CATR: Please tell us about yourself.
Dr. Petrakis: I’m an addiction psychiatrist, professor at Yale School of Medicine, and the Chief of Mental Health for the VA Connecticut Healthcare System. I have several research focuses, one of which is the treatment of individuals with comorbid psychiatric illness and alcohol use disorder (AUD).

CATR: We know AUD prevalence is higher among patients with mental illness. But how big of a problem is it really?
Dr. Petrakis: It’s a big problem. The prevalence of AUD in people who have mental illness is significantly higher than it is in the general population. And the risk goes both ways. By that I mean, if you start with a group of patients with psychiatric illness, the prevalence of AUD is higher than the general population, and if you start with a group of patients with AUD, the prevalence of psychiatric illness will be elevated. This holds for inpatient units and outpatient facilities alike, which suggests that AUD is important to look for in any mental health treatment setting, not just a specialty addiction clinic.

CATR: And how does the prevalence of AUD break down by diagnosis?
Dr. Petrakis: That’s a tough question to answer exactly because, believe it or not, there is no comprehensive single study that answers this question. So, that means comparing studies with differing methodologies. But it’s clear that there are increases across the board, with bipolar disorder probably conferring the greatest risk. For some context, the 12-month prevalence of AUD in the general population is less than 10% (Hasin DS and Grant BF, Soc Psych Psychiatr Epidemiol 2015;50(11):1609–1640). That number is in the range of 20% for schizophrenia; 30% for depression, ADHD, anxiety disorders, and PTSD; and up to 40% for bipolar disorder (Castillo-Carniglia A et al, Lancet Psychiatry 2019;6(12):1068–1080).

CATR: How do you suggest clinicians make a diagnosis? What should they be looking for specifically?
Dr. Petrakis: The first step is to make sure that there is a protocol for screening in place. Every patient having an intake in a mental health setting should be screened for AUD, and that screening should be repeated periodically, say every year or so. Here at the VA, we use the AUDIT-C, which is pretty easy to use (Editor’s note: See AUDIT-C questionnaire on page 4). Whatever screening tool you use, be sure you know what it’s meant for; the AUDIT-C won’t diagnose AUD, but it can identify who needs further investigation (Bush K et al, Arch Intern Med 1998;158(16):1789–1795; www.tinyurl.com/mba74m3f).