Self-medication of anxiety disorders with alcohol and drugs: Results from a nationally representative sample

Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
Journal of Anxiety Disorders (Impact Factor: 2.96). 04/2008; 23(1):38-45. DOI: 10.1016/j.janxdis.2008.03.013
Source: PubMed

ABSTRACT Self-medication--the use of alcohol or drugs in an attempt to reduce anxiety--has often been invoked as an explanatory mechanism for the high co-occurrence of anxiety and substance use disorders (for reviews, see Allan, C. A. (1995). Alcohol problems and anxiety disorders-A critical review. Alcohol & Alcoholism, 30(2), 145-151; Kushner, M. G., Abrams, K., & Borchardt. (2000). The relationship between anxiety disorders and alcohol use disorders: A review of major perspectives and findings. Clinical Psychology Review, 20(2), 149-171). The current study expands upon previous self-medication research by: (1) examining prevalence and comorbidity of self-medication for anxiety disorders (panic disorder, social phobia, specific phobia, and generalized anxiety disorder); (2) using a nationally representative sample (National Epidemiologic Survey on Alcohol and Related Conditions; N=43,093) to do so; and (3) by differentiating self-medication with alcohol from self-medication with drugs. Prevalence rates ranged from 18.3% (self-medication with alcohol for generalized anxiety disorder) to 3.3% (self-medication with both alcohol and drugs for specific phobia and panic disorder without agoraphobia). Multiple logistic regression analyses determined that self-medication with alcohol was associated with increased likelihood of any mood or personality disorder diagnosis, while self-medication with both alcohol and drugs further increased these associations over and above self-medication with alcohol alone. Findings remained significant after adjusting for sociodemographic and substance use disorder variables, which suggests that independently of substance use disorders, self-medication can be viewed as a marker of severity.

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    • "Therapeutic strategies such as psychoeducation, relaxation, and exposurebased strategies could be provided to decrease SP symptoms and the odds of alcohol use. Moving toward intervention, to the extent that alcohol use may develop in order to manage preexisting symptoms of SP (Robinson et al., 2009), intervention programs for alcohol use among adolescents could also directly target symptoms of SP. Although the present sample was a nonclinical sample with relatively low rates of alcohol use, existing theories suggest that one of the functions of alcohol use is to manage SP symptoms and that youth with elevated SP symptoms may be at risk for the development of more problematic levels of SP over time as well as for problematic alcohol use. "
    Journal of studies on alcohol and drugs 11/2014; 75(6):929. DOI:10.15288/jsad.2014.75.929 · 2.27 Impact Factor
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    • "Both genetic and environmental factors play important roles in the development of alcoholism (Cloninger, 1987; Heath et al., 1997; Enoch and Goldman, 2001). Anxiety disorders have been found to be potential risk factors for the development of alcohol-use disorders, often co-morbid together (Schuckit and Hesselbrock, 1994; Kushner et al., 2000; Robinson et al., 2009). Acute alcohol exposure produces anxiolytic effects, whereas withdrawal after protracted exposure leads to the development of anxiety-like behaviours (Koob, 2003; Pandey, 2003; Moberg and Curtin, 2009). "
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    ABSTRACT: Recent studies have demonstrated the involvement of epigenetic mechanisms in psychiatric disorders, including alcoholism. Here, we investigated the effects of histone deacetylase (HDAC) inhibitor, trichostatin A (TSA) on amygdaloid HDAC-induced histone deacetylation and neuropeptide Y (NPY) expression and on anxiety-like and alcohol-drinking behaviours in alcohol-preferring (P) and -non-preferring (NP) rats. It was found that P rats displayed higher anxiety-like and alcohol-drinking behaviours, higher amygdaloid nuclear, but not cytosolic, HDAC activity, which was associated with increased HDAC2 protein levels and deficits in histone acetylation and NPY expression in the central (CeA) and medial nucleus of amygdala (MeA), as compared to NP rats. TSA treatment attenuated the anxiety-like and alcohol-drinking behaviours, with concomitant reductions in amygdaloid nuclear, but not cytosolic HDAC activity, and HDAC2, but not HDAC4, protein levels in the CeA and MeA of P rats, without effect in NP rats. TSA treatment also increased global histone acetylation (H3-K9 and H4-K8) and NPY expression in the CeA and MeA of P, but not in NP rats. Histone H3 acetylation within the NPY promoter was also innately lower in the amygdala of P rats compared with NP rats; which was normalized by TSA treatment. Voluntary ethanol intake in P, but not NP rats, produced anxiolytic effects and decreased the HDAC2 levels and increased histone acetylation in the CeA and MeA. These results suggest that higher HDAC2 expression-related deficits in histone acetylation may be involved in lower NPY expression in the amygdala of P rats, and operative in controlling anxiety-like and alcohol-drinking behaviours.
    The International Journal of Neuropsychopharmacology 02/2014; 17(08):1-14. DOI:10.1017/S1461145714000054 · 5.26 Impact Factor
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    • "However, patterns of comorbidity vary according to the subtypes of specific phobias (LeBeau et al. 2010; MacDonald et al. 2011); there is a higher comorbidity of animal, situational and blood/injury subtypes than of so-called environmental subtypes (Becker et al. 2007; Depla et al. 2008). Up to 30% of patients with fear of heights sometimes use medication or alcohol for relief (Stransky 1957; Menzies and Clarke 1995; Robinson et al. 2009). The observation by Curlee and Stern (1973) that alcoholics in a psychotherapy group often report fear of heights was not confirmed by others (Ruff et al. 1976) and does not allow generalization. "
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    ABSTRACT: Background Visual height intolerance occurs when a visual stimulus causes apprehension of losing balance and falling from some height. Affecting one-third of the population, it has a broad spectrum of symptoms, ranging from minor distress to fear of heights, which is defined as a specific phobia. Specific phobias are associated with higher alcohol consumption. This has not been specifically shown for susceptibility to the more general visual height intolerance. Methods Representative case-control study nested within a population-based cross-sectional telephone survey to assess epidemiologically 1253 individuals ≥14 years, using a questionnaire on sociodemographic data, typical symptoms, precipitating visual stimuli, and alcohol drinking patterns (overall frequency of alcohol consumption, the daily quantities, and the motives). Results Individuals susceptible or nonsusceptible to visual height intolerance showed no significant differences in drinking patterns. The daily average alcohol consumption was slightly higher in persons susceptible to visual height intolerance (4.1 g/day vs. 3.7 g/day). Of those consuming alcohol, cases and controls reported on average consuming 2.3 glasses per day. The prevalence of visual height intolerance was insignificantly higher in the small minority of those drinking 2-3 times per week versus teetotalers. Conclusions Our study does not provide evidence that visual height intolerance - contrary to various specific phobias - is significantly associated with individual alcohol consumption patterns.
    Brain and Behavior 09/2013; 3(5):596-601. DOI:10.1002/brb3.162
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