Alcohol consumption has become a significant public health issue globally, contributing substantially to morbidity, mortality, and socio-economic burden. Harmful alcohol use is associated with various physical, psychological, and social complications. Among these, psychiatric co-morbidities are particularly important because they influence the course, treatment response, and prognosis of alcohol dependence. Alcohol dependence syndrome is characterized by a strong craving for alcohol, impaired control over drinking, tolerance, withdrawal symptoms, and continued use despite harmful consequences. Patients with alcohol dependence frequently suffer from mental illnesses such as depression, anxiety disorders, bipolar disorder, schizophrenia, and personality disorders. These psychiatric conditions may either precede alcohol use or develop secondary to chronic alcohol consumption. The coexistence of alcohol dependence and mental illness presents diagnostic and therapeutic challenges. Psychiatric symptoms may be masked by intoxication or withdrawal states, resulting in delayed diagnosis and inadequate treatment. Moreover, patients with dual diagnoses often experience poor treatment adherence, repeated hospitalizations, higher relapse rates, suicidal tendencies, and impaired quality of life. India has witnessed increasing alcohol consumption over recent decades due to urbanization, social changes, and lifestyle modifications. Despite this rise, limited hospital-based studies have examined the pattern of psychiatric co-morbidities among alcohol-dependent patients in tertiary care settings. Therefore, this study aims to assess the prevalence and types of psychiatric disorders among patients with alcohol dependence admitted to a Psychiatry Department of a tertiary care teaching hospital. Alcohol dependence is statistically prevalent in societies where alcohol consumption is socially accepted. Many individuals experience an urge to consume alcohol, often triggered by a range of in-ternal or external stimuli [1]. Long-term alcohol consumption has numerous adverse effects across various physiological systems, contributing to mental health problems, chronic pancreatitis, malnutrition, coronary heart disease, and hepatocellular carcinoma. Additionally, alcohol use increases the risk of oropharyngeal and esophageal cancer. Central and peripheral nervous systems are also weak-ened and impacted by ethanol [2]. Alcohol Use Disorder (AUD) is a major public health issue, characterized by impaired control over drinking [3]. The severity of alcohol dependence serves as a valuable indicator in determining the likelihood of relapse, and early interventions are commonly applied to individuals with emerging problematic drinking patterns [4]. Although alcohol withdrawal symptoms usually appear upon waking, a thorough examination of the highly dependent individual could reveal the individual may experience sub-acute withdrawal throughout the day or even wakes up during the night with symptoms of withdrawal [1]. Alcohol is a depressant of the central nervous system that simultaneously changes multiple neural pathways, producing significant neurological and behavioural changes. Understanding its impact on neural signaling pathways brings up new therapy options for the rehabilitation of alcoholics by enabling the discovery of effectors that may block the central action of alcohol [5]. Patients and their families are greatly impacted by alcohol addiction and dependence. It has been demonstrated that people who overuse and dependent on alcohol have a much lower quality of life, especially in terms of mental health and social functioning [6]. Advancements in neurobiology have led to the development of novel drugs to treat alcoholism and the discovery of pharmacological targets, and many patients will benefit from pharmacotherapy as part of their treatment regimen. When implemented with psychosocial interventions, pharmacotherapy can increase the efficacy of treatment [7]. The objective of the research is to assess the severity of alcohol dependence in patients with alcohol dependence syndrome and to evaluate the psychiatric comorbidities among these individuals. The study also explores the association between socio-demographic characteristics and psychiatric comorbidities among individuals with ADS.

Study Design: This was a cross-sectional observational study conducted on 100 patients diagnosed with Alcohol Use Disorder (AUD) according to DSM V TR Diagnostic Criteria for Research (DCR), from November 2022 to October 2023, in the outpatient/inpatient setting of the Department of Psychiatry, Rajshree Medical Research Institute, Bareilly. All participants gave written informed consent prior to enrolment, after receiving details about the purpose of the study in simple terms. Inclusion Criteria:  The patients with AUD as per DSM V TR criteria.  Patient belongs to the age 18 to 60 yrs.  Individuals who are willing to take part in the study and can provide informed permission  Patients of any gender, including male, female, or other  Patients who are capable of understanding Hindi or English Exclusion Criteria:  Those who are suffering from mental illnesses due to identifiable organic causes.  A patient who suffers multiple mental and physical disorders at the same time.  Individuals using drugs that can cause cognitive and other psychological problems, aside from nicotine and caffeine. Study Technique: Information on the socio-demographic characteristics of the patients with alcohol dependence was obtained using a standardized proforma. The level of alcohol dependence of study population's was evaluated using the SADQ (Severity of Alcohol Dependence Questionnaire). The SADQ is a 20-item self-administered test eval-uating physical withdrawal, affective withdrawal, withdrawal relief drinking, and rapidity of rein-statement. MINI English Version 7.0.2 for DSM-5 a brief, systematic diagnostic examination used to assess Psychiatric diseases. To minimize the impact of withdrawal symptoms, the diagnosis is verified using DSM-5 two weeks later. Statistical Analysis: The information was gathered, condensed, and organized in a master data sheet in Microsoft Excel. SPSS version 25 was used to analyze the data using the Chi-Square tests based on objectives of the study (p-value < 0.05 is regarded as significant). Ethical Concerns: The study received prior approval from the Institutional Ethics Committee and Research Review Board of Rajshree Medical Research Institute, Bareilly. All the information of the patients collected during study was kept confidential.

