Relapse vulnerability across lesch alcoholism typology: a systematic review and network meta-analysis.

BACKGROUND: Alcohol Use Disorder (AUD) is an emerging concern with heterogeneous symptomatology. Lesch Alcoholism Typology categorizes AUD into four subtypes, namely, AUD with positive family history, AUD with comorbid depression, AUD with comorbid anxiety and AUD with traumatic brain injury. Evidence on subtype-specific risk of return to use remains limited. This study systematically reviews and compares the risk of return to use across Lesch subtypes using network meta-analysis. METHODS: Six electronic databases were searched, and 23 studies were included. Risk of bias was assessed using the "Joanna Briggs Critical Appraisal checklist". RESULTS: Individuals with AUD and comorbid anxiety (OR = 1.71, 95% CI: 1.22-2.39), comorbid depression (OR = 1.57, 95% CI: 1.25-1.98), and positive family history (OR = 1.67, 95% CI: 1.08-2.57) had higher odds of the risk of return to use compared with AUD with no significant comorbidity. Risk of return to use did not differ significantly in individuals with AUD having a history of brain injury (OR = 1.11, 95% CI: 0.68-1.84). Individuals with AUD and comorbid anxiety showed the highest risk of return to use, followed by individuals with AUD who had a positive family history and those with comorbid depression. Substantial heterogeneity was observed across studies (I2 = 79.7%). Subgroup analyses identified significant variation between clinical and community studies for individuals with AUD having premorbid brain injury (Q = 4.35, p < 0.05). CONCLUSION: Individuals with AUD and comorbid anxiety, depression or positive family history are associated with a significantly higher risk of return to use. The present study emphasizes the need for subtype-specific treatment approaches to improve outcomes.