Skip to main content
Top
Published in: Current Psychiatry Reports 3/2012

01-06-2012 | ANXIETY DISORDERS (DJ STEIN, SECTION EDITOR)

Exploring the Comorbidity of Anxiety and Substance Use Disorders

Author: Sonja Pasche

Published in: Current Psychiatry Reports | Issue 3/2012

Login to get access

Abstract

Anxiety disorders and substance use disorders are highly comorbid, and such comorbidity complicates treatment and worsens prognosis. The mechanisms underlying the relationship between anxiety and substance use disorders are poorly understood. This paper reviews recent research attempting to explain these associations. Cognitive factors, such as attentional bias, expectancies, and anxiety sensitivity, appear to impact on the relation between anxiety and substance misuse. Temporality of the anxiety and substance use disorder may also indicate whether the substance use disorder is primary (anxiety may be a result of use) or secondary (substances may be used to self-medicate). Social phobia has been predominantly identified as a primary disorder preceding substance use, while the temporality of other anxiety and substance use disorders is less clear. The efficacy of concurrent treatment compared with separate treatment of either anxiety or substance use disorder is unclear and requires further research.
Literature
1.
go back to reference Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61:807–16.PubMedCrossRef Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61:807–16.PubMedCrossRef
2.
go back to reference Martins SS, Gorelick DA. Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. population. Drug Alcohol Depend. 2011;119:28–36.PubMedCrossRef Martins SS, Gorelick DA. Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. population. Drug Alcohol Depend. 2011;119:28–36.PubMedCrossRef
3.
go back to reference • Marmorstein NR. Anxiety disorders and substance use disorders: different associations by anxiety disorder. J Anxiety Disord. 2012, In press. This study examined the associations between various ADs and SUDs, as well as the temporality of these disorders among a large sample of US civilians. • Marmorstein NR. Anxiety disorders and substance use disorders: different associations by anxiety disorder. J Anxiety Disord. 2012, In press. This study examined the associations between various ADs and SUDs, as well as the temporality of these disorders among a large sample of US civilians.
4.
go back to reference Fatseas M, Denis C, Lavie E, Auriacombe M. Relationship between anxiety disorders and opiate dependence—a systematic review of the literature: Implications for diagnosis and treatment. J Subst Abuse Treat. 2010;38:220–30.PubMedCrossRef Fatseas M, Denis C, Lavie E, Auriacombe M. Relationship between anxiety disorders and opiate dependence—a systematic review of the literature: Implications for diagnosis and treatment. J Subst Abuse Treat. 2010;38:220–30.PubMedCrossRef
5.
go back to reference Tepe E, Dalrymple K, Zimmerman M. The impact of comorbid cannabis use disorders on the clinical presentation of social anxiety disorder. J Psychiatr Res. 2012;46:50–6.PubMedCrossRef Tepe E, Dalrymple K, Zimmerman M. The impact of comorbid cannabis use disorders on the clinical presentation of social anxiety disorder. J Psychiatr Res. 2012;46:50–6.PubMedCrossRef
6.
go back to reference Boschloo L, Vogelzangs N, Smit JH, et al. Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders. Findings from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord. 2011;131:233–42.PubMedCrossRef Boschloo L, Vogelzangs N, Smit JH, et al. Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders. Findings from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord. 2011;131:233–42.PubMedCrossRef
7.
go back to reference Myrick H, Brady K. Current review of the comorbidity of affective, anxiety, and substance use disorders. Curr Opin Psychiatry. 2003;16(3):261–70. Myrick H, Brady K. Current review of the comorbidity of affective, anxiety, and substance use disorders. Curr Opin Psychiatry. 2003;16(3):261–70.
8.
