Project Title: Problematic drinking and comorbid depression and anxiety: testing the
robustness of the ‘self-medication’ hypothesis
Supervisors: Dr Orla McBride and Dr Jamie Murphy
Contact Details: Tel: 028 71675341
Email: [email protected]
Level: PhD
Background to the project:
Problems with alcohol use and mental health difficulties, including depressed mood and
anxiety, often co-occur (are ‘comorbid’) within individuals, either simultaneously or in
sequence (1-5). Lifetime prevalence estimates suggest ~35% of adults meet criteria for
diagnosable alcohol use disorders (AUD) and major depression or anxiety disorders in their
lifetime (6, 7). Presently, however, the mechanisms underlying this substantial comorbidity
are not clearly understood. It is likely that experiences of either of these mental health
difficulties or alcohol-related problems increases the risk of developing the other (8),
regardless of which set of problems occurs first in the lifespan. That being said, a dominant
hypothesis is that it is more common for individuals to experience depressed mood or anxiety
first and then to develop alcohol-related problems through attempts to ‘self-medicate’ (9, 10).
Support for this position has emerged from several studies. Recently, however, there have
been calls for this position to be abandoned due to lack of clinical focus on addiction as the
primary problem (11). Indeed, it could argued that there is stronger support for the alternative
stance, that alcohol-related problems influence the development of experiences of anxiety
and/or depression (12, 13). This increased risk for mood difficulties following alcohol-related
problems could be due to biological mechanisms, for example decreased white and grey
matter as a result of drinking, or ethanol influencing neurotransmitter functioning (10, 14);
however, it is also plausible that specific alcohol-related experiences such as social and
occupational role impairment, unsuccessful attempts to control use and relationship difficulties
may increase the risk for depressed mood and anxiety (15, 16). More detailed research is
required to uncover the nature of the association between problematic drinking and
experiences of anxiety and depressed mood.
Methods to be used:
This research project has ethics approval to access and analyse a secondary data resource
– the third National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III).
This survey data was collected and is managed by the US National Institute on Alcohol and
Alcohol Abuse (NIAAA). Briefly, the NESARC-III was sponsored, designed and directed by
the NIAAA between April 2012 and June 2013. It is a cross-sectional survey, based on a
nationally representative sample of the civilian non-institutionalized population of the United
States aged 18 years and older. A multi-stage probability sampling survey design was used
to select respondents for recruitment. Primary sampling units were counties or groups of
contiguous counties, secondary sampling units (SSUs) comprised groups of Census-defined
blocks, and tertiary sampling units were households within SSUs. Eligible adults within
sampled households were randomly selected. Hispanics, Blacks, and Asians were
oversampled. The total sample size was 36,309. The overall response rate was 60.1%.
Further
details
of
the
survey
can
be
accessed
here
https://www.niaaa.nih.gov/research/nesarc-iii
The semi-structured Diagnostic Interview used to collect information was the NIAAA Alcohol
Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5). The AUDADIS-5
collects a wealth of information via a computerised-assisted personal interview (face-to-face
in the person’s home), including: background information; alcohol, drug and tobacco use and
dependence; mood and anxiety disorders; childhood experiences; family history of
mental health
behaviour.
difficulties;
personality
characteristics;
and
treatment-seeking
Objectives of the research:
This project aims to test a number of key hypotheses in relation to comorbid problematic
alcohol use and experiences of anxiety/depression, including:
(1) Test how different patterns of alcohol use (e.g. periodic binge drinking or low-quantity
regular daily drinking) are associated with specific experiences of anxiety and depression
(e.g. sleep difficulties, lack of concentration, irritability).
(2) Determine the socio-demographic and psychological characteristics of adults with different
drinking patterns who experience specific experiences of anxiety/depression
(3) Inspect the temporal ordering of onset of alcohol problems and experiences of
depression/anxiety
(4) Examine how general health related functioning varies conditional upon the temporal
ordering of onset of alcohol problems and experiences of depression/anxiety
These research aims will be addressed using appropriate statistical models, including
regression analysis and latent variable modelling.
Skills required of applicant:



Be able to demonstrate a strong interest in pursuing a doctoral degree in the area of mental
health
Have a good knowledge of statistics (i.e. undergraduate level) and be eager to develop
their skills in this area
Be enthusiastic and willing to work independently (under supervision)
References:
1.
Slade T, McEvoy P, Chapman C, Grove R, Teesson M. Onset and temporal
sequencing of lifetime anxiety, mood and substance use disorders in the general population.
Epidemiology and psychiatric sciences. 2013:1-9.
2.
Davis L, Uezato A, Newell JM, Frazier E. Major depression and comorbid substance
use disorders. Current Opinion in Psychiatry. 2008;21(1):14-8.
3.
Grant B, Hasin D, Dawson D. The relationship between DSM-IV alcohol use disorders
and DSM-IV major depression: examination of the primary-secondary distinction in a general
population sample. J Affect Disord. 1996;38(2):113-28.
4.
Merikangas KR, Mehta RL, Molnar BE, Walters EE, Swendsen JD, Aguilar-Gaziola S,
et al. Comorbidity of substance use disorders with mood and anxiety disorders: results of the
International Consortium in Psychiatric Epidemiology. Addict Behav. 1998;23(6):893-907.
5.
Robinson J, Sareen J, Cox BJ, Bolton J. Self-medication of anxiety disorders with
alcohol and drugs: Results from a nationally representative sample. J Anxiety Disord.
2009;23(1):38-45.
6.
Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime
co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders
in the National Comorbidity Survey. Archives of general psychiatry. 1997;54(4):313-21.
7.
Grant BF, Harford TC. Comorbidity between DSM-IV alcohol use disorders and major
depression: results of a national survey. Drug and alcohol dependence. 1995;39(3):197-206.
8.
Lynskey MT. The comorbidity of alcohol dependence and affective disorders:
treatment implications. Drug and alcohol dependence. 1998;52(3):201-9.
9.
Khantzian EJ. The self-medication hypothesis of addictive disorders: focus on heroin
and cocaine dependence. Am J Psychiatry. 1985;142(11):1259-64.
10.
Conner KR, Pinquart M, Gamble SA. Meta-analysis of depression and substance use
among individuals with alcohol use disorders. Journal of substance abuse treatment.
2009;37(2):127-37.
11.
Lembke A. From self‐medication to intoxication: time for a paradigm shift. Addiction.
2013;108(4):670-1.
12.
Lembke A. Time to abandon the self-medication hypothesis in patients with psychiatric
disorders. The American journal of drug and alcohol abuse. 2012;38(6):524-9.
13.
Boden JM, Fergusson DM. Alcohol and depression. Addiction. 2011;106(5):906-14.
14.
Raimo EB, Schuckit MA. Alcohol dependence and mood disorders. Addictive
behaviors. 1998;23(6):933-46.
15.
Conner KR. Clarifying the relationship between alcohol and depression. Addiction.
2011;106(5):915-6.
16.
McBride O, Cheng HG, Slade T, Lynskey MT. The role of specific alcohol-related
problems in predicting depressive experiences in a cross-sectional national household survey.
Alcohol Alcohol. 2016:agw010.