Anxiety Disorder and Substance Use Disorder Co-Morbidity: Common Themes and Future Directions

  • Sherry H. Stewart
  • Patricia J. Conrod
Part of the Series in Anxiety and Related Disorders book series (SARD)


Anxiety Disorder Generalize Anxiety Disorder Social Phobia Social Anxiety Disorder Panic Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed. – DSM-IV). Washington, DC: American Psychiatric Association.Google Scholar
  2. Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford.Google Scholar
  3. Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230.CrossRefGoogle Scholar
  4. Barlow, D. H., & Craske, M. G. (2000). Mastery of your anxiety and panic: Client workbook for anxiety and panic (3rd ed.). New York: Graywind Publications, Oxford University Press.Google Scholar
  5. Barrowclough, C., Haddock, G., Tarrier, N., Lewis, S. W., Moring, J., O’Brien, R., et al. (2001). Randomized controlled trial of cognitive behavioral therapy plus motivational intervention for schizophrenia and substance use. American Journal of Psychiatry, 158, 1706–1713.PubMedCrossRefGoogle Scholar
  6. Bolton, J., Cox, B. J., Clara, I., & Sareen, J. (2006). Use of alcohol and drugs to self-medicate anxiety disorders in a nationally representative sample. Journal of Nervous and Mental Disease, 194, 818–825.PubMedCrossRefGoogle Scholar
  7. Bowen, R. C., D’Arcy, C., Keegan, D., & Senthilselvan, A. (2000). A controlled trial of cognitive behavioral treatment of panic in alcohol inpatients with co-morbid panic disorder. Addictive Behaviors, 25, 593–597.PubMedCrossRefGoogle Scholar
  8. Brady, K. T., Dansky, B. S., Back, S. E., Foa, E. B., & Carroll, K. M. (2001). Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: Preliminary findings. Journal of Substance Abuse Treatment, 21, 47–54.PubMedCrossRefGoogle Scholar
  9. Brown, P. J., Stout, R. L., & Gannon-Rowley, J. (1998). Substance use disorder – PTSD co-morbidity: Patients’ perceptions of symptom interplay and treatment issues. Journal of Substance Abuse Treatment, 15, 445–448.PubMedCrossRefGoogle Scholar
  10. Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., et al. (2005). Influence of psychiatric co-morbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. American Journal of Psychiatry, 162, 1179–1187.PubMedCrossRefGoogle Scholar
  11. Burke, R. S., & Stephens, R. S. (1997). Effect of anxious affect on drinking self-efficacy in college students. Psychology of Addictive Behaviors, 11, 65–75.CrossRefGoogle Scholar
  12. Castellanos, N., & Conrod, P. (2006). Brief interventions targeting personality risk factors for adolescent substance misuse reduce depression, panic and risk-taking behaviors. Journal of Mental Health, 15, 645–658.CrossRefGoogle Scholar
  13. Chilcoat, H. D., & Breslau, N. (1998). Investigations of causal pathways between PTSD and drug use disorders. Addictive Behaviors, 23, 827–840.PubMedCrossRefGoogle Scholar
  14. Conrod, P. J., & Stewart, S. H. (2005). A critical look at dual focused cognitive-behavioral treatment for co-morbid substance abuse and psychiatric disorders: Strengths, limitations and future directions. Journal of Cognitive Psychotherapy, 19, 265–289.Google Scholar
  15. Conrod, P. J., Stewart, S. H., Comeau, M. N., & Maclean, M. (2006). Efficacy of cognitive behavioral interventions targeting personality risk factors for youth alcohol misuse. Journal of Clinical Child and Adolescent Psychology, 35, 550–563.PubMedCrossRefGoogle Scholar
  16. Conrod, P. J., Stewart, S. H., Pihl, R. O., Côté, S., Fontaine, V., & Dongier, M. (2000). Efficacy of brief coping skills interventions that match different personality profiles of female substance abusers. Psychology of Addictive Behaviors, 14, 231–242.PubMedCrossRefGoogle Scholar
  17. Driessen, M., Meier, S., Hill, A., Wetterling, T., Lange, W., & Junghanns, K. (2001). The course of anxiety, depression and drinking behaviors after completed detoxification in alcoholics with and without co-morbid anxiety and depressive disorders. Alcohol and Alcoholism, 36, 249–255.PubMedCrossRefGoogle Scholar
  18. Forbes, D., Creamer, M., Hawthorne, G., Allen, N., & McHugh, T. (2003). Comorbidity as a predictor of symptom change after treatment in combat-related posttraumatic stress disorder. Journal of Nervous and Mental Disease, 191, 93–99.PubMedCrossRefGoogle Scholar