go back to reference Gentil AF, de Mathis MA, Torresan RC, et al. Alcohol use disorders in patients with obsessive-compulsive disorder: the importance of appropriate dual-diagnosis. Drug Alcohol Depend. 2009;100:173–7.PubMedCrossRef Gentil AF, de Mathis MA, Torresan RC, et al. Alcohol use disorders in patients with obsessive-compulsive disorder: the importance of appropriate dual-diagnosis. Drug Alcohol Depend. 2009;100:173–7.PubMedCrossRef
9.
go back to reference Wolitzky-Taylor K, Operskalski JT, Ries R, et al. Understanding and treating comorbid anxiety disorders in substance users: review and future directions. J Addict Med. 2011;5:233–47.PubMedCrossRef Wolitzky-Taylor K, Operskalski JT, Ries R, et al. Understanding and treating comorbid anxiety disorders in substance users: review and future directions. J Addict Med. 2011;5:233–47.PubMedCrossRef
10.
go back to reference Bacon AK, Ham LS. Attention to social threat as a vulnerability to the development of comorbid social anxiety disorder and alcohol use disorder: an avoidance-coping cognitive model. Addict Behav. 2010;35:925–39.PubMedCrossRef Bacon AK, Ham LS. Attention to social threat as a vulnerability to the development of comorbid social anxiety disorder and alcohol use disorder: an avoidance-coping cognitive model. Addict Behav. 2010;35:925–39.PubMedCrossRef
11.
go back to reference Conger JJ. Alcoholism: theory, problem, and challenge: II. Reinforcement theory and the dynamics of alcoholism. Q J Stud Alcohol. 1956;17:296–305.PubMed Conger JJ. Alcoholism: theory, problem, and challenge: II. Reinforcement theory and the dynamics of alcoholism. Q J Stud Alcohol. 1956;17:296–305.PubMed
12.
go back to reference Sher K, Levenson R. Risk for alcoholism and individual differences in the stress-response-dampening effect of alcohol. J Abnorm Psychol. 1982;91:350–67.PubMedCrossRef Sher K, Levenson R. Risk for alcoholism and individual differences in the stress-response-dampening effect of alcohol. J Abnorm Psychol. 1982;91:350–67.PubMedCrossRef
13.
go back to reference Khantzian E. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. Am J Psychiatry. 1985;142:1259–64.PubMed Khantzian E. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. Am J Psychiatry. 1985;142:1259–64.PubMed
14.
go back to reference Morris EP, Stewart SH, Ham LS. The relationship between social anxiety disorder and alcohol use disorders: a critical review. Clin Psychol Rev. 2005;25:734–60.PubMedCrossRef Morris EP, Stewart SH, Ham LS. The relationship between social anxiety disorder and alcohol use disorders: a critical review. Clin Psychol Rev. 2005;25:734–60.PubMedCrossRef
15.
go back to reference Buckner JD, Proctor SL, Reynolds E, et al. Cocaine dependence and anxiety sensitivity among patients presenting for residential drug use treatment. J Cogn Psychotherapy: An International Quarterly. 2011;25:22–30.CrossRef Buckner JD, Proctor SL, Reynolds E, et al. Cocaine dependence and anxiety sensitivity among patients presenting for residential drug use treatment. J Cogn Psychotherapy: An International Quarterly. 2011;25:22–30.CrossRef
16.
go back to reference Buckner JD, Schmidt NB, Lang AR, et al. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res. 2008;42:230–9.PubMedCrossRef Buckner JD, Schmidt NB, Lang AR, et al. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res. 2008;42:230–9.PubMedCrossRef
17.
go back to reference Buckner JD, Turner RJ. Social anxiety disorder as a risk factor for alcohol use disorders: a prospective examination of parental and peer influences. Drug Alcohol Depend. 2009;100:128–37.PubMedCrossRef Buckner JD, Turner RJ. Social anxiety disorder as a risk factor for alcohol use disorders: a prospective examination of parental and peer influences. Drug Alcohol Depend. 2009;100:128–37.PubMedCrossRef
18.
go back to reference Fröjd S, Ranta K, Kaltiala-Heino R, Marttunen M. Associations of social phobia and general anxiety with alcohol and drug use in a community sample of adolescents. Alcohol Alcohol. 2011;46:192–9.PubMed Fröjd S, Ranta K, Kaltiala-Heino R, Marttunen M. Associations of social phobia and general anxiety with alcohol and drug use in a community sample of adolescents. Alcohol Alcohol. 2011;46:192–9.PubMed
19.
