalence of harmful use of alcohol is 3.0% while the prevalence of dependence is 3.5%. Men are twice as likely to experience dependence compared with women.
The secondary effects of alcohol make it dangerous with motor vehicle accidents, alcohol-related violence (including domestic violence) and liver disease which are all major causes of morbidity and mortality.
The depressive effects of alcohol make it a significant risk factor in the development of mental health problems, particularly depression.
Effects sought from the substance: Relaxation and reduced social inhibition.
Associated harms: Slurring of speech, reduced motor-coordination, reduced vision and consciousness, liver disease, gastrointestinal disease, anaemia, malnutrition (thiamine deficiency), central nervous system disturbances (from psychosis through to dementia) and heart disease.
Overdose: Moderate risk of overdose. Alcohol becomes particularly dangerous when used in conjunction with other depressant substances (e.g. benzodiazepines).
Withdrawal: If dependence is established, then withdrawal effects include nausea and vomiting, agitation, tremor, sweating, hallucinations, and seizures. Withdrawal can be life threatening.
Psychological presentations commonly associated with use (likely to resolve on cessation of
substance use): Depression(16, 17) and anxiety(10, 18-23).