اعتیاد به الکل و اختلال عاطفی فصلی

Seasonal changes in mood and behavior (seasonality) may be closely related to alcoholism. Some patients with alcoholism have a seasonal pattern to their alcohol misuse. They may be self-medicating an underlying seasonal affective disorder (SAD) with alcohol or manifesting a seasonal pattern to alcohol-induced depression. Both genetic and environmental factors play a role in the etiology and pathogenesis of alcoholism and SAD, operating, at least in part, through the brain serotonergic system. Family and molecular genetic studies suggest that there may be a genetic link between seasonality and alcoholism. Certain environmental and social factors may contribute to the development of seasonality in patients with alcoholism. The fact that SAD and alcoholism may be comorbid shows the importance of a thorough diagnostic interview. Both mental health and drug and alcohol professionals should be provided with education to assist with appropriate identification, management, and referral of patients presenting with comorbid alcoholism and SAD.

ALCOHOL USE and alcohol-related problems are very common in Western societies.1 and 2 For example, 90% of people in the United States drink alcohol.3 Thirty percent or more drinkers develop temporary alcohol-related problems. Severe alcohol-related impairment (alcohol dependence) is observed at some time during their lives of approximately 10% of men and 3% to 5% of women, with an additional 5% to 10% of each sex developing persistent but less intense alcohol-related problems that are diagnosed as abuse.1 Alcoholism and depression are a prevalent combination of psychiatric disorders among individuals seeking treatment.4 The Epidemiologic Catchment Area study reported a high concordance for alcoholism and mood disorders.5 Among subjects with a lifetime history of alcoholism, 13.4% had a history of mood disorder. These disorders clustered together at a rate approximately two times higher (odds ratio = 1.9) than would be expected relative to the prevalence of each disorder in the general population. Among patients with a history of mood disorder, 21.8% met criteria for alcohol abuse or dependence at some points of their lives (odds ratio = 1.9); and among patients with bipolar disorder, the comorbidity for alcoholism was 81.6% (odds ratio = 3.7). Hasin and Grant6 using data from the National Longitudinal Alcohol Epidemiologic Survey demonstrated that prior alcohol dependence increased the risk of current major depressive disorder more than fourfold.