Skip to main content
SpringerLink
Log in

Comorbid Anxiety and Substance Use Disorders

  • Chapter
  • First Online:
Drug Abuse and Addiction in Medical Illness

  • 4605 Accesses

Abstract

The relationship between symptoms of anxiety, anxiety disorders and substance use, abuse and dependence is complex. Converging evidence from epidemiologic studies as well as studies of treatment-seeking individuals indicates that anxiety disorders, symptoms of anxiety, and substance use disorders (SUDs) commonly co-occur, and the interaction is not unidirectional, but multifaceted and variable. Anxiety symptoms often emerge during the course of chronic intoxication and withdrawal. Anxiety disorders may be a risk factor for the development of SUDs. Anxiety disorders modify the presentation and treatment outcome for SUDs. Substance use, abuse and SUDs modify the presentation and treatment outcome for anxiety disorders. In this chapter, recent findings on co-occurring SUDs and anxiety disorders will be reviewed including prevalence, diagnostic, and treatment issues.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997;54(4):313–21.

    Article  PubMed  CAS  Google Scholar 

  2. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8–19.

    Article  PubMed  CAS  Google Scholar 

  3. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study [see comments]. JAMA. 1990;264(19):2511–8.

    Article  PubMed  CAS  Google Scholar 

  4. Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, 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(8):807–16.

    Article  PubMed  Google Scholar 

  5. Conway KP, Compton W, Stinson FS, Grant BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006;67(2):247–57.

    Article  PubMed  CAS  Google Scholar 

  6. Bakken K, Landheim AS, Vaglum P. Axis I and II disorders as long-term predictors of mental distress: a six-year prospective ­follow-up of substance-dependent patients. BMC Psychiatry. 2007;7:29.

    Article  PubMed  Google Scholar 

  7. Aagaard J, Vestergaard P, Maarbjerg K. Adherence to lithium prophylaxis: II. Multivariate analysis of clinical, social, and psychosocial predictors of nonadherence. Pharmacopsychiatry. 1988;21(4):166–70.

    Article  PubMed  CAS  Google Scholar 

  8. Danion JM, Neunreuther C, Krieger-Finance F, Imbs JL, Singer L. Compliance with long-term lithium treatment in major affective disorders. Pharmacopsychiatry. 1987;20(5):230–1.

    Article  PubMed  CAS  Google Scholar 

  9. Keck Jr PE, McElroy SL, Strakowski SM, Stanton SP, Kizer DL, Balistreri TM, et al. Factors associated with pharmacologic noncompliance in patients with mania. J Clin Psychiatry. 1996;57(7):292–7.

    PubMed  CAS  Google Scholar 

  10. Petrakis IL, Poling J, Levinson C, Nich C, Carroll K, Rounsaville B. Naltrexone and disulfiram in patients with alcohol dependence and comorbid psychiatric disorders. Biol Psychiatry. 2005;57(10):1128–37.

    Article  PubMed  CAS  Google Scholar 

  11. Reed PL, Anthony JC, Breslau N. Incidence of drug problems in young adults exposed to trauma and posttraumatic stress disorder: do early life experiences and predispositions matter? Arch Gen Psychiatry. 2007;64(12):1435–42.

    Article  PubMed  Google Scholar 

  12. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048–60.

    Article  PubMed  CAS  Google Scholar 

  13. Cottler LB, Compton 3rd WM, Mager D, Spitznagel EL, Janca A. Posttraumatic stress disorder among substance users from the general population. Am J Psychiatry. 1992;149(5):664–70.

    PubMed  CAS  Google Scholar 

  14. Dansky BS, Brady KT, Roberts JT. Post-traumatic stress disorder and substance abuse: empirical findings and clinical issues. Subst Abuse. 1994;15(4):247–57.

    Google Scholar 

  15. Jacobsen LK, Southwick SM, Kosten TR. Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. Am J Psychiatry. 2001;158(8):1184–90.

    Article  PubMed  CAS  Google Scholar 

  16. Brady KT, Sonne S, Anton RF, Randall CL, Back SE, Simpson K. Sertraline in the treatment of co-occurring alcohol dependence and posttraumatic stress disorder. Alcohol Clin Exp Res. 2005;29(3):395–401.

    Article  PubMed  CAS  Google Scholar 

  17. Van Ameringen M, Mancini C, Pipe B, Bennett M. Antiepileptic drugs in the treatment of anxiety disorders: role in therapy. Drugs. 2004;64(19):2199–220.

    Article  PubMed  Google Scholar 

  18. Tucker P, Trautman RP, Wyatt DB, Thompson J, Wu SC, Capece JA, et al. Efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2007;68(2):201–6.

