Alcohol and Alcoholism Advance Access originally published online on July 4, 2005
Alcohol and Alcoholism 2005 40(5):394-400; doi:10.1093/alcalc/agh182
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INTENTION TO CHANGE DRINKING BEHAVIOUR IN GENERAL PRACTICE PATIENTS WITH PROBLEMATIC DRINKING AND COMORBID DEPRESSION OR ANXIETY
1 Medical University of Luebeck, Department of Psychiatry and Psychotherapy, Research Group S:TEP (Substance Abuse: Treatment, Epidemiology and Prevention), Luebeck, Federal Republic of Germany and 2 Ernst-Moritz Arndt University, Department of Epidemiology and Prevention, Greifswald, Federal Republic of Germany
* Author to whom correspondence should be addressed at: Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Psychiatrie und Psychotherapie, Ratzeburger Allee 160, 23538 Lübeck, Germany. Tel.: +49 451 5004813; Fax: +49 451 5003480; E-mail: Janina.Grothues{at}ukl.mu-luebeck.de
(First received 8 October 2004; first review notified 20 January 2005; final revised form 18 May 2005; accepted 10 June 2005)
Aims: This paper examines the interaction of intention to change drinking behaviour with comorbid depression and anxiety in pro-actively recruited individuals with a range of drinking problems. Methods: Cross-sectional data of 408 general practice (GP) patients aged 18–64 years, who meet the diagnostic criteria of alcohol dependence or abuse according to DSM-IV, criteria of at-risk drinking or binge drinking, were drawn from a brief intervention study. Of the sample, 89 participants were diagnosed with comorbid anxiety and/or depressive disorders. The Transtheoretical Model (TTM) of behaviour change constructs: stages and processes of change, self-efficacy, and decisional balance were assessed in relation to presence and absence of the respective psychiatric disorders. Results: Analysis including all categories of problematic drinking revealed comorbid anxiety and/or depression to be significantly related to later stages of change. Within subgroups, this was only true for alcohol abuse, not for dependence, at-risk or binge drinking. In addition, comorbidity was related to higher use of processes of change and more pros and cons of drinking, when compared to non-comorbid participants. Comorbid individuals showed higher temptation to drink and lower self-efficacy to abstain from drinking. Separate analyses of readiness to change drinking between the categories anxiety/no comorbidity and depression/no comorbidity both obtained significance, while for anxiety disorders, this was more profound. A multinomial logistic regression analysis revealed that adverse consequences better predicted readiness to change when compared to comorbidity. Discussion: Individuals with problematic drinking and comorbid anxiety or depression may be well accessible for pro-active intervention to reduce drinking. Strategies should focus on the enhancement of coping skills to control temptation and self-efficacy.