Anxiety Disorders Linked With Alcoholism Relapse

People who suffer from anxiety disorders may be more likely to experience relapses following attempts to quit drinking.

"At a practical level, our study indicates clinicians should be screening for co-occurring anxiety disorders, which is not routinely done at this time. Identifying these disorders — especially social phobia and anxiety disorder — should serve as a red flag for heightened relapse risk," says researcher Matt Kushner.

The study appears in the August issue of Alcoholism: Clinical & Experimental Research.

Anxiety disorders and alcohol dependence frequently go hand-in-hand, write the authors.

Currently, nearly 14 million Americans — one in every 13 adults — abuse alcohol or are alcoholic, according to the National Institute of Alcohol Abuse and Alcoholism. More than half of the men and women in the U.S. — 53 percent — report that one or more of their close relatives has a drinking problem.

Two of the most common anxiety disorders found among alcoholics — social phobia, or fear and avoidance of social situations; and panic disorder, or persistent "panic attacks" or episodes of intense anxiety — are the ones most often associated with alcohol relapse, they write.

Your Guide to Anxiety Disorders

Anxiety Rate Two to Four Times Higher

Research shows that among those suffering from alcohol dependence, the rate of anxiety disorders is two to four times greater than that found in the general population. One reason for this could be that those who are excessively anxious may tend to "self-medicate" in an effort to reduce or control their anxiety level.

Anxiety disorders affect about 15 percent of all adults. Among those with alcohol dependency, as many as half may suffer from anxiety disorders.

Mental Illness and Substance Abuse

Added Support Beneficial

Researchers evaluated the daily drinking patterns of 82 individuals one week after they entered treatment for alcoholism and 120 days later.

"Our key finding is that having an anxiety disorder when starting treatment for alcohol abuse puts individuals at a significantly higher risk for relapse within four months," Kushner says.

Twenty-nine of the participants completed the study. Of these, more than half (55 percent) had at least one anxiety disorder. Anxiety disorders, at the start of the study, were more than twice as common in women compared with men.

The researchers also show that:

—Depression was also more likely in those with anxiety disorders.

—Alcohol withdrawal symptoms are more pronounced in those with baseline anxiety disorders.

—A higher percentage of those with anxiety disorders returned to drinking.

—Those with anxiety disorders had fewer days until their first drink compared with those without anxiety.

—Those with no baseline anxiety showed a greater reduction in the amount of their drinking over the course of follow-up.

Understanding Alcohol Abuse

They concluded that patients who were at highest risk should be provided with additional resources during the four-month period when danger of relapse is highest.

According to Sherry H. Stewart, professor of psychiatry, psychology, and community health and epidemiology at Dalhousie University, Kushner's findings suggest that traditional alcoholism treatment may not necessarily be the best route for those with existing anxiety disorders.

"It appears that we must develop new treatments, or modify existing treatments, to better serve those with co-occurring anxiety and alcohol use disorders," she says in a news release.

Among physicians, whether anxiety disorders are "independent disorders" or a consequence of alcoholics' abuse/dependence, is a topic for ongoing debate. Additional studies on the subject are needed, says Kushner.

"It's possible that alcohol dependence and withdrawal can, themselves, either imitate or cause anxiety disorders via the neuro-chemical and environmental disruptions associated with alcohol addiction. Once this process occurs, an individual could begin to use alcohol to self-medicate the very anxiety symptoms that were caused by pathological drinking in the first place. This creates a vicious cycle, in which more drinking leads to greater anxiety, which, in turn, leads to more drinking. Once this vicious cycle is firmly in place, which disorder is operating as the 'cause' and which is the 'effect' becomes murky," he says.

Easy Relaxation Techniques to Calm Anxiety

By Patti Connor, reviewed by Brunilda Nazario, MD

SOURCES: National Institute on Alcohol Abuse and Alcoholism. Anxiety disorders can compromise success of alcohol-dependence treatment, news release. Follow-up Study of Anxiety Disorder and Alcohol Dependence in Comorbid Alcoholism Treatment Patients, Alcoholism, Clinical & Experimental Research, August 2005. Matt G. Kushner, associate professor, University of Minnesota. Sherry H. Stewart, professor of psychiatry, psychology, and community health and epidemiology, Dalhousie University.