Drinking Distilled. Onset, course and treatment of alcohol use disorders in the general population

Although most people in Western society drink alcohol and regard this to be harmless and normal, some people drink excessively and develop an alcohol use disorder. This thesis examined the onset, course and treatment of alcohol use disorders in the general population using 3-year longitudinal data from a large population-based study (NEMESIS-2), including 6,646 adults (aged 18-64). - Childhood externalizing disorders proved to be strongly related with alcohol use disorders: a pathway was observed from childhood ADHD to alcohol use disorder via childhood conduct disorder. - Most people with an alcohol use disorder had mild and transient problems: 75-80% did not drink excessively, 70% remitted spontaneously within three years and only 12% of those in remission relapsed. - Individuals with a high drinking level, a high number of alcohol use disorder criteria, and comorbid psychopathology, specifically anxiety disorders, were at risk of a chronic alcohol use disorder. - Only 10% of those with an alcohol use disorder received specialized alcohol treatment, but this process seems quite adequate with those most in need of help having the highest contact rate. To prevent alcohol use disorders, early recognition and treatment of individuals with childhood externalizing disorders appears important. Although treatment resources seem to be allocated quite efficiently, treatment access may be further improved by targeting the small group of non-treatment seekers at risk of a chronic course

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Smoking behavior of women before, during, and after pregnancy: Indicators of smoking, quitting, and relapse

Background: Smoking cessation during pregnancy and preventing relapse postpartum is a pivotal public health priority. Objectives: This study examined the risk and protective indicators of women who (a) smoke before pregnancy, (b) smoke during the entire pregnancy, (c) successfully quit smoking during pregnancy, and (d) relapse postpartum. Method: This paper reports secondary analyses of the Dutch population-based Monitor on Substance Use and Pregnancy (2016). A representative sample of mothers of young children (n = 1,858) completed questionnaires at youth health care centers. Bivariate and multivariate logistic regression analyses were conducted. Results: Main results showed that women's smoking around pregnancy was strongly associated with the partner's smoking status before pregnancy, partner's change in smoking during pregnancy, and partner's change in smoking postpartum. Women's educational level and cannabis use before pregnancy were also related with women's smoking before and during pregnancy. Women's intensity of alcohol use before pregnancy was ambiguously related with women's smoking before and during pregnancy. Conclusions: One of the key findings of this study suggests that it is essential that partners quit smoking before pregnancy and do not smoke during pregnancy. If partners continue smoking during pregnancy, they should quit smoking postpartum. Health care professionals can play an important role in addressing partners' smoking and giving them evidence-based cessation support before, during, and after pregnancy

Recurrence and chronicity of major depressive disorder and their risk indicators in a population cohort

Objective: The naturalistic course of major depressive disorder (MDD) and risk indicators for recurrence and chronicity are best studied using a population sample without clear selection bias. However, such studies are scarce. This limits clinical decision-making concerning monitoring and maintenance treatment. Method: Data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among a representative adult population. Two groups at baseline were selected to study recurrence and chronicity of MDD at follow-up. Diagnoses were assessed with the Composite International Diagnostic Interview 3.0. Results: Among remitted MDD cases (n = 746), the cumulative recurrence rate was 4.3% at 5 years, 13.4% at 10 years and 27.1% at 20 years. Time to recurrence was predicted by vulnerability characteristics (childhood abuse, negative life events, parental psychopathology), physical health, functioning, clinical characteristics of depression (previous episodes, severity, medication use), psychiatric comorbidity and mental health use. Among current MDD cases (n = 242), 12% developed a chronic depressive episode over 6 years. Chronic course was predicted by similar risk indicators as recurrence, except for vulnerability characteristics and physical health. Conclusion: These risk indicators may help to identify patients requiring monitoring and who could benefit from preventive interventions or maintenance treatment