A 5-Year Follow-Up of Depressed and Bipolar Patients with Alcohol Use Disorder in an Irish Population Conor K. Farren, Philip Murphy, and Sharon McElroy Background: Alcohol use disorders (AUDs) and affective disorders commonly co-occur, and this co-occurrence is mutually detrimental. To date, few long-term outcome studies exist involving patients with these comorbid disorders. We wished to determine treatment outcomes 5 years after inpatient integrated treatment in patients with these co-occurring disorders, and identify prognostic factors associated with long-term outcome. Methods: Two hundred and five depressed and bipolar patients with AUD who completed an inpatient integrated treatment program for dual diagnosis were assessed at baseline, posttreatment discharge, and at 3 months, 6 months, 2 years, and 5 years after treatment. Results: The retention rate at 3 months postdischarge was 95.6%, 75.6% at 6 months, 70.2% at 2 years, and 55.6% at 5 years. Depression, elation, anxiety, and craving scores all fell over the 5-year period, as did the drinking outcome measures in both the depressed and bipolar alcoholics. Each of the primary drinking outcome measures had independent prognostic factors: abstinence at 2 years pre- dicted abstinence at 5 years; number of drinking days at 6 months and 2 years predicted number of drinking days at 5 years; number of drinks per drinking day at 6 months and 2 years predicted number of drinks per drinking day at 5 years. Moreover, the majority of nonabstinent light drinkers at 3 months, who had significantly reduced their mean weekly alcohol consumption since baseline, remained light drinkers at 5 years and very few went on to be heavy drinkers. Indeed, if they did alter category by 5 years, they tended to become abstinent. Conclusions: Dual diagnosis of AUD and depression or bipolar disorder may be treated successfully together with intensive intervention and follow-up, and various prognostic factors emerge. Early absti- nence predicts later abstinence, and the vast majority of those who achieve light drinking early in recov- ery remain light drinkers or become abstinent at 5 years. Key Words: Alcohol Use Disorder, Depression, Bipolar Disorder, Treatment. A LARGE PERCENTAGE of patients with alcohol use disorder (AUD) have an associated or independent mood disorder, either depression or bipolar disorder, with a significant increase in morbidity and mortality associated (Hasin et al., 2007). This particular group is not only difficult to treat initially (Burns et al., 2005), but is associated with increased relapse to alcohol relative to AUD alone (Curran et al., 2000). The significant incidence of comorbidity between AUD and affective disorders may be influenced by a number of fac- tors. First, these disorders are among the most common psy- chiatric disorders and high rates of comorbidity could reflect that high prevalence (Hasin et al., 2005). Second, there may be a genetic component to the link between AUDs and affec- tive disorders, primarily bipolar disorder (Farren et al., 2012; Yip et al., 2012), but also a genetic link between major depression and AUDs (Weissman et al., 2006); however, some reports suggest that there is little evidence for increased major depression in offspring of alcoholic parents without independent depression (Schuckit et al., 2006). Last, alcohol is a mood altering substance, and thus can produce an increase in affective symptoms in patients with histories of affective disorder (Sullivan et al., 2005). Long-term studies of treatment interventions in either AUD or affective disorders are difficult to find, presumably because of the significant logistical difficulty at tracing patients over long periods of time, and the significant cost factors involved in long-term cohort research. While there are some long-term naturalistic studies in AUD (Powell et al., 1998; Schuckit et al., 2001; Vaillant, 1996), and in affective disorders (Judd et al., 2002; Keller and Boland, 1998; Kennedy et al., 2003), there are few in dual disorders of any kind (Hasin et al., 2007; Strakowski et al., 2005; Xie et al., 2010). An early study from our institution found that alcoholics with an associated bipolar disorder functioned at a higher level than those with depression or alcohol depen- dence alone 2 years postinpatient treatment (O’Sullivan et al., 1988). Abstinence from alcohol has been the almost universally accepted goal for most treatments for AUD, or dual diagno- sis therapies (Pettinati et al., 2010; Project Match Research From the Trinity College Dublin (CKF, PM, SME), St Patrick’s University Hospital, Dublin, Ireland. Received for publication July 8, 2013; accepted October 18, 2013. Reprint requests: Conor K. Farren, MD, PhD, Trinity College Dublin, St Patrick’s University Hospital, James Street, Dublin 8, Ireland; Tel.: 353 1 2493523; Fax: 353 1 6798865; E-mail: cfarren@stpatsmail.com Copyright © 2014 by the Research Society on Alcoholism. DOI: 10.1111/acer.12330 Alcohol Clin Exp Res, Vol **, No *, 2014: pp 1–10 1 ALCOHOLISM:CLINICAL AND EXPERIMENTAL RESEARCH Vol. **, No. * ** 2014