go back to reference Mancebo MC, Grant JE, Pinto A. Substance use disorders in an obsessive compulsive disorder clinical sample. J Anxiety Disord. 2009;23:429–35.PubMedCrossRef Mancebo MC, Grant JE, Pinto A. Substance use disorders in an obsessive compulsive disorder clinical sample. J Anxiety Disord. 2009;23:429–35.PubMedCrossRef
20.
go back to reference DeMartini KS, Carey KB. The role of anxiety sensitivity and drinking motives in predicting alcohol use: a critical review. Clin Psychol Rev. 2011;31:169–77.PubMedCrossRef DeMartini KS, Carey KB. The role of anxiety sensitivity and drinking motives in predicting alcohol use: a critical review. Clin Psychol Rev. 2011;31:169–77.PubMedCrossRef
21.
go back to reference Brady KT, Verduin ML. Pharmacotherapy of comorbid mood, anxiety, and substance use disorders. Subst Use Misuse. 2005;40:2021–41.PubMedCrossRef Brady KT, Verduin ML. Pharmacotherapy of comorbid mood, anxiety, and substance use disorders. Subst Use Misuse. 2005;40:2021–41.PubMedCrossRef
22.
go back to reference Kirby LG, Zeeb FD, Winstanley CA. Contributions of serotonin in addiction vulnerability. Neuropharmacology. 2011;61:421–32.PubMedCrossRef Kirby LG, Zeeb FD, Winstanley CA. Contributions of serotonin in addiction vulnerability. Neuropharmacology. 2011;61:421–32.PubMedCrossRef
23.
go back to reference Myrick H, Wright T. Comorbid anxiety and substance use disorders: diagnostic and treatment considerations. J Dual Diagn. 2005;1:9–26.CrossRef Myrick H, Wright T. Comorbid anxiety and substance use disorders: diagnostic and treatment considerations. J Dual Diagn. 2005;1:9–26.CrossRef
24.
go back to reference Carrigan MH, Randall CL. Self-medication in social phobia. A review of the alcohol literature. Addict Behav. 2003;28:269–84.PubMedCrossRef Carrigan MH, Randall CL. Self-medication in social phobia. A review of the alcohol literature. Addict Behav. 2003;28:269–84.PubMedCrossRef
25.
go back to reference Ham LS, Zamboanga BL, Bacon AK. Putting thoughts into context: alcohol expectancies, social anxiety, and hazardous drinking. J Cogn Psychotherapy: An International Quarterly. 2011;25:47–60.CrossRef Ham LS, Zamboanga BL, Bacon AK. Putting thoughts into context: alcohol expectancies, social anxiety, and hazardous drinking. J Cogn Psychotherapy: An International Quarterly. 2011;25:47–60.CrossRef
26.
go back to reference Goldsmith AA, Thompson RD, Black JJ, et al. Drinking refusal self-efficacy and tension-reduction alcohol expectancies moderating the relationship between generalised anxiety and drinking behaviors in young adult drinkers. Psychol Addict Behav. 2012, In press. Goldsmith AA, Thompson RD, Black JJ, et al. Drinking refusal self-efficacy and tension-reduction alcohol expectancies moderating the relationship between generalised anxiety and drinking behaviors in young adult drinkers. Psychol Addict Behav. 2012, In press.
27.
go back to reference Douglas KR, Chan G, Gelernter J, et al. Adverse childhood events as risk factors for substance dependence: partial mediation by mood and anxiety disorders. Addict Behav. 2010;35:7–13.PubMedCrossRef Douglas KR, Chan G, Gelernter J, et al. Adverse childhood events as risk factors for substance dependence: partial mediation by mood and anxiety disorders. Addict Behav. 2010;35:7–13.PubMedCrossRef
28.
go back to reference Crippa JA, Zuardi AW, Martin-Santos R, et al. Cannabis and anxiety: a critical review of the evidence. Hum Psychopharmacol. 2009;24:515–23.PubMedCrossRef Crippa JA, Zuardi AW, Martin-Santos R, et al. Cannabis and anxiety: a critical review of the evidence. Hum Psychopharmacol. 2009;24:515–23.PubMedCrossRef
29.
go back to reference • Baker AL, Thornton LK, Hiles S, et al. Psychological interventions for alcohol misuse among people with co-occurring depression or anxiety disorders: a systematic review. J Affect Disord. 2012, In press. A systematic review of randomized controlled trials examines the evidence for psychological interventions for alcohol misuse among people with co-occurring depression or ADs. • Baker AL, Thornton LK, Hiles S, et al. Psychological interventions for alcohol misuse among people with co-occurring depression or anxiety disorders: a systematic review. J Affect Disord. 2012, In press. A systematic review of randomized controlled trials examines the evidence for psychological interventions for alcohol misuse among people with co-occurring depression or ADs.
