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Am J Psychiatry 1994; 151:1723-1734
Copyright © 1994 by American Psychiatric Association
Alcohol dependence and anxiety disorders: what is the relationship?
MA Schuckit and V Hesselbrock
Department of Psychiatry, School of Medicine, University of California, San Diego.
OBJECTIVE: In this critical review the authors evaluate the literature
regarding the relationship between lifelong DSM-III-R anxiety disorders and
alcohol dependence. Many alcohol-dependent individuals demonstrate severe
anxiety symptoms in the context of acute or protracted abstinence
syndromes, but it is unclear whether these anxiety conditions are
independent psychiatric disorders or temporary syndromes likely to
disappear on their own. METHODS: Reports since 1975 describing the
relationship between alcoholism and anxiety disorders were reviewed to
determine whether 1) lifelong anxiety disorders are unusually prevalent
among alcohol-dependent individuals, 2) children of alcoholics are more
likely to develop anxiety disorders than comparison populations, 3) anxiety
syndromes are likely to disappear with abstinence, 4) the rate of alcohol
dependence among subjects with lifelong anxiety disorders is higher than
normal, 5) there is familial crossover between alcohol dependence and
anxiety disorders, and 6) alcoholism is often preceded by anxiety disorders
in groups from the general population studied prospectively. RESULTS: The
interaction between alcohol use and anxiety disorders is complex. The
available data, while imperfect, do not prove a close relationship between
life- long anxiety disorders and alcohol dependence. Further, prospective
studies of children of alcoholics and individuals from the general
population do not indicate a high rate of anxiety disorders preceding
alcohol dependence. CONCLUSIONS: The high rates of comorbidity in some
studies likely reflect a mixture of true anxiety disorders among alcoholics
at a rate equal to or slightly higher than that for the general population,
along with temporary, but at times severe, substance-induced anxiety
syndromes.
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