Alcohol use disorder exacerbates clinical and vascular risks differentially in psychiatric disorders

Alcohol Use Disorder (AUD) is a major public health concern with detrimental effects on cognitive and neurological function, yet its impact on psychiatric populations remains incompletely defined. In this global propensity score–matched cohort study, we examined the clinical and vascular consequences of comorbid alcohol abuse across diverse psychiatric disorders. Data from the TriNetX network, encompassing electronic medical records from 143 healthcare organizations, were analyzed. For each disorder—anxiety, depression, bipolar disorder, schizophrenia, reaction to severe stress, eating disorders, personality disorders, psychoactive substance dependence, developmental disorders, and obsessive-compulsive disorder—patients with alcohol abuse were matched 1:1 to those without, controlling for demographic and clinical factors. Over a 1095-day follow-up, outcomes evaluated included emergency department visits, pain prevalence, mortality, and cerebrovascular events (transient ischemic attacks and strokes). Alcohol abuse was consistently associated with significantly higher emergency care utilization, increased somatic pain, and elevated mortality across all groups. For instance, anxiety and depression cohorts exhibited 8.1% and 7.3% higher emergency visits and increased mortality by 2.7% and 2.4%, respectively, while schizophrenia showed a twofold increase in stroke risk and markedly higher pain (risk ratio 2.21). These results underscore that AUD exacerbates clinical and vascular risks in psychiatric patients, highlighting the urgent need for targeted interventions.