Psychiatric Quarterly

, Volume 64, Issue 2, pp 135–149 | Cite as

The association of alcoholism and anxiety

  • Kathleen T. Brady
  • R. Bruce Lydiard


The relationship between alcoholism and anxiety disorders is complex and has been the subject of much investigation. While data from community samples as well as samples of treatment-seeking populations indicate that these disorders co-occur far more commonly than would be expected by chance, the nature of the relationship is unclear. It is clear from both prevalence as well as order of onset data that various anxiety disorders have differing associations with alcohol problems. There is much overlap in symptomatology of panic disorder, generalized anxiety disorder, and alcohol withdrawal. This observation has led to speculation about common neurochemical perturbations and a kindling phenomenon as a possible connection between these disorders. Cognitive theories have been used to connect alcohol abuse and phobic disorders. Treatment of patients with co-morbid anxiety and alcoholism is discussed.


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  1. 1.
    Regier DA, Farmer ME, Rae DS, et al: Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study.Journal American Med Assoc 264(19):2511–2518, 1990.Google Scholar
  2. 2.
    Ross HE, Glaser FB, Germanson T: The prevalence of psychiatric disorders in patients with alcohol and other drug problems.Arch Gen Psychiatry 45:1023–1031, 1988.Google Scholar
  3. 3.
    Mirin SM, Weiss RD, Griffin ML, et al: Psychopathology in drug abusers and their families.Comprehen Psychiatry 32(1):36–51, 1991.Google Scholar
  4. 4.
    Meyer RE: How to understand the relationship between psychopathology and addictive disorder: Another example of the chicken and the egg, in Meyer RE (ed):Psychopathology and Addictive Disorders pp. 3–16. New York, Guilford Press, 1986.Google Scholar
  5. 5.
    Hippocrates: Aphorisms VII, 56, inWorks of Hippocrates, Vol. 2. New York, William Wood, 1886.Google Scholar
  6. 6.
    Marks IM:Fears, Phobias, and Rituals. New York, Oxford University Press, 1987.Google Scholar
  7. 7.
    Wilson GT: Alcohol and anxiety.Behav Res Ther 26:369–381, 1988.Google Scholar
  8. 8.
    Capella H, Herman CP: Alcohol and tension reduction: A review.J Stud Alcohol 33:33–64, 1972.Google Scholar
  9. 9.
    Hodgson RJ, Stockwell TR, Rankin HJ: Can alcohol reduce tension?Behav Res Ther 17:459–466, 1979.Google Scholar
  10. 10.
    Freed EX: Alcohol and mood: An updated review.Int J Addict 13:173–200, 1978.Google Scholar
  11. 11.
    Peyser H: Stress and alcohol, in Goldberg L, Breznotz S (ed):Handbook of Stress. New York, Free Press, 1982.Google Scholar
  12. 12.
    Vaillant GE: Natural history of male psychological health VII: Antecedents of alcoholism and “orality.”Am J Psychiatry 137:181–186, 1980.Google Scholar
  13. 13.
    Weissman M: Anxiety and alcoholism.J Clin Psychiatry 49(10):17–19, 1988.Google Scholar
  14. 14.
    Helzer JE, Pryzbeck TR: The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment.J of Studies Alcohol 49(3):219–224, 1987.Google Scholar
  15. 15.
    Mullaney JA, Trippett CJ: Alcohol dependence and phobias: Clinical description and relevance.Br J Psychiatry 135:565–573, 1979.Google Scholar
  16. 16.
    Powell BJ, Penick EC, Othmer E, et al: Prevalence of additional psychiatric syndromes among male alcoholics.J Clin Psychiatry 43:404–407, 1982.Google Scholar
  17. 17.
    Bowen RC, Cipywnyk D, D'Arcy C, et al: Alcoholism, anxiety disorders, and agoraphobia.Alcoholism 8:48–50, 1984.Google Scholar
  18. 18.
    Hesselbrock MN, Meyer RE, Keener JJ: Psychopathology in hospitalized alcoholics.Arch Gen Psychiatry 42:1050–1055, 1985.Google Scholar
  19. 19.
