Co-occurring psychiatric disorders are key determinants of disability in alcohol use disorder: a cross-sectional analysis in 157 recently detoxified patients.

BACKGROUND: Disability is a central outcome in alcohol use disorder (AUD), yet little is known about its determinants. METHODS: In the baseline data from the QUALIFACT multicenter prospective cohort study, which enrolled 157 recently detoxified patients with AUD between April 2021 and March 2024, Functional disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Clinical, psychiatric, and patient-reported variables were collected, including Diagnostic and Statistical Manual-5th edition (DSM-5) AUD criteria and the Alcohol Quality of Life Scale (AQoLS). To identify predictors of disability, we applied penalized linear regression with elastic net regularization, combined with nested cross-validation to ensure model robustness. RESULTS: Five predictors were consistently selected in predictive models: major depressive disorder (β = 4.97) and psychotic syndrome (β = 4.85) showed the strongest associations with higher disability scores followed by the AQoLS "Activities" dimension (β = 0.76), while anxiety disorder (β = 0.23) and antisocial personality disorder (β = 0.19) showed smaller but significant contributions. Notably, no markers of AUD severity such as DSM-5 criteria were retained as predictors. CONCLUSIONS: Disability in AUD appears to be driven primarily by psychiatric co-occurring psychiatric disorders and patient-perceived functional limitations, rather than by traditional markers of AUD severity. These findings suggest that WHODAS 2.0 captures dimensions of impairment not reflected in DSM-5 criteria and highlight the importance of integrated care approaches addressing co-occurring psychiatric disorders. Future studies should validate these findings in larger and more diverse AUD populations.