Current Psychiatry Reports

, Volume 14, Issue 3, pp 176–181

Exploring the Comorbidity of Anxiety and Substance Use Disorders



Anxiety disorders and substance use disorders are highly comorbid, and such comorbidity complicates treatment and worsens prognosis. The mechanisms underlying the relationship between anxiety and substance use disorders are poorly understood. This paper reviews recent research attempting to explain these associations. Cognitive factors, such as attentional bias, expectancies, and anxiety sensitivity, appear to impact on the relation between anxiety and substance misuse. Temporality of the anxiety and substance use disorder may also indicate whether the substance use disorder is primary (anxiety may be a result of use) or secondary (substances may be used to self-medicate). Social phobia has been predominantly identified as a primary disorder preceding substance use, while the temporality of other anxiety and substance use disorders is less clear. The efficacy of concurrent treatment compared with separate treatment of either anxiety or substance use disorder is unclear and requires further research.


Anxiety disorders Substance use disorders Comorbidity Temporality Anxiety sensitivity Expectancies Attentional bias Obsessive-compulsive disorder Alcohol Social phobia 


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61:807–16.PubMedCrossRefGoogle Scholar
  2. 2.
    Martins SS, Gorelick DA. Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. population. Drug Alcohol Depend. 2011;119:28–36.PubMedCrossRefGoogle Scholar
  3. 3.
    • Marmorstein NR. Anxiety disorders and substance use disorders: different associations by anxiety disorder. J Anxiety Disord. 2012, In press. This study examined the associations between various ADs and SUDs, as well as the temporality of these disorders among a large sample of US civilians. Google Scholar
  4. 4.
    Fatseas M, Denis C, Lavie E, Auriacombe M. Relationship between anxiety disorders and opiate dependence—a systematic review of the literature: Implications for diagnosis and treatment. J Subst Abuse Treat. 2010;38:220–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Tepe E, Dalrymple K, Zimmerman M. The impact of comorbid cannabis use disorders on the clinical presentation of social anxiety disorder. J Psychiatr Res. 2012;46:50–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Boschloo L, Vogelzangs N, Smit JH, et al. Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders. Findings from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord. 2011;131:233–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Myrick H, Brady K. Current review of the comorbidity of affective, anxiety, and substance use disorders. Curr Opin Psychiatry. 2003;16(3):261–70.Google Scholar
  8. 8.
    Gentil AF, de Mathis MA, Torresan RC, et al. Alcohol use disorders in patients with obsessive-compulsive disorder: the importance of appropriate dual-diagnosis. Drug Alcohol Depend. 2009;100:173–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Wolitzky-Taylor K, Operskalski JT, Ries R, et al. Understanding and treating comorbid anxiety disorders in substance users: review and future directions. J Addict Med. 2011;5:233–47.PubMedCrossRefGoogle Scholar
  10. 10.
    Bacon AK, Ham LS. Attention to social threat as a vulnerability to the development of comorbid social anxiety disorder and alcohol use disorder: an avoidance-coping cognitive model. Addict Behav. 2010;35:925–39.PubMedCrossRefGoogle Scholar
  11. 11.
    Conger JJ. Alcoholism: theory, problem, and challenge: II. Reinforcement theory and the dynamics of alcoholism. Q J Stud Alcohol. 1956;17:296–305.PubMedGoogle Scholar
  12. 12.
    Sher K, Levenson R. Risk for alcoholism and individual differences in the stress-response-dampening effect of alcohol. J Abnorm Psychol. 1982;91:350–67.PubMedCrossRefGoogle Scholar
  13. 13.
    Khantzian E. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. Am J Psychiatry. 1985;142:1259–64.PubMedGoogle Scholar
  14. 14.
    Morris EP, Stewart SH, Ham LS. The relationship between social anxiety disorder and alcohol use disorders: a critical review. Clin Psychol Rev. 2005;25:734–60.PubMedCrossRefGoogle Scholar
  15. 15.
    Buckner JD, Proctor SL, Reynolds E, et al. Cocaine dependence and anxiety sensitivity among patients presenting for residential drug use treatment. J Cogn Psychotherapy: An International Quarterly. 2011;25:22–30.CrossRefGoogle Scholar
  16. 16.