    Smail P, Stockwell T, Canter S, et al: Alcohol dependence and phobic anxiety states, I: A prevalence study.Br J Psychiatry 144:53–57, 1984.Google Scholar
  20. 20.
    Weiss KJ, Rosenberg DJ: Prevalence of anxiety disorders among alcoholics.J Clin Psychiatry 46:3–5, 1985.Google Scholar
  21. 21.
    Schuckit M: The clinical implications of primary diagnostic groups among alcoholics.Arch Gen Psychiatry 42:1043–1049, 1985.Google Scholar
  22. 22.
    Stravynski A, Lamontagne Y, Lavallee YJ: Clinical phobias and avoidant personality disorder among alcoholics admitted to an alcoholism rehabilitation setting.Can J Psychiatry 31:714–719, 1986.Google Scholar
  23. 23.
    Chambless DL, Cherney J, Caputo GC, et al: Anxiety disorders and alcoholism: A study with inpatient alcoholics.J Anxiety Disorders 1:29–40, 1987.Google Scholar
  24. 24.
    Eisen JL, Rasmussen SA: Coexisting obsessive compulsive disorder and alcoholism.J Clin Psychiatry 50:96–98, 1989.Google Scholar
  25. 25.
    Lydiard RB, Howell EF, Ballenger JC, et al: Prevalence of anxiety and mood disorders in hospitalized alcoholics. Presented at the Annual meeting of the American College of Neuropsychopharmacology, San Juan, Puerto Rico, December, 1987.Google Scholar
  26. 26.
    Cox BJ, Norton GR, Dorward J, et al: The relationship between panic attacks and chemical dependencies.Addictive Behaviors 14:53–60, 1989.Google Scholar
  27. 27.
    Pollard CA, Detrick P, Flynn T, et al: Panic attacks and related disorders in alcohol-dependent, depressed, and nonclinical samples.J of Nervous and Mental Disease 178(3):180–185, 1990.Google Scholar
  28. 28.
    Schuckit MA, Irwin M, Brown SA: The history of anxiety symptoms among 171 primary alcoholics.J of Studies on Alcohol 51(1):34–41, 1990.Google Scholar
  29. 29.
    Winokur G, Holeman E: Chronic anxiety neurosis: Clinical and sexual aspects.Acta Psychiatr Scand 39:384–412, 1963.Google Scholar
  30. 30.
    Woodruff RA Jr, Guze SB, Clayton PJ: Anxiety neurosis among psychiatric outpatients.Compr Psychiatr 13:165–170, 1972.Google Scholar
  31. 31.
    Amies PL, Gelder MG, Shaw PM: Social phobia: A comparative clinical study.Br J Psychiatr 142:174–179, 1983.Google Scholar
  32. 32.
    Thyer BA, Parrish RT, Himle J, et al: Alcohol abuse among clinically anxious patients.Behav Res Ther 24:357–359, 1986.Google Scholar
  33. 33.
    Bibb J, Chambless DL: Alcohol use and abuse among diagnosed agoraphobics.Behav Res Ther 24:49–58, 1986.Google Scholar
  34. 34.
    Noyes R Jr., Crowe RR, Harris EL, et al: Relationship between panic disorder and agoraphobia: A family study.Arch Gen Psychiatry 43:227–232, 1986.Google Scholar
  35. 35.
    George DT, Zerby A, Noble S, et al: Panic attacks and alcohol withdrawal: Can subjects differentiate the symptoms?Biol Psychiatry 24:240–243, 1988.Google Scholar
  36. 36.
    Stockwell T, Smail P, Hodgson R, et al: Alcohol dependence and phobic anxiety states, II: A retrospective study.Br J Psychiatry 144:58–63, 1984.Google Scholar
  37. 37.
    Munkack KJ, Moss HB: Affective disorder and alcoholism in families of agoraphobics.Arch Gen Psychiatry 38:869–871, 1981.Google Scholar
  38. 38.
    Leckman JF, Weissman MM, Merikangas KR, et al: Panic disorder and major depression: Increased risk of depression, alcoholism, panic, and phobic disorders in families of depressed probands with panic disorder.Arch Gen Psychiatry 40:1055–1060, 1983.Google Scholar
  39. 39.
    Noyes R Jr, Clancy J, Crowe R, et al: The familial prevalence of anxiety neurosis.Arch Gen Psychiatry 37:173–178, 1978.Google Scholar
  40. 40.
    Norton GR, Dorward J, Cox BJ: Factors associated with panic attacks in nonclinical subjects.Behavior Therapy 17:239–252, 1986.Google Scholar
  41. 41.
    Ciraulo CA, Alderson LM, Chapron DJ, et al: Imipramine disposition in alcoholics.J Clin Psychopharm 2(1):2–7, 1982.Google Scholar
