Factors affecting outcome of depressive symptoms in alcoholics.

Eighty-eight patients consecutively admitted to an alcohol treatment program were studied to determine the amount of depressive symptoms on entry to the program and after 4 weeks of treatment. The degree of symptoms was in turn related to various aspects of their drinking behavior. Twenty-two of the patients were classified as having moderate to marked depressive symptoms, 40 had mild symptoms, and 26 had no significant symptoms at the time of entry into the program. Factors in drinking behavior that best characterized those with moderate to marked symptoms were addiction, sleep disturbance, hangover incapacitation, loss of control, neurological signs, and organicity/toxicity. At the end of treatment, only four patients could actually be diagnosed as depressed, while 12 had mild residual symptoms and 72 no longer had significant symptoms. The one factor that clearly distinguished those patients with residual depressive symptoms was the use of drinking for social facilitation. For such individuals, bars and drinking were the focus of social life. The favorable course of depressive symptoms in alcoholics soon after they stop drinking suggests that they are more likely the consequence of drinking than the cause of it. The fact that patients who drink primarily to facilitate social aspects of their lives were the most likely to have residual symptoms suggests that treatment of such individuals should involve development of alternative mechanisms of social interaction.