  19. Gilles, D. M., Turk, C. L., & Fresco, D. M. (2006). Social anxiety, alcohol expectancies, and self-efficacy as predictors of heavy drinking in college students. Addictive Behaviors, 31, 388–398.PubMedCrossRefGoogle Scholar
  20. Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, P., Dufour, M. C., Compton, W., et al. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders. Archives of General Psychiatry, 61, 807–816.PubMedCrossRefGoogle Scholar
  21. Greeley, J., & Oei, T. (1999). Alcohol and tension reduction. In K. E. Leonard & H. T. Blane (Eds.), Psychological theories of drinking and alcoholism (2nd ed., pp. 14–53). New York: Guilford.Google Scholar
  22. Khantzian, E. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 1259–1264.PubMedGoogle Scholar
  23. Kranzler, H. R., Burleson, J. A., Del Boca, F. K., Babor, T. F., Korner, P., Brown, J., et al. (1994). Buspirone treatment of anxious alcoholics: A placebo-controlled trial. Archives of General Psychiatry, 51, 720–731.PubMedGoogle Scholar
  24. Kushner, M. G., Abrams, K., & Borchardt, C. (2000). The relationship between anxiety disorders and alcohol use disorders: A review of major perspectives and findings. Clinical Psychology Review, 20, 149–171.PubMedCrossRefGoogle Scholar
  25. Kushner, M. G., Abrams, K., Thuras, P., Hanson, K. L., Brekke, M., & Sletten, S. (2005). Follow-up study of anxiety disorder and alcohol dependence in comorbid alcoholism treatment patients. Alcoholism: Clinical and Experimental Research, 29, 1432–1443.CrossRefGoogle Scholar
  26. Kushner, M. G., Donahue, C., Sletten, S., Thuras, P., Abrams, K., Peterson, J., et al. (2006). Cognitive behavioral treatment of co-morbid anxiety disorder in alcoholism treatment patients: Presentation of a prototype program and future directions. Journal of Mental Health, 15, 697–707.CrossRefGoogle Scholar
  27. Kushner, M. G., Sher, K. J., & Beitman, B. D. (1990). The relation between alcohol problems and the anxiety disorders. American Journal of Psychiatry, 147, 685–695.PubMedGoogle Scholar
  28. MacDonald, A. B., Baker, J. M., Stewart, S. H., & Skinner, M. (2000). Effects of alcohol on the response to hyperventilation of participants high and low in anxiety sensitivity. Alcoholism: Clinical and Experimental Research, 24, 1656–1665.CrossRefGoogle Scholar
  29. Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). New York: Guilford.Google Scholar
  30. Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford.Google Scholar
  31. Marquenie, L. A., Schade, A., Van Balkom, A. J., Koeter, M., Frenken, S., Van Den Brink, W., et al. (2006). Comorbid phobic disorders do not influence outcome of alcohol dependence treatment: Results of a naturalistic follow-up study. Alcohol and Alcoholism, 41, 168–173.PubMedCrossRefGoogle Scholar
  32. Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press.Google Scholar
  33. Morris, E. P., Stewart, S. H., & Ham, L. S. (2005). The relationship between social anxiety disorder and alcohol use disorders: A critical review. Clinical Psychology Review, 25, 734–760.PubMedCrossRefGoogle Scholar
  34. Otto, M. W., Pollack, M. H., Sachs, G. S., Reiter, S. R., Meltzer-Brody, S., & Rosenbaum, J. F. (1993). Discontinuation of benzodiazepine treatment: Efficacy of cognitive-behavior therapy for patients with panic disorder. American Journal of Psychiatry, 150, 1485–1490.PubMedGoogle Scholar
  35. Prochaska, J. O., & DiClemente, C. C. (1992). The transtheoretical approach. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 300–334). New York: Basic Books.Google Scholar
  36. Randall, C. L., Johnson, M. R., Thevos, A. K., Sonne, S. C., Thomas, S. E., Willard, S. L., et al. (2001). Parotexine for social anxiety and alcohol use in dual diagnosed patients. Depression and Anxiety, 14, 255–262.PubMedCrossRefGoogle Scholar
  37. Randall, C. L., Thomas, S., & Thevos, A. K. (2001). Concurrent alcoholism and social anxiety disorder: A first step toward developing effective treatments. Alcoholism: Clinical and Experimental Research, 25, 210–220.CrossRefGoogle Scholar
  38. Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keither, S. J., Judd, L. L. O., et al. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. Journal of the American Medical Association, 264, 2511–2518.PubMedCrossRefGoogle Scholar