    Buckner JD, Schmidt NB, Lang AR, et al. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res. 2008;42:230–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Buckner JD, Turner RJ. Social anxiety disorder as a risk factor for alcohol use disorders: a prospective examination of parental and peer influences. Drug Alcohol Depend. 2009;100:128–37.PubMedCrossRefGoogle Scholar
  18. 18.
    Fröjd S, Ranta K, Kaltiala-Heino R, Marttunen M. Associations of social phobia and general anxiety with alcohol and drug use in a community sample of adolescents. Alcohol Alcohol. 2011;46:192–9.PubMedGoogle Scholar
  19. 19.
    Mancebo MC, Grant JE, Pinto A. Substance use disorders in an obsessive compulsive disorder clinical sample. J Anxiety Disord. 2009;23:429–35.PubMedCrossRefGoogle Scholar
  20. 20.
    DeMartini KS, Carey KB. The role of anxiety sensitivity and drinking motives in predicting alcohol use: a critical review. Clin Psychol Rev. 2011;31:169–77.PubMedCrossRefGoogle Scholar
  21. 21.
    Brady KT, Verduin ML. Pharmacotherapy of comorbid mood, anxiety, and substance use disorders. Subst Use Misuse. 2005;40:2021–41.PubMedCrossRefGoogle Scholar
  22. 22.
    Kirby LG, Zeeb FD, Winstanley CA. Contributions of serotonin in addiction vulnerability. Neuropharmacology. 2011;61:421–32.PubMedCrossRefGoogle Scholar
  23. 23.
    Myrick H, Wright T. Comorbid anxiety and substance use disorders: diagnostic and treatment considerations. J Dual Diagn. 2005;1:9–26.CrossRefGoogle Scholar
  24. 24.
    Carrigan MH, Randall CL. Self-medication in social phobia. A review of the alcohol literature. Addict Behav. 2003;28:269–84.PubMedCrossRefGoogle Scholar
  25. 25.
    Ham LS, Zamboanga BL, Bacon AK. Putting thoughts into context: alcohol expectancies, social anxiety, and hazardous drinking. J Cogn Psychotherapy: An International Quarterly. 2011;25:47–60.CrossRefGoogle Scholar
  26. 26.
    Goldsmith AA, Thompson RD, Black JJ, et al. Drinking refusal self-efficacy and tension-reduction alcohol expectancies moderating the relationship between generalised anxiety and drinking behaviors in young adult drinkers. Psychol Addict Behav. 2012, In press.Google Scholar
  27. 27.
    Douglas KR, Chan G, Gelernter J, et al. Adverse childhood events as risk factors for substance dependence: partial mediation by mood and anxiety disorders. Addict Behav. 2010;35:7–13.PubMedCrossRefGoogle Scholar
  28. 28.
    Crippa JA, Zuardi AW, Martin-Santos R, et al. Cannabis and anxiety: a critical review of the evidence. Hum Psychopharmacol. 2009;24:515–23.PubMedCrossRefGoogle Scholar
  29. 29.
    • Baker AL, Thornton LK, Hiles S, et al. Psychological interventions for alcohol misuse among people with co-occurring depression or anxiety disorders: a systematic review. J Affect Disord. 2012, In press. A systematic review of randomized controlled trials examines the evidence for psychological interventions for alcohol misuse among people with co-occurring depression or ADs. Google Scholar
  30. 30.
    • Hesse M. Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literature. BMC Psychiatry. 2009;9:6. A systematic review is provided regarding the evidence for integrated psychological treatment for ADs and SUDs versus standalone treatment.PubMedCrossRefGoogle Scholar
  31. 31.
    • Hobbs JDJ, Kushner MG, Lee SS, et al. Meta-analysis of supplemental treatment for depressive and anxiety disorders in patients being treated for alcohol dependence. Am J Addict. 2011;20:319–29. This meta-analysis synthesizes randomized controlled trials to examine the impact of supplementing treatment for alcohol use disorders with psychiatric treatment for co-occurring ADs and depressive disorders.PubMedCrossRefGoogle Scholar
  32. 32.
    Randall C, Thomas S, Thevos A. Concurrent alcoholism and social anxiety disorder: a first step toward developing effective treatments. Alcohol Clin Exp Res. 2001;25:210–20.PubMedCrossRefGoogle Scholar
  33. 33.
    Puleo CM, Conner BT, Benjamin CL, Kendall PC. CBT for childhood anxiety and substance use at 7.4-year follow-up: a reassessment controlling for known predictors. J Anxiety Disord. 2011;25:690–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Hall W, Degenhardt L, Teesson M. Reprint of “Understanding comorbidity between substance use, anxiety and affective disorders: Broadening the research base”. Addict Behav. 2009;34:795–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Hassan I, Ali R. The association between somatic symptoms, anxiety disorders and substance use. A literature review. Psychiatr Q. 2011;82:315–28.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Psychiatry and Mental HealthUniversity of Cape TownRondeboschSouth Africa

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