Comorbidity Doesn't Explain the Prevalence of Alcoholism in Native Americans

The co-occurrence of anxiety or affective disorders and alcoholism in Native Americans has not been well characterized. To determine the prevalence of these co-occurring disorders, investigators interviewed 483 Southwest California Indians (known as Mission Indians) who were at least one-sixteenth Native American and lived on contiguous reservations.

• Subjects were demographically similar to Mission Indians as a whole, according to United States census figures (mean age 30 years). Sixty-six percent of the men and 53% of the women had current or past alcohol dependence.
• The most common anxiety and affective disorders independent of substance use included major depressive disorder (12%), agoraphobia (7%), and social phobia (7%). The prevalences of these disorders did not differ significantly between people with and without alcohol dependence.
• The same was true for the prevalences of agoraphobia and social phobia overall (i.e., independent disorders and those concurrent with substance abuse).
• However, major depressive disorders overall (independent disorders and those concurrent with substance abuse) were significantly more common in people with alcohol dependence than in people without dependence (22% versus 11%).

Comments:

At least in this Native American population, anxiety and affective disorders independent of substance abuse were not more common in people with alcohol dependence. And even though major depressive disorders overall were more prevalent in those with dependence, they were much less common than was dependence. Affective and anxiety disorders remain important considerations in the treatment of Native Americans with alcohol dependence. However, they do not appear to explain the high prevalence of alcoholism in this group.

Richard Saitz, MD, MPH

Reference:

Gilder DA, Wall TL, Ehlers CL. Comorbidity of select anxiety and affective disorders with alcohol dependence in southwest California Indians. Alcohol Clin Exp Res. 2004;28(12):1805–1813.