For the present study, a total of 100 individuals with Alcohol Use Disorder (AUD) as per DSM V TR criteria were selected, aged between 18-60 years. Of these, 39% were between the ages of 26-35 years, with a mean age of 35.98±8.63 years. Most of the patients were males (96%) compared to females (4%), and 92% identified as Hindu, while 8% identified as Muslim. The participants were nearly evenly divided between those who were employed (48%) and those who were unemployed (52%). Participants belonged to varying socioeconomic classes, with 52% from the lower class, 33% from the middle class, and 15% from the upper class. In terms of family structure, 17% lived in joint families, 30% in extended nuclear families, and 53% in nuclear families. Regarding educational status, the largest proportion had completed only primary education (37%), followed by secondary education (22%), graduation (17%), no formal education (14%), and post-graduation (10%). The majority of the participants were married (71%), while 20% were single, 5% widowed, and 4% divorced. With respect to residence, 42% were from urban areas, 38% from rural areas, and 20% from semi-urban regions. A history of psychiatric illness was reported by 21% of participants, whereas 79% had no such history. Additionally, 81% did not report any family history of psychiatric illness. Table 1 presents the relation-ship between socio-demographic variables and psychiatric comorbidity in alcohol use disorder. Statistical analysis revealed a significant association between psychiatric comorbidity and gender, history of psychiatric illness, and family history of psychiatric illness, while no significant associations were observed with other socio-demographic factors. *Significant p value (≤0.05) According to the MINI 7.02 diagnostic interview, 48% of respondents were found to have a psychiatric comorbidity. The most common was Major Depressive Disorder (13%), with other comorbid conditions including Antisocial Personality Disorder (5%), Generalized Anxiety Disorder (4%), Mixed Anxiety Depression (3%), Dysthymia (3%), Panic Disorder (3%), Borderline Personality Disorder (3%), Substance-Induced Mood Disorder (3%), Hypomania (2%), Adjustment Disorder (2%), Obsessive-Compulsive Disorder (1%), Substance-Induced Psychotic Disorder (2%), Social Anxiety Disorder (1%), Somatoform Disorder (1%), Mania (1%), and Schizophrenia (1%) (Figure 1). The remaining 52% did not have any psychiatric comorbidity. Table 2: Relation between psychiatric comorbidity and severity of dependence in alcohol use patient: SADQ Severity Percentage Psychiatric Comorbidity Absent Psychiatric Comorbidity Present Mild 9% 8 1 Moderate 37% 27 10 Severe 54% 17 37 Table 1: Relation between socio-demographic data with psychiatric comorbidity in alcohol use disorder Variable Category Absent psychiatric comorbidity Present psychiatric comorbidity Total Present psychiatric comorbidity (%) Chi-Square Value p-value Age 18-25 6 5 11 45.45 3.97 0.41 26-35 20 19 39 48.72 36-45 14 19 33 57.58 >45 12 5 17 29.41 Gender Female 1 3 4 75 74.46 0.000* Male 51 45 96 46.88 Religion Hindu 46 46 92 50 7.96 0.979 Muslim 6 2 8 25 Occupation Employed 27 21 48 43.75 12.55 0.818 Unemployed 25 27 52 51.92 Socioeconomic Status Lower 26 26 52 50 20.86 0.979 Middle 15 18 33 54.55 Upper 11 4 15 26.67 Type of Family Extended Nuclear 13 17 30 56.67 32.29 0.6458 Joint 8 9 17 52.94 Nuclear 31 22 53 41.51 Education Status Graduate 8 9 17 52.94 73.73 0.421 Illiterate 6 8 14 57.14 Postgraduate 5 5 10 50 Primary 20 17 37 45.95 Secondary 13 9 22 40.91 Marital Status Divorced 2 2 4 50 37.59 0.956 Married 38 33 71 46.48 Single 8 12 20 60 Widow 4 1 5 20 Domicile Rural 17 21 38 55.26 38.82 0.344 Semi-Urban 12 8 20 40 Urban 23 19 42 45.24 History of Psychiatric Illness No 47 32 79 40.51 59.66 0.000* Yes 5 16 21 76.19 Family History of Psychiatric Illness No 45 36 81 44.44 36.86 0.005* Yes 7 12 19 63.16 Figure 1: Prevalence of different types of psychiatric comorbidities Table 2 presents the prevalence of severity in patients and relation between psychiatry comorbidity and severity of dependence in alcohol use patient. Figure 2 is graphical presentation of psychiatric comorbidity in relation with severity of dependence. Figure 2: Comparison of psychiatric comorbidity in relation with severity of dependence

