Correlates of Self-Medication for Anxiety Disorders

Department of Psychology, University of Manitoba, Winnipeg, MB, Canada.
The Journal of nervous and mental disease (Impact Factor: 1.69). 12/2009; 197(12):873-8. DOI: 10.1097/NMD.0b013e3181c299c2
Source: PubMed


Self-medication is a common behavior among individuals with anxiety disorders, yet few studies have examined the correlates of this behavior. The current study addresses this issue by exploring the pattern of mental health service use and quality of life among people who self-medicate for anxiety. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions and was limited to the subsample of individuals meeting criteria for an anxiety disorder in the past 12 months (n = 4880). Multiple regression analyses compared 3 groups-(1) no self-medication, (2) self-medication with alcohol, and (3) self-medication with drugs, on mental health service use and quality of life. After adjusting for potentially confounding covariates, individuals who engaged in self-medication had significantly higher service use compared with people with anxiety disorders who did not self-medicate (adjusted odds ratio = 1.41, 95% CI = 1.06-1.89). Self-medication was also associated with a lower mental health-related quality of life compared with those who did not self-medicate. Clinicians should recognize and respond to the unique needs of this particular subpopulation of individuals with anxiety disorders.

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    • "Therefore, it appears that alcohol drinking is much less coordinated in male– female pairs, which is consistent with our lack of social housing effects on alcohol drinking in these animals. We also examined the relationship between anxiety-like behavior and alcohol drinking in Experiment 2. In humans, a bidirectional relationship between drinking and anxiety has been described, such that anxiety may promote drinking behavior via acute anxiolytic effects, and prolonged ethanol consumption may increase anxiety (Allan 1995; Kushner et al. 2000; Robinson et al. 2009). The relationship between anxiety and drinking is less clear in rodents, as studies have found a positive (Colombo et al. 1995; Izidio and Ramos 2007; Spanagel et al. 1995; Stewart et al. 1993), negative (Fernandez-Teruel et al. 2002; Henniger et al. 2002; Langen and Fink 2004; Viglinskaya et al. 1995), or no relationship (Da Silva et al. 2004; Tuominen et al. 1990; Viglinskaya et al. 1995) between measures of these behaviors. "
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    ABSTRACT: Social environment influences alcohol consumption in humans; however, animal models have only begun to address biological underpinnings of these effects. We investigated whether social influences on alcohol drinking in the prairie vole are specific to the sex of the social partner. In Experiment 1, control, sham, and gonadectomized voles were placed either in mesh-divided housing with a same-sex sibling or isolation with access to ethanol. In Experiment 2, animals were given an elevated plus maze test (EPM) and then females were paired with a castrated male followed by isolation or mesh-divided housing with access to ethanol. In Experiment 3, subjects categorized as low or high drinkers based on initial ethanol intake were placed in mesh-divided housing with an opposite-sex partner of the same or opposite drinking group and ethanol access. Subjects were then moved back to isolation for a final ethanol access period. Same-sex pairs showed social facilitation of drinking similar to previous reports. Gonadectomy did not affect alcohol drinking. Opposite-sex paired animals in Experiment 2 did not differ in alcohol drinking based on social housing. EPM measures suggested a relationship between anxiety-like behaviors and drinking that depended on social environment. Experiment 3 identified moderate changes in alcohol preference based on social housing, but these effects were influenced by the animal's own drinking behavior and were independent of their partner's drinking. Social influences on alcohol self-administration in prairie voles differ based on the sex of a social partner, consistent with human drinking behavior.
    Full-text · Article · Aug 2012 · Psychopharmacology
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    • "That is, efforts aimed at reducing the "high risk" for alcohol dependence that has previously been associated with anxiety disorder in general (e.g., Kushner et al., 1990, 2000) might appropriately be concentrated on the much smaller subset of those who report self-medicating anxiety symptoms with alcohol. Also relevant here are recent studies showing that self-medication is associated with multiple psychiatric variables like suicidality, treatment utilization, and overall mental health (Bolton et al., 2006; Robinson et al., 2009); perhaps multiple clinical resources besides alcoholreduction interventions should be focused on this particular subgroup. "
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    ABSTRACT: Alcohol dependence (AD) is more likely to occur among individuals with rather than without an anxiety disorder. Self-medication theory (SMT) holds that drinking behavior is negatively reinforced when alcohol temporarily reduces anxiety and that the resulting escalation of drinking increases the risk for AD. We set out to empirically scrutinize SMT using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) dataset. We found that only a minority (about 20%) of anxiety disordered individuals endorsed drinking to control anxiety symptoms. This minority drank more alcohol, had a higher cross-sectional rate of AD, and was at higher risk for developing new AD over four years compared to anxiety disordered non-self-medicators and individuals with no anxiety disorder. Consistent with SMT, increased prospective risk for AD among self-medicators is partially mediated by an increased level of alcohol use. Understanding the processes that promote and inhibit self-medication should be a priority for anxiety disorder researchers.
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