Alcohol use disorder criteria exhibit different comorbidity patterns

Background: Alcohol use disorder is comorbid with numerous other forms of psychopathology, including externalizing disorders (e.g., conduct disorder) and, to a lesser extent, internalizing conditions (e.g., depression, anxiety). Much of the time, overlap among alcohol use disorder and other conditions is explored at the disorder-level, assuming that criteria are co-equal indicators of other psychopathology even though alcohol use disorder criteria span numerous varied domains. Emerging evidence suggests that there are symptom clusters within the construct of alcohol use disorder that relate differentially with important external criteria, including psychopathology and allied personality traits (e.g., impulsivity, novelty seeking). Aims: The present study mapped individual alcohol use disorder criteria onto internalizing and externalizing dimensions. Design: We used multivariate and factor analytic modeling and data from 2 large nationally representative samples of past year drinkers (ns = 25,604; 19,454). Findings: Four different patterns emerged. First, several alcohol use disorder criteria were relatively weakly associated with externalizing and internalizing. Second, withdrawal was associated with internalizing, but this association was not specific to distress. Third, there was a general lack of specificity between alcohol use disorder criteria and narrower forms of internalizing, despite what might be predicted by modern models of addiction. Fourth, recurrent use in hazardous situations reflected higher degrees of externalizing and lower internalizing liability. Conclusions: Different symptom combinations appear to yield differential expressions of alcohol use disorder that are disorder-specific, or reflect broader tendencies toward externalizing, internalizing, or both. Thus, symptoms may be ideal targets in investigations of alcohol use disorder’s etiology and correlates, as well as its treatment.