When a family member has an alcohol addiction, everyone in the family has ongoing stress and various kinds of difficulties [8]. Socio-demographic data for the patients including (Age, Gender, Religion, Occupation, Socioeconomic Status, Type of Family, Education Status, Marital Status, Domicile, History of Psychiatric Illness, and Family History of Psychiatric Illness) were recorded. Statistical analysis revealed a significant association between psychiatric comorbidity and gender, history of psychiatric illness, and family history of psychiatric illness. Female patients showed more psychiatric comorbidity as compare to males. These results are inconsistent with the results of earlier research conducted by Petrović et al. [9] find no gender differences, but the quality of life was lower for participants with alcohol dependency than for healthy controls. Høiland et al.[10] stated that women with alcohol use disorders who are seeking treatment have unique requirements that should be evaluated and addressed throughout therapy. In individuals with alcohol use disorder, age and education were linked to hypertension, whereas gender, education, and body mass index (BMI) were linked to hyperlipidemia [11]. García-Marchena et al. [12] there were differences by sex among those beginning alcohol use disorder treatment for the first time and when developing individualized treatment plans for men and women, these distinctions need to be considered. It is essential to examine at the increase in alcohol use, the more serious consequences of chronic alcohol use in women, and the reduction of the gender gap [13]. Alcohol is one of the most often used psychoactive substances in the world. There is compelling evidence that Alcohol use disorders have a complicated polygenic architecture and are genetically impacted. Similarly, there is strong evidence that environmental factors, such unfavorable early exposures and maladaptive developmental pathways, have consequences [3]. It was found that the prevalence of mental comorbidities rises in line with the severeity of alcohol dependency. The severity and prognosis of bipolar illness and alcohol use disorder are strongly influenced by one another, and the course of both conditions is more complicated [14]. Kattukulathil et al. (2015) [15] stated that addiction to alcohol is associated with a high prevalence of mental comorbidities. In present study, 48% of respondents were found to have a psychiatric comorbidity. The most common was Major Depressive Disorder (13%), with other comorbid conditions including Antisocial Personality Disorder (5%), Generalized Anxiety Disorder (4%), Mixed Anxiety Depression (3%), Dysthymia (3%), Panic Disorder (3%), Bor-derline Personality Disorder (3%), Substance-Induced Mood Disorder (3%), Hypomania (2%), Adjustment Disorder (2%), Obsessive-Compulsive Disorder (1%), Substance-Induced Psychotic Dis-order (2%), Social Anxiety Disorder (1%), Somato-form Disorder (1%), Mania (1%), and Schizophre-nia (1%). Mannes et al. (2021) [16] stated several functional, psychiatric, and alcohol related validators are linked to higher probabilities of severe ADS than mild or moderate ADS and the results of present study also shows more cases of psychiatric comorbidity in severe alcohol dependence. Ummels et al. (2022) [17] stated that anxiety disorders (AD) are more likely to develop in people with alcohol use disorders, and vice versa. And the correlation between alcohol use disorders and AD prediction is unaffected by clinical, smoking, or socio-demographic characteristics. According to Puddephatt et al. (2022) [18] individuals who suffer from common mental diseases, such as anxiety, phobia, or depression, are twice as likely to report having an alcohol use disorder compared to those who do not. A number of comorbidities have been found to be at risk for developing and getting worse when major depressive disorder is present [19]. There are several causal routes that link alcohol use disorder to other mental health conditions. A number of theories are put forth to explain these relationships: common genetic and environmental origins, reciprocal direct causal linkages, and shared psychopathological traits of larger diagnostic entities [20]. Because the association between alcohol and mental health is more complicated, therapy for co-occurring mental health and alcohol disorders should be offered simultaneously access to both services [18]. In the present cross-sectional study on psychiatric comorbidity and severity of alcohol dependence, patients were reassessed two weeks after detoxification to accurately evaluate psychiatric disorders and reduce diagnostic confounding. This approach highlights the clinical importance of integrated management strategies that simultaneously identify and treat cooccurring psychiatric conditions and alcohol dependence, thereby contributing to improved patient outcomes.

Alcohol dependence commonly coexists with psychiatric illnesses, especially depressive and anxiety disorders. Early identification and integrated treatment approaches are necessary for improving patient outcomes and reducing relapse rates. It was concluded from the study that psychiatric disorders are associated with gender, history of psychiatric illness, and family history of psychiatric illness among AUD patients. Psychiatriac comorbidity also show an association with higher levels of dependence severity in patients with AUD. These results suggest that comorbid psychiatric conditions may make alcohol dependence more severe. It is recommended that future studies employ longitudinal designs to examine the directionality and causal connections between the severity of alcohol dependency and mental problems. In particular, prospective research might assess if mental health conditions can be detected and managed early to reduce the likelihood or intensity of AUD in the future.

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