  39. Sabourin, B., & Stewart, S. H. (in press). Alcohol use and anxiety disorders. In M. J. Zvolensky & J. A. J. Smits (Eds.), Health behaviors and physical illness in anxiety and its disorders: Contemporary theory and research. New York: Springer.Google Scholar
  40. Schade, A., Marquenie, L. A., Balkom, A. J., Koeter, M. W. J., de Ceurs, E., Van Den Brink, W., et al. (2005). The effectiveness of anxiety treatment on alcohol-dependent patients with a co-morbid phobic disorder: A randomized controlled trial. Alcoholism: Clinical and Experimental Research, 29, 794–800.CrossRefGoogle Scholar
  41. Sher, K., & Levenson, R. (1982). Risk for alcoholism and individual differences in the stress-response-dampening effect of alcohol. Journal of Abnormal Psychology, 91, 350–367.PubMedCrossRefGoogle Scholar
  42. Stein, M. B., Jang, K. L., & Livesley, W. J. (1999). Heritability of anxiety sensitivity: A twin study. American Journal of Psychiatry, 156, 246–251.PubMedGoogle Scholar
  43. Stewart, S. H. (1996). Alcohol abuse in individuals exposed to trauma: A critical review. Psychological Bulletin, 120, 83–112.PubMedCrossRefGoogle Scholar
  44. Stewart, S. H., & Kushner, M. G. (2001). Introduction to the special issue on anxiety sensitivity and addictive behaviors. Addictive Behaviors, 26, 775–785.PubMedCrossRefGoogle Scholar
  45. Stewart, S. H., Morris, E. P., Mellings, T., & Komar, J. A. (2006). Relations of social anxiety variables to drinking motives, drinking quantity and frequency, and alcohol-related problems in undergraduates. Journal of Mental Health, 15, 671–682.CrossRefGoogle Scholar
  46. Stewart, S. H., Samoluk, S. B., & MacDonald, A. B. (1999). Anxiety sensitivity and substance use and abuse. In S. Taylor (Ed.), Anxiety sensitivity: Theory, research and treatment of the fear of anxiety (pp. 287–319). Mahwah, NJ: Erlbaum.Google Scholar
  47. Tambs, K., Harris, J. R., & Magnus, P. (1997). Genetic and environmental contributions to the correlation between alcohol consumption and symptoms of anxiety and depression: Results from a bivariate analysis of Norwegian twin data. Behavior Genetics, 27, 241–249.PubMedCrossRefGoogle Scholar
  48. Tollefson, G. D., Montague-Clouse, J., & Tollefson, S. L. (1992). Treatment of comorbid generalized anxiety in a recently detoxified alcoholic population with a selective serotonergic drug (buspirone). Journal of Clinical Psychopharmacology, 12, 19–26.PubMedCrossRefGoogle Scholar
  49. Watkins, K. E., Hunter, S. B., Burnam, M. A., Pincus, H. A., & Nicholson, G. (2005). Review of treatment recommendations for persons with a co-occurring affective or anxiety and substance use disorder. Psychiatric Services, 56, 913–926.PubMedCrossRefGoogle Scholar
  50. Watt, M. C., Stewart, S. H., Birch, C. D., & Bernier, D. (2006). Brief CBT for high anxiety sensitivity decreases drinking problems, relief alcohol outcome expectancies, and conformity drinking motives: Evidence from a randomized controlled trial. Journal of Mental Health, 15, 683–695.CrossRefGoogle Scholar
  51. Westra, H. A., Dozois, D. J., & Marcus, M. (2007). Expectancy, homework compliance, and initial change in cognitive-behavioral therapy for anxiety. Journal of Consulting and Clinical Psychology, 75, 363–373.PubMedCrossRefGoogle Scholar
  52. Westra, H. A., Stewart, S. H., & Conrad, B. E. (2002). Naturalistic manner of benzodiazepine use and cognitive behavioral therapy outcome in panic disorder with agoraphobia. Journal of Anxiety Disorders, 16, 233–246.PubMedCrossRefGoogle Scholar
  53. Willinger, U., Lenzinger, E., Hornik, K., Fischer, G., Schonbeck, G., Aschauer, H. N., et al. (2002). Anxiety as a predictor of relapse in detoxified alcohol-dependent patients. Alcohol and Alcoholism, 37, 609–612.PubMedCrossRefGoogle Scholar
  54. Zahradnik, M. & Stewart, S. H. (in press). Anxiety disorders and substance use disorder co-morbidity: Epidemiology, theories of interrelation, and recent treatment approaches. In M. Antony & M. Stein (Eds.), Handbook of anxiety and the anxiety disorders. Oxford, UK: Oxford University Press.Google Scholar
  55. Zvolensky, M. J., Schmidt, N. B., & Stewart, S. H. (2003). Panic disorder and smoking. Clinical Psychology: Science and Practice, 10, 29–51.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Sherry H. Stewart
    • 1
  • Patricia J. Conrod
  1. 1.Departments of Psychiatry and Psychology, Alcohol Research LaboratoryDalhousie University, Life Sciences CentreHalifaxCanada B3H 4J1

Personalised recommendations