  42. 42.
    Quitkin FM, Rifkin A, Kaplan J, et al: Phobic anxiety syndrome complicated by drug dependence and addiction: A treatable form of drug abuse.Arch Gen Psychiatry 27:159, 1972.Google Scholar
  43. 43.
    Meyer RE: Anxiolytics and the alcoholic patient.J Stud Alcohol 47:269–273, 1986.Google Scholar
  44. 44.
    Jaffe HJ, Ciraulo D: Drugs used in the treatment of alcoholism, in Mendelson JH, Mellow NK (eds):The Diagnosis and Treatment of Alcoholism. New York, McGraw-Hill, 1985.Google Scholar
  45. 45.
    Ciraulo DA, Sands BF, Shader RI: Critical review of liability for benzodiazepine abuse among alcoholics.Am J Psychiatry 145(12):1501–1506, 1988.Google Scholar
  46. 46.
    Ciraulo DA, Barnhill JG, Greenblatt DJ, et al: Abuse liability and clinical pharmacokinetics of alprazolam in alcoholic men.J Clin Psychiatry 49(4):333–337, 1988.Google Scholar
  47. 47.
    Baron DH, Sands BF, Ciraulo DA, et al: The diagnosis and treatment of panic disorder in alcoholics: Three cases.Am J Drug Alcohol Abuse 16(3):287–295, 1990.Google Scholar
  48. 48.
    Kranzler HR, Liebowitz NR: Anxiety and depression in substance abuse: Clinical implications.Medical Clinics of North America 72(4):867–885, 1987.Google Scholar
  49. 49.
    Tollefson GD, Montague-Clouse JM, Lancaster SP: A 5HT1a agonist treatment of comorbid anxiety and alcoholism. Presented at the 30th annual NCDEU meeting, Key Biscayne, June 1, 1990.Google Scholar
  50. 50.
    Malcolm RJ, Anton R, Brady KT, et al: Controlled trial of buspirone in alcoholism relapse. American Psychiatric Association 144th Annual Meeting. NR270, 1991.Google Scholar
  51. 51.
    George DT, Nutt DJ, Dwyer BA, et al: Alcoholism and panic disorder: Is the comorbidity more than coincidence?Acta Psychiatr Scand 81:97–107, 1990.Google Scholar
  52. 52.
    Grant SJ, Huang YH, Redmond DE: Benzodiazepines attenuate single unit activity in the locus coeruleus.Life Sci 27:2231–2236, 1980.Google Scholar
  53. 53.
    Brown ME, Anton RF, Malcolm R, et al: Alcoholic detoxification and withdrawal seizures: Clinical support for a kindling hypothesis.Bio Psychiatry 43:107–113, 1986.Google Scholar
  54. 54.
    Poldrugo F, Snead OC: Electroencephalograph behavior correlates during repeated ethanol withdrawal syndromes.Psychopharmacology 83:140–146, 1984.Google Scholar
  55. 55.
    Walker DW, Zornetzer SF: Alcohol withdrawal in mice: Electroencephalographic and behavioral correlates.Electroencephalogr Clin Neurophysiol 36:233–244, 1974.Google Scholar
  56. 56.
    Klein DF: Anxiety reconceptualized.Compr Psychiatry 2:411–427, 1980.Google Scholar
  57. 57.
    Mancillas JR, Siggins GR, Bloom FE: Systemic ethanol: Selective enhancement of responses to acetylcholine and somatostatin in hippocampus.Science 231:161–163, 1986.Google Scholar
  58. 58.
    Reiman EM, Raichle ME, Robins E, et al: The application of positron emission tomography to the study of panic disorder.Am J Psychiatry 143:469–477, 1986.Google Scholar
  59. 59.
    Kushner MG, Sher KJ, Beitman BD: The relation between alcohol problems and the anxiety disorders.American Journal of Psychiatry 147(7):685–695, 1990.Google Scholar
  60. 60.
    Cameron OG, Liepman MR, Curtis GC, et al: Ethanol retards desensitization of simple phobias in non-alcoholics.Br J Psychiatry 150:845–849, 1987.Google Scholar
  61. 61.
    Chambless DL, Foa EB, Groves GA, et al: Brevital in flooding with agoraphobics.Behav Res Ther 17:243–251, 1979.Google Scholar

Copyright information

© Human Sciences Press, Inc 1993

Authors and Affiliations

  • Kathleen T. Brady
    • 1
  • R. Bruce Lydiard
  1. 1.Department of PsychiatryMedical University of South CarolinaCharleston

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