The relationship between anxiety disorders and alcohol use disorders: A review of major perspectives and findings
Section snippets
Defining comorbidity
There exists no consensus as to the optimal way to operationalize comorbidity. The simplest and most often used approach counts as comorbid those cases in which both substance use and anxiety symptoms have been deemed clinically significant (typically defined as meeting criteria from the Diagnostic and Statistical Manual of Mental Disorders) at some time (but not necessarily at the same time) over the life of the individual (e.g., Kessler et al. 1997, Regier et al. 1990).
This broad definitional
Anxiety disorder promotes alcoholism
One causal explanation for the etiology of comorbidity is that anxiety disorder (or anxiety symptoms per se) serves to promote directly the pathological use of alcohol or drugs. The primary hypothesis fitting within this general view, sometimes referred to as the “self-medication hypothesis” (e.g., Quitkin, Rifkin, Kaplan, & Klein, 1972), suggests that the pharmacological and/or psychological effects of alcohol and some drugs serve to decrease aversive anxiety symptoms, thereby promoting
Laboratory Studies
As noted above, the idea that some aspect of one disorder serves to promote the onset of a second disorder is a conspicuous possibility when considering the etiology of comorbidity. In fact, high percentages of comorbid patients report that anxiety symptoms cue alcohol use aimed at relief from those symptoms (e.g., Bibb & Chambless 1986, Chambless, Cherney, Caputo, & Rheinstein 1987, Cox, Norton, Dorward, & Fergusson 1989: Quitkin et al. 1972, Smail, Stockwell, Canter, & Hodgson 1984).
Clinical Studies
Clinical studies can provide information relevant to etiological processes in comorbidity. For example, if anxiety disorder promotes pathological alcohol use then active anxiety symptoms should increase risk for relapse following alcoholism treatment. Alternatively, if pathological alcohol use promotes anxiety symptoms then successful alcoholism treatment should reduce or eliminate anxiety symptoms. Below we selectively review clinical studies of comorbidity that help to address these and
Primary Conclusions
Perhaps the strongest conclusion that can be drawn from this review is that anxiety disorder and alcohol use disorder each appear to have the capacity to serve as a causal stimulus in the development of the other. Providing strong support for this conclusion, prospective studies show that having either an anxiety disorder alone or an alcohol use disorder alone predicts the later development of the other (e.g., Kushner et al., 1999). Patterns of familial transmission—that is, increased
Conclusion
Comorbidity constitutes one of the most perplexing problems faced by taxonomists, epidemiologists, and psychopathologists today. The main goal of this article was to identify seemingly competing views on the etiology of comorbidity and to review literature bearing on the validity of each. Major conclusions are that either an anxiety disorder or alcohol dependence can serve as a causal stimulus for the other and that anxiety disorder can contribute to the persistence of pathological alcohol use
Acknowledgements
This research was supported, in part, by National Institute on Alcohol Abuse and Alcholism grant no. R29-AA09871 to the first author.
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