title: Age of onset and temporal sequencing of lifetime DSM-IV alcohol use disorders relative to comorbid mood and anxiety disorders.
abstract: BACKGROUND
  Understanding the temporal sequencing of alcohol use disorders (AUDs) and comorbid mood and anxiety disorders may help to disentangle the etiological underpinnings of comorbidity. Methodological limitations of previous studies, however, may have led to inconsistent or inconclusive findings.
  
  
  OBJECTIVE
  To describe the temporal sequencing of the onset of AUDs relative to the onset of specific comorbid mood and anxiety disorders using a large, nationally representative survey.
  
  
  RESULTS
  AUD onset tended to follow the onset of 2 of the 9 mood and anxiety disorders (specific and social phobia). The onset of alcohol abuse tended to precede the onset of 5 of the 9 mood and anxiety disorders (GAD, panic, panic with agoraphobia, major depression, and dysthymia), whereas the onset of alcohol dependence tended to precede the onset of only 2 of the 9 mood and anxiety disorders (GAD and panic). Lag times between primary and subsequent disorders generally ranged from 7 to 16 years. Comorbid individuals whose alcohol dependence came after panic with agoraphobia, hypomania, and GAD had increased risk of persistent alcohol dependence.
  
  
  CONCLUSIONS
  Alcohol abuse, but not dependence, precedes many mood and anxiety disorders. If the primary disorder does in fact play a causative or contributing role in the development of the subsequent disorder, this role can best be described as "temporally distal." However, in assessing the risk for persistent alcohol dependence, clinicians should not only consider the type of comorbid mood/anxiety disorder, but also the temporal ordering of these disorders.
authors.affiliation: Alcohol Epidemiologic Data System, CSR, Incorporated, 2107 Wilson Boulevard, Suite 1000, Arlington, VA 22201-3085, United States. dfalk@csrincorporated.com
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Falk
authors.forename: Hsiao-Ye
authors.initials: HY
authors.lastname: Yi
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hilton
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000437:Alcoholism / Q000453:epidemiology*; D001008:Anxiety Disorders / Q000453:epidemiology*; D002391:Catchment Area, Health; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D019964:Mood Disorders / Q000453:epidemiology*; D015995:Prevalence; D017678:Sex Distribution; D013997:Time Factors; D014481:United States / Q000453:epidemiology