Origin of the Comorbidity of Anxiety Disorders and Alcohol Dependence: Findings of a General Population Study

Department of Psychiatry, VU University Amsterdam, Amsterdamo, North Holland, Netherlands
European Addiction Research (Impact Factor: 2.1). 02/2007; 13(1):39-49. DOI: 10.1159/000095814
Source: PubMed


A representative general population sample (n = 7,076) was used to study retrospectively and prospectively the nature of the relationship between co-morbid alcohol dependence and anxiety disorders. Four different models were tested: (1) anxiety disorders increase the risk of alcohol dependence; (2) alcohol dependence increases the risk of anxiety disorders; (3) family history or childhood traumatisation increase the risk of both alcohol dependence and anxiety disorders, and (4) comorbid conditions are a separate psychopathological entity. The data show that alcohol dependence does not precede the onset of anxiety disorders, that anxiety disorders do precede the onset of alcohol dependence, that family history is not very likely to be the third factor explaining the elevated comorbidity, and that in women childhood trauma might be partially responsible for the association between both disorders. The data are inconsistent with regard to comorbidity as a distinct psychopathological entity. These findings are of great importance for treatment planning in patients with alcohol dependence and comorbid anxiety disorders.

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Available from: Richard van Dyck, Aug 20, 2015
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    • "In parallel, clinical studies have reported a strong comorbidity between several anxiety-related disorders and drug abuse. In addition to the role of withdrawal-induced anxiety in the maintenance of drug use (Koob and Le Moal 1997), several epidemiological studies support the idea of a predisposition to drugs of abuse in individuals suffering from psychoemotional disorders such as anxiety and depression that preexisted any drug consumption (Rounsaville et al. 1991, Merikangas et al. 1998, Marquenie et al. 2007). In rodents, the same relationship between preexisting anxiety and predisposition to consumption of drugs of abuse has been observed. "
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    ABSTRACT: Drug addiction is defined as a recurring cycle of intoxication, abstinence and relapse. The behavioural trait of novelty seeking is frequently observed in alcohol abusers. Moreover, converging evidence indicates that anxious individuals are also predisposed to alcohol abuse. We have analyzed the respective implication of those two behavioural factors on vulnerability to ethanol intake on rats in situations designed to reflect drug intoxication and relapse phases in humans. In a general population of Wistar rats, animals were tested in both the light/dark box and the novelty preference tests. Ethanol consumption was measured in a two-bottle free-choice procedure across three successive procedures. Animals were first exposed to increasing concentrations of ethanol (2, 4, 6, 8, 10, 12 % for 8 days at each concentration). Then, the concentration of the solution was diminished from 12 to 6 %. Finally, all rats were re-exposed to 6 % ethanol after 12 days of ethanol deprivation. Novelty preference predicted the amount of ethanol consumed across all phases. In contrast, anxiety was associated with a quicker recovery of ethanol consumption after the concentration drop and a greater increase in ethanol consumption after deprivation. Novelty seeking and anxiety are both but differentially implicated in predisposition to ethanol abuse. Whereas novelty seeking is related to the amount of ethanol consumed, anxiety is associated to higher ethanol consumption when ethanol concentration is decreased or after ethanol deprivation.
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    • "As to comorbid mental health and alcohol problems, most (Regier et al., 1990; Merikangas et al., 1998b; Teesson et al., 2009), though not all (Kessler et al., 2012b) population studies have investigated CAMHD in adults, therefore describing comorbidity years after its initial development. Occurring on a backdrop of anxiety and behaviour problems in childhood and adolescence, with depression developing through late teenage years to early adulthood (Merikangas et al., 1998b; Marquenie et al., 2007; McEvoy et al., 2011), early adulthood is arguably a sensitive period for the development of CAMHD (Cerda et al., 2010), as well as for determining trajectories of social functioning. In this respect, it is surprising that little research attention has been paid to the role of behaviour problems and how these may be associated with CAMHD in young adults. "
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    ABSTRACT: This article examines whether young individuals in the general population with comorbid alcohol use and mental health disorders experience worse internalising and externalising behaviour problems than those with single disorders. A large cohort of women at the Mater Misericordiae Hospital in Brisbane, Australia, was enrolled during pregnancy in a longitudinal study. Mother/offspring dyads were followed over twenty-one years. At age 21, offspring behaviour problems were examined using the Young Adult Self Report, alcohol and mental health disorders with the Composite International Diagnostic Interview. Associations between comorbidity and behaviour problems were assessed using multinomial logistic regression, accounting for life-course factors. Twelve percent of young adults had alcohol/mental health DSM-IV disorders with significant temporal overlap. A further 16% had alcohol disorders only and 23% mental health disorders only. The comorbid group scored significantly higher on total and externalizing behaviour problems but not internalizing behaviour problems. Stronger associations of aggression/delinquency with comorbidity were not fully accounted for by factors known to influence separate development of mental health and alcohol disorders. Young adults with comorbid alcohol/mental health disorders experience more, and more severe, behavioural problems than those with single disorder types, indicating an increased burden from comorbidity, with implications for treatment and public order.
    Full-text · Article · Oct 2014 · Psychiatry Research
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    • "On the other hand, health risk behaviours, like heavy drinking, may be used as self-medication when people encounter symptoms such as anxiety. That is, in people with comorbid alcohol dependence and anxiety disorders, anxiety more often preceded alcohol dependence than the other way around (Marquenie et al., 2007). Second, health risk behaviours and mental disorders may be indirectly rather than directly related (e.g. through chronic somatic illnesses ). "
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    ABSTRACT: Background: Health risk behaviours tend to co-occur and are found to be related to mental health symptoms. This is the first study to identify health behaviour clusters in relation to mental disorders. Methods: Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), a nationally representative sample of adults (n=5303). Latent class analysis was performed to identify clusters based on four health risk behaviours (smoking, heavy drinking, physical inactivity, and unhealthy diet). Concurrently, we examined the relationship between the identified clusters and a range of DSM-IV diagnoses, assessed with the Composite International Diagnostic Interview 3.0. Results: Four distinct health behaviour clusters were identified: most healthy (mainly non-smokers, moderate drinkers, active, healthy diet; class 1: 79.3%); smokers, moderate drinkers, inactive, unhealthy diet (class 2: 13.2%); smokers, heavy episodic drinkers, active, unhealthy diet (class 3: 3.8%); Smokers, frequent heavy drinkers, active, low fruit (class 4: 3.6%). Despite their different lifestyles, individuals in all three unhealthy clusters had double the risk of depression. Unhealthy behaviour clusters were strongly associated with drug dependence (classes 2 and 3), alcohol abuse and dependence (classes 3 and 4), and social phobia (class 4). Limitations: Due to the cross-sectional design, no conclusions about the causality of the relationship between HRB clusters and mental disorders can be drawn from the current study. Conclusions: Health behaviour clusters are strongly associated with mental disorders. This co-existence of behaviours and disorders emphasises the importance of an integrative approach in the prevention of mental illnesses.
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