![]() ![]() 5 Indeed, patients with anxiety disorders who self-medicate were at increased risk for SUD however, patients who did not self-medicate were still at greater risk for SUD than those with no anxiety disorder. We found that only about 1 of 5 patients with an anxiety disorder reports ever having used alcohol explicitly for anxiety relief. Although it is clear that alcohol’s acute effects can include attenuation of stress and anxiety responding, there is little evidence that this effect alone accounts for the progression to alcohol and drug dependence among those with anxiety disorders. The view that individuals with anxiety disorders are at risk for SUDs because of escalating substance use aimed at “self-medication” is ubiquitous relative to its limited empirical support. For each class of drug that is endorsed, additional ASSIST questions are asked.ĭrinking to cope. 11 The patient is first asked about lifetime and previous 3-month substance use by class (eg, marijuana, pain medication, prescription stimulants, cocaine). The World Health Organization and the NIAAA have developed the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) to quantify drug-related risk and behavior of patients ( Table 4). This reflects the greater overall rate of alcohol-related disorders and suggests that clinicians are 2 to 3 times more likely to see alcohol dependence than drug dependence in their patients with anxiety disorders. ![]() ![]() Table 1 shows greater correlations between anxiety disorders and drug dependence the Figureshows greater absolute numbers for alcohol use disorder among patients with an anxiety disorder. The Figureshows the 12-month prevalence rates of alcohol and drug dependence in patients with anxiety disorders and in persons in the general population. Therefore, it is important to know the actual percentage of people with an anxiety disorder who also have an SUD. Odds ratios are base-rate neutral by design (ie, they are insensitive to the raw number of individuals classified). (Substance abuse-unlike dependence-does not appear to be strongly correlated with anxiety disorders.) The odds of alcohol dependence being diagnosed are 2 to 3 times greater among patients with an anxiety disorder these correlations are even greater for drug dependence. Table 1 summarizes the magnitude of these associations for current (ie, past 12 months) diagnoses expressed as odds ratios. Substance use disorders (SUDs) occur significantly more often in patients with anxiety disorders than in the general population. Toward this end, we draw heavily on our own research (funded by the National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse) and our clinical experience, as well as on the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). In this article, we attempt to leverage state-of-the-art research findings to provide empirically informed perspectives and practices related to these issues. How to respond clinically when comorbid drug or alcohol problems exist or when there is a high risk of such problems to develop.The signs of elevated risk of substance use problems developing in patients with anxiety disorders.How to reliably identify comorbid drug and alcohol use disorders in patients with anxiety disorders.The specific prevalence of substance use disorders among those with anxiety disorders.Therefore, it benefits mental health practitioners to be aware of the following: Patients who seek treatment for anxiety disorders often have problems with alcohol or drug abuse and are otherwise at an increased risk for developing such problems. ![]()
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