    Article  PubMed  CAS  Google Scholar 

  19. Johnson DR, Rosenheck R, Fontana A, Lubin H, Charney D, Southwick S. Outcome of intensive inpatient treatment for combat-related posttraumatic stress disorder. Am J Psychiatry. 1996;153(6):771–7.

    PubMed  CAS  Google Scholar 

  20. Zvolensky MJ, Bernstein A, Sachs-Ericsson N, Schmidt NB, Buckner JD, Bonn-Miller MO. Lifetime associations between cannabis, use, abuse, and dependence and panic attacks in a representative sample. J Psychiatr Res. 2006;40(6):477–86.

    Article  PubMed  Google Scholar 

  21. Bonn-Miller MO, Zvolensky MJ, Bernstein A. Marijuana use motives: concurrent relations to frequency of past 30-day use and anxiety sensitivity among young adult marijuana smokers. Addict Behav. 2007;32(1):49–62.

    Article  PubMed  Google Scholar 

  22. Bartzokis G, Lu PH, Turner J, Mintz J, Saunders CS. Adjunctive risperidone in the treatment of chronic combat-related posttraumatic stress disorder. Biol Psychiatry. 2005;57(5):474–9.

    Article  PubMed  CAS  Google Scholar 

  23. Reich DB, Winternitz S, Hennen J, Watts T, Stanculescu C. A preliminary study of risperidone in the treatment of posttraumatic stress disorder related to childhood abuse in women. J Clin Psychiatry. 2004;65(12):1601–6.

    Article  PubMed  CAS  Google Scholar 

  24. Kampman KM, Pettinati HM, Lynch KG, Whittingham T, Macfadden W, Dackis C, et al. A double-blind, placebo-controlled pilot trial of quetiapine for the treatment of Type A and Type B alcoholism. J Clin Psychopharmacol. 2007;27(4):344–51.

    Article  PubMed  CAS  Google Scholar 

  25. Najavits LM. Seeking safety: a treatment manual for PTSD and substance abuse. New York: Guilford; 2002.

    Google Scholar 

  26. Hien DA, Wells EA, Jiang H, Suarez-Morales L, Campbell AN, Cohen LR, et al. Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. J Consult Clin Psychol. 2009;77(4):607–19.

    Article  PubMed  Google Scholar 

  27. Triffleman E. Gender differences in a controlled pilot study of psychosocial treatments in substance dependent patients with post-traumatic stress disorder: design considerations and outcomes. Alcohol Treat Q. 2000;18(3):113–26.

    Article  Google Scholar 

  28. Brady KT, Dansky BS, Back SE, Foa EB, Carroll KM. Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: preliminary findings. J Subst Abuse Treat. 2001;21(1):47–54.

    Article  PubMed  CAS  Google Scholar 

  29. Mills KL, Teesson M, Back SE, Hopwood S, Brady KT. Integrated treatment for substance use and PTSD using exposure therapy: preliminary findings. Paper presented at the College on Problems of Drug Dependence, San Juan, Puerto Rico, 2008.

    Google Scholar 

  30. Donovan B, Padin-Rivera E, Kowaliw S. “Transcend”: initial outcomes from a posttraumatic stress disorder/substance abuse treatment program. J Trauma Stress. 2001;14(4):757–72.

    Article  PubMed  CAS  Google Scholar 

  31. Harris M. Trauma recovery and empowerment: a clinician’s guide for working with women in groups. New York: Free; 1998.

    Google Scholar 

  32. Grant BF, Hasin DS, Stinson FS, Dawson DA, Goldstein RB, Smith S, et al. The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006;67(3):363–74.

    Article  PubMed  Google Scholar 

  33. Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA. 1994;272(22):1741–8.

    Article  PubMed  CAS  Google Scholar 

  34. Cosci F, Schruers KR, Abrams K, Griez EJ. Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship. J Clin Psychiatry. 2007;68(6):874–80.

    Article  PubMed  Google Scholar 

  35. Schuckit MA, Tipp JE, Bucholz KK, Nurnberger Jr JI, Hesselbrock VM, Crowe RR, et al. The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls. Addiction. 1997;92(10):1289–304.

    Article  PubMed  CAS  Google Scholar 

  36. American Psychiatric Association. Practice guideline for the treatment of patients with panic disorder. Work Group on Panic Disorder. Am J Psychiatry. 1998;155:1–34.

    Google Scholar 

  37. Kushner MG, Abrams K, Thuras P, Hanson KL, Brekke M, Sletten S. Follow-up study of anxiety disorder and alcohol dependence in comorbid alcoholism treatment patients. Alcohol Clin Exp Res. 2005;29(8):1432–43.

    Article  PubMed  Google Scholar 

  38. Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry. 2004;61(11):1107–15.