30.
go back to reference • Hesse M. Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literature. BMC Psychiatry. 2009;9:6. A systematic review is provided regarding the evidence for integrated psychological treatment for ADs and SUDs versus standalone treatment.PubMedCrossRef • Hesse M. Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literature. BMC Psychiatry. 2009;9:6. A systematic review is provided regarding the evidence for integrated psychological treatment for ADs and SUDs versus standalone treatment.PubMedCrossRef
31.
go back to reference • Hobbs JDJ, Kushner MG, Lee SS, et al. Meta-analysis of supplemental treatment for depressive and anxiety disorders in patients being treated for alcohol dependence. Am J Addict. 2011;20:319–29. This meta-analysis synthesizes randomized controlled trials to examine the impact of supplementing treatment for alcohol use disorders with psychiatric treatment for co-occurring ADs and depressive disorders.PubMedCrossRef • Hobbs JDJ, Kushner MG, Lee SS, et al. Meta-analysis of supplemental treatment for depressive and anxiety disorders in patients being treated for alcohol dependence. Am J Addict. 2011;20:319–29. This meta-analysis synthesizes randomized controlled trials to examine the impact of supplementing treatment for alcohol use disorders with psychiatric treatment for co-occurring ADs and depressive disorders.PubMedCrossRef
32.
go back to reference Randall C, Thomas S, Thevos A. Concurrent alcoholism and social anxiety disorder: a first step toward developing effective treatments. Alcohol Clin Exp Res. 2001;25:210–20.PubMedCrossRef Randall C, Thomas S, Thevos A. Concurrent alcoholism and social anxiety disorder: a first step toward developing effective treatments. Alcohol Clin Exp Res. 2001;25:210–20.PubMedCrossRef
33.
go back to reference Puleo CM, Conner BT, Benjamin CL, Kendall PC. CBT for childhood anxiety and substance use at 7.4-year follow-up: a reassessment controlling for known predictors. J Anxiety Disord. 2011;25:690–6.PubMedCrossRef Puleo CM, Conner BT, Benjamin CL, Kendall PC. CBT for childhood anxiety and substance use at 7.4-year follow-up: a reassessment controlling for known predictors. J Anxiety Disord. 2011;25:690–6.PubMedCrossRef
34.
go back to reference Hall W, Degenhardt L, Teesson M. Reprint of “Understanding comorbidity between substance use, anxiety and affective disorders: Broadening the research base”. Addict Behav. 2009;34:795–9.PubMedCrossRef Hall W, Degenhardt L, Teesson M. Reprint of “Understanding comorbidity between substance use, anxiety and affective disorders: Broadening the research base”. Addict Behav. 2009;34:795–9.PubMedCrossRef
35.
go back to reference Hassan I, Ali R. The association between somatic symptoms, anxiety disorders and substance use. A literature review. Psychiatr Q. 2011;82:315–28.PubMedCrossRef Hassan I, Ali R. The association between somatic symptoms, anxiety disorders and substance use. A literature review. Psychiatr Q. 2011;82:315–28.PubMedCrossRef
Metadata
Title
Exploring the Comorbidity of Anxiety and Substance Use Disorders
Author
Sonja Pasche
Publication date
01-06-2012
Publisher
Current Science Inc.
Published in
Current Psychiatry Reports / Issue 3/2012
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-012-0264-0

Other articles of this Issue 3/2012

Current Psychiatry Reports 3/2012 Go to the issue

SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS (SJ SIEGEL, SECTION EDITOR)

Family Interventions in Schizophrenia: Promise and Pitfalls over 30 Years

SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS (SJ SIEGEL, SECTION EDITOR)

Functional Outcomes in Schizophrenia: Employment Status as a Metric of Treatment Outcome

ANXIETY DISORDERS (DJ STEIN, SECTION EDITOR)

Advances in Psychotherapy for Generalized Anxiety Disorder

SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS (SJ SIEGEL, SECTION EDITOR)

Is Rational Antipsychotic Polytherapy Feasible? A Selective Review