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Anxiety Disorders Can Prompt Alcoholic Relapse

Social Phobia, Panic Disorder Common Causes

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Updated August 21, 2005

Anxiety disorders and alcohol dependence co-occur at an alarming rate. A study in the August 2005 issue of Alcoholism: Clinical & Experimental Research examines what effects a co-existing anxiety disorder may have on relapse following treatment for alcoholism.

Results indicate that two of the most common anxiety disorders found among alcoholics – social phobia and panic disorder – are more strongly associated with alcohol relapse than other anxiety disorders.

"Researchers and clinicians have long observed that the rate of anxiety disorders among those suffering with alcohol dependence is two to four times greater than that found in the general population," said Matt G. Kushner, associate professor at the University of Minnesota and corresponding author for the study. "Anxiety disorders are fairly common to begin with, about 15 percent of all adults, but the rate of anxiety disorders among alcohol-disordered individuals can be as high as 50 percent."

"Although the high rate of co-occurrence of these two types of mental health disorders is very well established," added Sherry H. Stewart, professor of psychiatry, psychology, and community health and epidemiology at Dalhousie University, "relatively little is known about the 'clinical significance' of this co-morbidity. For example, does having a co-morbid anxiety disorder influence a person's response to alcoholism treatment? More specifically, do those with a co-occurring anxiety disorder at the outset of alcoholism treatment fare worse in terms of increased risk for relapse to problematic alcohol use over time?"

Kushner and his colleagues examined the diagnostic status and daily drinking patterns of 82 (53 males, 29 females) individuals one week after they entered treatment for alcoholism, and again 120 days later (n=53).

Results indicate that screening for co-existing anxiety disorders in an alcoholism-treatment setting is clearly warranted.

High Risk Period for Relapse

"The key finding from our study is that having an anxiety disorder when starting treatment for alcohol dependence marks individuals at a significantly greater risk for relapse to drinking within four months," said Kushner. "This finding suggests that clinicians ought to provide additional resources for these patients during this 'high risk' period."

"Another very interesting finding was that different anxiety disorders predicted different aspects of alcohol relapse at alcoholism-treatment follow-up," said Stewart. "Having 'social phobia' – significant social fears and avoidance of social situations – at the outset of alcoholism treatment was the best predictor of a return to any drinking at treatment follow-up.

Panic Disorder a Risk Factor

"Having 'panic disorder' – persistent 'panic attacks' or episodes of intense anxiety and arousal – at the outset of alcoholism treatment was the best predictor of a relapse to dependence at treatment follow-up. This pattern suggests that panic disorder is a risk factor for a major relapse, and social phobia a risk factor for a minor relapse, following alcoholism treatment."

"At a practical level," said Kushner, "our study tells clinicians that they should screen for co-occurring anxiety disorders, which is not typically done at this time, and that identifying these disorders, especially social phobia and panic disorder, should serve as a red flag for heightened relapse risk.

Must Develop New Treatments

"In the past, many clinicians assumed that co-occurring anxiety problems were simply a product of excessive drinking and would 'take care of themselves' as soon as the drinking stopped. Our study, on the other hand, suggests that the chances that drinking will stop for as little as four months after treatment is severely undermined by the presence of an active anxiety disorder."

Stewart added that Kushner's findings also suggest that traditional alcoholism treatment is not particularly effective for those with co-occurring 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 said.

Heightened Risk for Relapse

"However," she added, "we cannot simply assume that such integrated treatments would be superior to existing alcoholism treatments in improving alcohol outcomes in co-morbid patients. This assumption would need to be tested rigorously."

Kushner agreed. "While seeming very logical based on our findings," he said, "this conclusion is not directly demonstrated by our study. That is, while we show that anxiety disorders mark a heightened risk for relapse to drinking following alcoholism treatment, it does not necessarily follow that treating the anxiety disorder would partially or wholly eliminate that risk."

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