    Article  PubMed  Google Scholar 

  39. Breslau N, Klein DF. Smoking and panic attacks: an epidemiologic investigation. Arch Gen Psychiatry. 1999;56(12):1141–7.

    Article  PubMed  CAS  Google Scholar 

  40. Morissette SB, Tull MT, Gulliver SB, Kamholz BW, Zimering RT. Anxiety, anxiety disorders, tobacco use, and nicotine: a critical review of interrelationships. Psychol Bull. 2007;133(2):245–72.

    Article  PubMed  Google Scholar 

  41. Amering M, Bankier B, Berger P, Griengl H, Windhaber J, Katschnig H. Panic disorder and cigarette smoking behavior. Compr Psychiatry. 1999;40(1):35–8.

    Article  PubMed  CAS  Google Scholar 

  42. Zvolensky MJ, Schmidt NB, McCreary BT. The impact of smoking on panic disorder: an initial investigation of a pathoplastic relationship. J Anxiety Disord. 2003;17(4):447–60.

    Article  PubMed  Google Scholar 

  43. Bowen RC, D’Arcy C, Keegan D, Senthilselvan A. A controlled trial of cognitive behavioral treatment of panic in alcoholic inpatients with comorbid panic disorder. Addict Behav. 2000;25(4):593–7.

    Article  PubMed  CAS  Google Scholar 

  44. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th text revision). Washington, DC: American Psychiatric Press; 2000.

    Book  Google Scholar 

  45. Grant BF, Hasin DS, Blanco C, Stinson FS, Chou SP, Goldstein RB, et al. The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2005;66(11):1351–61.

    Article  PubMed  Google Scholar 

  46. Sareen J, Chartier M, Kjernisted KD, Stein MB. Comorbidity of phobic disorders with alcoholism in a Canadian community sample. Can J Psychiatry. 2001;46(8):733–40.

    PubMed  CAS  Google Scholar 

  47. Schade A, Marquenie LA, van Balkom AJ, Koeter MW, de Beurs E, van den Brink W, et al. The effectiveness of anxiety treatment on alcohol-dependent patients with a comorbid phobic disorder: a randomized controlled trial. Alcohol Clin Exp Res. 2005;29(5):794–800.

    Article  PubMed  Google Scholar 

  48. Book SW, Thomas SE, Randall PK, Randall CL. Paroxetine reduces social anxiety in individuals with a co-occurring alcohol use disorder. J Anxiety Disord. 2008;22(2):310–8.

    Article  PubMed  Google Scholar 

  49. Randall CL, Johnson MR, Thevos AK, Sonne SC, Thomas SE, Willard SL, et al. Paroxetine for social anxiety and alcohol use in dual-diagnosed patients. Depress Anxiety. 2001;14(4):255–62.

    Article  PubMed  CAS  Google Scholar 

  50. Pande AC, Davidson JR, Jefferson JW, Janney CA, Katzelnick DJ, Weisler RH, et al. Treatment of social phobia with gabapentin: a placebo-controlled study. J Clin Psychopharmacol. 1999;19(4):341–8.

    Article  PubMed  CAS  Google Scholar 

  51. Malcolm R, Myrick H, Brady KT, Ballenger JC. Update on anticonvulsants for the treatment of alcohol withdrawal. Am J Addict. 2001;10(Suppl):16–23.

    PubMed  Google Scholar 

  52. Verduin ML, McKay S, Brady KT. Gabapentin in comorbid anxiety and substance use. Am J Addict. 2007;16(2):142–3.

    Article  PubMed  Google Scholar 

  53. Randall CL, Thomas S, Thevos AK. Concurrent alcoholism and social anxiety disorder: a first step toward developing effective treatments. Alcohol Clin Exp Res. 2001;25(2):210–20.

    Article  PubMed  CAS  Google Scholar 

  54. Terra MB, Barros HM, Stein AT, Figueira I, Athayde LD, Spanemberg L, et al. Does co-occurring social phobia interfere with alcoholism treatment adherence and relapse? J Subst Abuse Treat. 2006;31(4):403–9.

    Article  PubMed  Google Scholar 

  55. Wittchen HU, Zhao S, Kessler RC, Eaton WW. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(5):355–64.

    Article  PubMed  CAS  Google Scholar 

  56. Grant BF, Hasin DS, Stinson FS, Dawson DA, June Ruan W, Goldstein RB, et al. Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2005;35(12):1747–59.

    Article  PubMed  Google Scholar 

  57. Bolton JM, Sareen J. Lifetime mood, anxiety, and drug use disorders are common in the United States population. Evid Based Ment Health. 2006;9(4):113.

    Article  PubMed  Google Scholar 

  58. Sartor CE, Lynskey MT, Heath AC, Jacob T, True W. The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence. Addiction. 2007;102(2):216–25.

    Article  PubMed  Google Scholar 

  59. Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, et al. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162(6):1179–87.

    Article  PubMed  Google Scholar 

  60. Compton 3rd WM, Cottler LB, Jacobs JL, Ben-Abdallah A, Spitznagel EL. The role of psychiatric disorders in predicting drug dependence treatment outcomes. Am J Psychiatry. 2003;160(5):890–5.

    Article  PubMed  Google Scholar 

  61. McKeehan MB, Martin D. Assessment and treatment of anxiety disorders and co-morbid alcohol/other drug dependency. Alcohol Treat Q. 2002;20:45–59.

    Article  Google Scholar 

  62. Clinical practice guidelines: management of anxiety disorders. Can J Psychiatry. 2006;51.

    Google Scholar 

  63. Posternak MA, Mueller TI. Assessing the risks and benefits of benzodiazepines for anxiety disorders in patients with a history of substance abuse or dependence. Am J Addict. 2001;10(1):48–68.

    Article  PubMed  CAS  Google Scholar 

  64. Kranzler HR, Burleson JA, Del Boca FK, Babor TF, Korner P, Brown J, et al. Buspirone treatment of anxious alcoholics. A ­placebo-controlled trial. Arch Gen Psychiatry. 1994;51(9):720–31.

    Article  PubMed  CAS  Google Scholar 

  65. Malec E, Malec T, Gagne MA, Dongier M. Buspirone in the treatment of alcohol dependence: a placebo-controlled trial. Alcohol Clin Exp Res. 1996;20(2):307–12.

    Article  PubMed  CAS  Google Scholar 

  66. Malcolm R, Anton RF, Randall CL, Johnston A, Brady K, Thevos A. A placebo-controlled trial of buspirone in anxious inpatient alcoholics. Alcohol Clin Exp Res. 1992;16(6):1007–13.

    Article  PubMed  CAS  Google Scholar 

  67. Tollefson GD, Montague-Clouse J, Tollefson SL. Treatment of comorbid generalized anxiety in a recently detoxified alcoholic population with a selective serotonergic drug (buspirone). J Clin Psychopharmacol. 1992;12(1):19–26.

    Article  PubMed  CAS  Google Scholar 

  68. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27.

    Article  PubMed  Google Scholar 

  69. Sbrana A, Bizzarri JV, Rucci P, Gonnelli C, Doria MR, Spagnolli S, et al. The spectrum of substance use in mood and anxiety disorders. Compr Psychiatry. 2005;46(1):6–13.

    Article  PubMed  Google Scholar 

  70. Satel SL, McDougle CJ. Obsessions and compulsions associated with cocaine abuse. Am J Psychiatry. 1991;148(7):947.

    PubMed  CAS  Google Scholar 

  71. Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007;164(7 Suppl):5–53.

    PubMed  Google Scholar 

  72. Chatterjee CR, Ringold AL. A case report of reduction in alcohol craving and protection against alcohol withdrawal by gabapentin. J Clin Psychiatry. 1999;60(9):617.

    Article  PubMed  CAS  Google Scholar 

  73. DiFranza JR, Savageau JA, Rigotti NA, Ockene JK, McNeill AD, Coleman M, et al. Trait anxiety and nicotine dependence in adolescents: a report from the DANDY study. Addict Behav. 2004;29(5):911–9.

    Article  PubMed  Google Scholar 

  74. Zvolensky MJ, Lejuez CW, Kahler CW, Brown RA. Nonclinical panic attack history and smoking cessation: an initial examination. Addict Behav. 2004;29(4):825–30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 250861, Charleston, SC, 29425, USA

    Kathleen Brady M.D., Ph.D.

Authors
  1. Kathleen Brady M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathleen Brady M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Inst. Pharmaceutical Sciences, Department of Psychopharmacology, Utrecht University, Universiteitsweg 99, Utrecht, 3584CG, Netherlands

    Joris C. Verster

  2. Dept. Psychiatry, Medical University of South Carolina, President St. 67, Charleston, 29425, South Carolina, USA

    Kathleen Brady

  3. School of Medicine, Div. Alcoholism & Drug Abuse, New York University, First Ave. 550, New York, 10016, New York, USA

    Marc Galanter

  4. Institute of Psychiatry, King's College London, National Addiction Centre, Windsor Walk 4, London, SE5 8AF, United Kingdom

    Patricia Conrod

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Brady, K. (2012). Comorbid Anxiety and Substance Use Disorders. In: Verster, J., Brady, K., Galanter, M., Conrod, P. (eds) Drug Abuse and Addiction in Medical Illness. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3375-0_20

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-3375-0_20

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-3374-3

  • Online ISBN: 978-1-4614-3375-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation