The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings

Associations between age of onset and lifetime history of panic attacks and alcohol use, abuse, and dependence in a representative sample

OBJECTIVE

The present investigation evaluated associations between lifetime panic attacks and lifetime alcohol use, abuse, and dependence. Specifically, the relations between lifetime panic attacks and alcohol use, abuse, and dependence were examined after controlling for theoretically relevant variables of comorbid psychopathology and polysubstance use.

DESIGN AND SETTING

Data for this study were obtained from a large statewide survey, the Colorado Social Health Survey. Participants were contacted using randomly sampled household addresses (response rate was 72%) and interviews took place in participants' homes.

PARTICIPANTS

The study consisted of a representative sample of the Colorado general adult population (n = 4,745; 52% women).

MAIN OUTCOME MEASURES

The Diagnostic Interview Schedule (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [3rd ed]. Washington [DC]: Author. 1980) was administered to obtain Axis I diagnoses.

RESULTS

After controlling for theoretically relevant variables of comorbid psychopathology and polysubstance use, a lifetime history of panic attacks was significantly associated with alcohol dependence but not alcohol use or abuse. In addition, among participants reporting a lifetime history of both panic attacks and alcohol abuse or dependence, the number of participants for whom panic attacks developmentally preceded the onset of alcohol use problems was significantly greater (85.5%) than the number of participants for whom alcohol use problems preceded the onset of panic attacks (13.4%) or the number of participants for whom these problems developed at the same age (2.2%).

CONCLUSIONS

These data suggest panic attacks, particularly of early onset, may serve as a risk marker for alcohol dependence.

Panic attacks, panic disorder, and agoraphobia: associations with substance use, abuse, and dependence

Anxiety and substance use disorders frequently co-occur. Despite the clinical importance of this co-occurrence, theory and research addressing the relations between anxiety-substance use disorder comorbidity remain limited. The present commentary is intended to briefly review and summarize key aspects of this literature, with a specific focus on panic-spectrum psychopathology (panic attacks, panic disorder, and agoraphobia) and its associations with tobacco, alcohol, and marijuana use, abuse, and dependence. A heuristic theoretical model for better understanding the panic-substance use relations also is offered. Extant data suggest clinically meaningful bidirectional associations are evident between panic problems and premorbid risk factors for such problems and various forms of tobacco, alcohol, and marijuana use. Key clinical implications and future directions are outlined based upon the review.

Behavioral predictors of substance-use initiation in adolescents with and without attention-deficit/hyperactivity disorder

OBJECTIVE

Our goal was to examine substance-use initiation in healthy adolescents and in adolescents who have been diagnosed with attention-deficit/hyperactivity disorder.

METHODS

Seventy-eight adolescents (28 healthy and 50 with attention-deficit/hyperactivity disorder) participated in an ongoing longitudinal study of predictors of substance use. The substances most commonly reported were tobacco, alcohol, and marijuana. Aggression, conduct problems, hyperactivity, impulsivity, inattention, anxiety/depression, social difficulties, and somatic complaints were assessed at study entry and tested as predictors for later substance use.

RESULTS

With an average of 4 years into the study, 37 adolescents had not used any substances, 41 had experimented with at least 1 substance, and 29 experimented with >1 substance. Psychiatric diagnoses (attention-deficit/hyperactivity disorder, attention-deficit/hyperactivity disorder and conduct disorder, and attention-deficit/hyperactivity disorder and depression/anxiety) did not influence reports of substance use. Distinct behavioral measures collected at study entry predicted use of different substances. In a multivariate analysis, aggression had the greatest association with tobacco smoking and marijuana use. Impulsivity was associated with alcohol use. Severity of drug exposure, indexed by the number of substances used, was predicted by aggression.

CONCLUSIONS

This 4-year longitudinal study captured the onset of substance use, not abuse. Behavioral predictors differed with the type of substance used. These behavioral characteristics may raise suspicion among pediatricians for enhanced risk for substance-use initiation.

Illicit drug use and anxiety disorders: findings from two community surveys

The focus of this investigation was the relationship between anxiety disorders and lifetime use of amphetamines, cocaine, hallucinogens and heroin in two contemporaneous samples. Data from two independent community surveys conducted in the US (N=5877) and Ontario (N=8116) were used to assess whether a lifetime anxiety disorder diagnosis (social phobia, panic disorder, agoraphobia, specific phobia, and generalized anxiety disorder) was significantly associated with lifetime use of amphetamines, hallucinogens, cocaine, and heroin. Posttraumatic stress disorder was assessed only in the US survey. After controlling for sociodemographics, a significant association between any anxiety disorder diagnosis and lifetime stimulant use, cocaine use, and hallucinogen use was found in both surveys (OR approximately 1.5-3.0). Any anxiety disorder diagnosis was significantly associated with lifetime heroin use in the US survey (OR approximately 3.0). Clinicians and researchers need to be aware of the relationship between anxiety disorders and illicit drug use.

Chronic daily ethanol and withdrawal: 6. Effects on rat sympathoadrenal activity during "abstinence"

We have reported that repetitive daily ethanol consumption increased anxiety-like behavior in rats 4 weeks after ethanol consumption had ceased, consistent with the persistently increased anxiety exhibited by abstinent alcoholics. Increased anxiety is associated with sympathoadrenal activation, so we have now also investigated ethanol-induced persistent changes in basal and stress-induced plasma epinephrine (E) and norepinephrine (NE) levels. Male Sprague-Dawley rats received liquid diet containing ethanol versus pair-fed isocaloric control liquid diet for 9 weeks. After 5 weeks' subsequent "abstinence" (i.e., no ethanol in the diet), the control rats exhibited low basal plasma E and NE, which were both increased by 150-300% within 5 min after transfer to a novel cage in a novel room, returning toward basal levels within 15 min. "Abstinent" ethanol-treated rats exhibited elevated basal E levels (195% of controls, P<.05), which were not significantly altered by transfer to novel environment; basal NE levels tended (P<.07) to be elevated and likewise were not altered by novel environment. These results suggest that daily ethanol consumption can induce persistent increases in sympathoadrenal activation during subsequent "abstinence," which are relatively refractory to further stimulation.

Early Ethanol's Anxiolytic Effects Assessed Through an Unconditional Stimulus Revaluation Procedure

BACKGROUND

Even though ethanol is considered to exert antianxiety effects, the existence of such properties during early ontogeny of the rat has rarely received attention, mainly because of the restricted behavioral repertoire of the pup. This study evaluated ethanol's anxiolytic properties in preweanling rats through an unconditional stimulus revaluation procedure.

METHODS

Optimal parameters for the acquisition of an odor avoidance response were obtained in Experiment 1. In Experiment 2 preweanlings experienced 4 conditioning trials defined by a 5 minute exposure to a lemon odor while they were intraorally infused with a sapid aversive stimulus (citric acid). Twenty-four hours later, pups were briefly exposed to the acid 5 minutes after being administered with 0.0, 0.25, 0.5, 1.25, or 2.5 g/kg of ethanol. Odor preferences were then evaluated in a 2-way odor preference test. Blood ethanol concentrations (BEC's) derived from these doses were assessed in Experiment 3. In Experiment 4, citric acid mediated-conditioning was followed by a similar odor-preference test after pups were re-exposed to the acid either 5 or 25 minutes after receiving a 2.5 g/kg ethanol dose. Ethanol's effects upon the avoidance response were also analyzed in an alternative rat strain (Experiment 5).

RESULTS

Moderate to low ethanol doses ameliorated the otherwise strong avoidance response. Further experiments: (a) replicated these phenomena, (b) established that they are correlated with BEC's in the range of 17-70 mg%, and (c) Indicated that ethanol's influence upon an avoidance response changes as a function of the temporal course of the intoxication.

CONCLUSIONS

Acute ethanol interacts with aversive nondrug-mediated learning. These findings are likely to be discussed in terms of possible negative reinforcing properties of ethanol and indicate that this drug exerts differential motivational effects during the course of the intoxication. The devaluation procedure should be considered as an alternative method to assess ethanol's motivational properties.

Alcohol use disorders in relatives of patients with panic disorder

OBJECTIVE

The aim of this study was to use data from a family study of anxiety disorders to examine the familial association between alcohol use disorders and panic disorder (PD), controlling for alcohol use disorders in the proband.

METHOD

Data from a family study of anxiety disorders were used to compare rates of alcohol use disorders in the relatives of 3 proband groups (PD with lifetime alcohol use disorders, PD without lifetime alcohol use disorders, and not-ill controls).

RESULTS

There was a significantly higher rate (12%) of alcohol use disorders among the relatives of PD probands compared with relatives of controls (5%), even in the absence of alcohol use disorders in the proband and after adjusting for differences in sociodemographic characteristics and lifetime drug use disorders (chi2 = 5.4; df = 1; P = .02). Anxiety symptoms were more frequent among the male relatives of panic probands who received an alcohol diagnosis, compared with those who did not have alcohol use disorders (10/25 vs 22/111; chi2 = 4.6; df = 1; P = .03). A similar pattern was found in women (8/11 vs 63/156; chi2 = 4.4; df = 1; P = .036).

CONCLUSIONS

These findings suggest a familial association between PD and alcohol use disorders. Future studies with more refined alcohol diagnoses are needed to replicate and investigate the mechanism of this association.

Emotional exposure in the treatment of substance use disorders: conceptual model, evidence, and future directions

In this article, we review research on the nature and treatment of panic disorder, and apply these findings to a discussion of the role of internal cue exposure in the treatment of substance use disorders (SUDs). Two features of panic treatment were used as a model for interventions for SUDs: exposure to internal (interoceptive) cues rather than reliance on external (environmental) exposure alone, and use of cue exposure to try to inoculate individuals against future maladaptive patterns. Specifically, we emphasized the role of exposure to internal, largely emotional cues, as a way to enhance resilience to cues for relapse in individuals with SUDs. Hypothesized moderators and mediators of this treatment approach were discussed, as were similarities between this research agenda and an increasing focus on the role of emotional acceptance/tolerance in cognitive-behavioral treatments.

Smoking and panic attacks, panic disorder, and agoraphobia: a review of the empirical literature

The empirical literature regarding panic-spectrum problems (i.e., panic attacks, panic disorder, and agoraphobia) and cigarette smoking is reviewed. In the first section of the paper, empirical studies that document the prevalence of smoking and panic-related problems are presented and discussed. In the second section of the paper, studies pertaining to the role cigarette smoking may play in the onset and maintenance of panic-related problems are critically reviewed. In the third section of the paper, studies related to the association between panic vulnerability factors and the nature of smoking behavior are presented. In the fourth section of the paper, specific areas not otherwise covered in the review are presented to stimulate further development in these areas (e.g., specialized treatment development).

COMORBID PHOBIC DISORDERS DO NOT INFLUENCE OUTCOME OF ALCOHOL DEPENDENCE TREATMENT. RESULTS OF A NATURALISTIC FOLLOW-UP STUDY

AIMS

Despite claims that comorbid anxiety disorders tend to lead to a poor outcome in the treatment of alcohol dependence, the few studies on this topic show conflicting results.

OBJECTIVE

To test whether the outcome of treatment-seeking alcohol-dependent patients with a comorbid phobic disorder is worse than that of similar patients without a comorbid phobic disorder.

METHODS

The probabilities of starting to drink again and of relapsing into regular heavy drinking in (i) a group of 81 alcohol-dependent patients with comorbid social phobia or agoraphobia were compared with those in (ii) a group of 88 alcohol-dependent patients without anxiety disorders in a naturalistic follow-up using Cox regression analysis.

RESULTS

Adjusted for initial group differences, the hazard ratio for the association of phobic disorders with resumption of drinking was 1.05 (95% CI, 0.85-1.30, P = 0.66) and the adjusted hazard ratio for the association of phobic disorders with a relapse into regular heavy drinking was 1.02 (95% CI, 0.78-1.33, P = 0.89).

CONCLUSION

The findings of this study do not confirm the idea that alcohol-dependent patients who have undergone alcohol-dependence treatment are at greater risk of a relapse if they have a comorbid anxiety disorder. No differences were found in abstinence duration or time to relapse into regular heavy drinking between patients with and without comorbid phobic disorders.

The relationship between social anxiety disorder and alcohol use disorders: A critical review

Epidemiological studies have demonstrated a significant co-morbidity between social anxiety disorder (SAD) and alcohol use disorders (AUDs). Despite the fact that many studies have demonstrated strong relationships between SAD and AUD diagnoses, there has been much inconsistency in demonstrating causality or even directionality of the relationship between social anxiety and alcohol-related variables. For example, some studies have showed a positive relationship between social anxiety and alcohol-related variables, while others have shown a negative relationship or no relationship whatsoever. In an attempt to better understand the relationship between social anxiety and alcohol, some researchers have explored potential moderating variables such as gender or alcohol expectancies. The present review reports on what has been found with regard to explaining the high co-morbidity between social anxiety and alcohol problems, in both clinical and non-clinical socially anxious individuals. With a better understanding of this complex relationship, treatment programs will be able to better target specific individuals for treatment and potentially improve the efficacy of the treatments currently available for individuals with co-morbid SAD and AUD.

Follow-up Study of Anxiety Disorder and Alcohol Dependence in Comorbid Alcoholism Treatment Patients

BACKGROUND

Anxiety disorders are present in a high percentage of alcoholism treatment patients. We tested the prediction that having a comorbid anxiety disorder increases the prospective risk for relapse to drinking after alcoholism treatment. We also explored the prospective associations of specific anxiety syndromes (and depression) with drinking and anxiety outcomes.

METHODS

We assessed the diagnostic status and daily drinking patterns of 82 individuals approximately one week after they entered alcoholism treatment (baseline) and again approximately 120 days later (follow-up) (n=53).

RESULTS

Consistent with study predictions, those with a baseline anxiety disorder (approximately 55%) were significantly more likely than others to meet various definitions of drinking relapse over the course of the follow-up. Regression models showed that baseline social phobia was the single best predictor of a return to any drinking after treatment, whereas panic disorder was the single best predictor of a relapse to alcohol dependence after treatment. Having multiple anxiety disorders (versus any specific anxiety disorder) at the baseline was the strongest predictor of having at least one active ("persistent") anxiety disorder at the follow-up. Cross-sectional analysis at the follow-up showed that anxiety disorder persisted in the absence of a relapse to alcohol dependence far more often than relapse to alcohol dependence occurred in the absence of a persistent anxiety disorder.

CONCLUSIONS

Screening for comorbid anxiety disorder in alcoholism treatment patients is warranted and, where found, should be considered a marker of high relapse risk relative to that of noncomorbid patients. The capacity of specific anxiety treatment to mitigate relapse risk among comorbid patients remains an open question.

Adolescent Rats Exposed to Repeated Ethanol Treatment Show Lingering Behavioral Impairments

BACKGROUND

Repeated ethanol treatment has been reported to differentially affect water maze performance in adolescent and adult rats. The present study was undertaken to determine the age-specific reversal of ethanol-induced deficit in water maze performance.

METHODS

Adolescent and adult male rats were subjected to repeated ethanol or saline treatments. Experimental rats were injected daily with 2 g/kg ethanol (intraperitoneally) for five consecutive days (Days 1-5) and tested in the hidden platform task of the Morris water maze 30 minutes after ethanol treatment; control rats received isovolumetric saline. On the last training day, all rats were tested in the probe trial and in the cued visual task. After an ethanol-free period of 4-25 days, rats were retested in the water maze.

RESULTS

Adolescent ethanol-treated rats had significantly higher latencies and swam greater distances to find the hidden platform, compared to age-matched saline control rats. Ethanol rats also showed increased hug time, i.e., spent significantly more time near the periphery of the pool than control rats. In the probe trial, compared to adolescent saline rats, ethanol rats spent less time in the target quadrant. However, there was no difference between ethanol- and saline-treated rats in the swim speed or in the visual task performance. Experimental and control rats were retested in the water maze 4 days (Day 9), 7 days (Day 12), and 25 days (Day 30) after the last ethanol/saline treatment; no injections were given on those days. Ethanol-treated rats continued to do poorly on all retest days. Ethanol treatment in adult male rats acutely increased latency and distance to find the hidden platform, but unlike adolescent alcohol rats, their performance in the probe trial did not differ from adult saline rats. Also, swim speed and visual task performance of adult rats were significantly affected by ethanol exposure. During retesting, their performance did not differ from adult control rats.

CONCLUSIONS

Adolescent rats exposed to ethanol showed deficits in water maze performance, had increased hug time, and failed to catch up with control rats during the weeks after the ethanol treatment period was over. Adult alcohol rats showed some behavioral dysfunction (increased latency and distance to find the hidden platform) but had problems swimming, and in the probe trial they performed as well as control rats. Also, in adult rats, ethanol-induced impairments were quickly reversed after the ethanol treatment was over, a finding that suggests impaired motor coordination more than a true learning deficit. Together, these data indicate that repeated ethanol treatment in adolescent rats, but not adult rats, show long-term impairments in maze performance.

Anxiety and risk for substance dependence among late adolescents/young adults

This study examined the relation between comorbid and pure (non-comorbid) anxiety disorders and both substance dependence and substance use problems in a community sample of 1747 young adults ages 18-23 years. Results indicate that collectively anxiety disorders, both pure and comorbid with other psychiatric diagnoses, are predictive of substance dependence. When temporal order was controlled, anxiety disorders generally preceded the onset of substance dependence. However in analyses in which PTSD was excluded, anxiety disorders were no longer predictive of substance dependence, suggesting that the increased risk associated with anxiety disorders is largely if not wholly attributable to PTSD. Finally, comorbid and pure anxiety disorders were found to be predictive of the number of alcohol and drug use problems.

Stress enhancement of craving during sobriety: a risk for relapse

This report of the proceedings of a symposium presented at the 2004 Research Society on Alcoholism Meeting provides evidence linking stress during sobriety to craving that increases the risk for relapse. The initial presentation by Rajita Sinha summarized clinical evidence for the hypothesis that there is an increased sensitivity to stress-induced craving in alcoholics. During early abstinence, alcoholics who were confronted with stressful circumstances showed increased susceptibility for relapse. George Breese presented data demonstrating that stress could substitute for repeated withdrawals from chronic ethanol to induce anxiety-like behavior. This persistent adaptive change induced by multiple withdrawals allowed stress to induce an anxiety-like response that was absent in animals that were not previously exposed to chronic ethanol. Subsequently, Amanda Roberts reviewed evidence that increased drinking induced by stress was dependent on corticotropin-releasing factor (CRF). In addition, rats that were stressed during protracted abstinence exhibited anxiety-like behavior that was also dependent on CRF. Christopher Dayas indicated that stress increases the reinstatement of an alcohol-related cue. Moreover, this effect was enhanced by previous alcohol dependence. These interactive effects between stress and alcohol-related environmental stimuli depended on concurrent activation of endogenous opioid and CRF systems. A.D. Lê covered information that indicated that stress facilitated reinstatement to alcohol responding and summarized the influence of multiple deprivations on this interaction. David Overstreet provided evidence that restraint stress during repeated alcohol deprivations increases voluntary drinking in alcohol-preferring (P) rats that results in withdrawal-induced anxiety that is not observed in the absence of stress. Testing of drugs on the stress-induced voluntary drinking implicated serotonin and CRF involvement in the sensitized response. Collectively, the presentations provided convincing support for an involvement of stress in the cause of relapse and continuing alcohol abuse and suggested novel pharmacological approaches for treating relapse induced by stress.

The Effectiveness of Anxiety Treatment on Alcohol-Dependent Patients with a Comorbid Phobic Disorder: A Randomized Controlled Trial

OBJECTIVE

Evidence has emerged which indicates that the post-treatment relapse rate for alcohol-dependent patients with a comorbid anxiety disorder is higher than for alcohol-dependent patients without a comorbid anxiety disorder. The question raised by this evidence is whether the relapse rate in these dually diagnosed patients could be reduced if they were given additional treatment for the comorbid anxiety disorder. We attempted to answer this question by conducting a trial among patients with a double diagnosis of alcohol dependence and agoraphobia or social phobia.

METHOD

We conducted a 32-week randomized controlled trial among 96 abstinent patients with a primary diagnosis of alcohol dependence and a comorbid anxiety disorder involving agoraphobia or social phobia. The patients were randomly assigned to an intensive psychosocial relapse-prevention program on its own (n = 49) or in combination with an anxiety treatment program comprising cognitive behavioral therapy (CBT) and optional pharmacotherapy consisting of an SSRI (n = 47). The primary outcome measure was the percentage of patients who suffered an alcohol relapse during a 32-week period. The secondary outcome measures were total abstinence, a reduction in the days of heavy drinking, and less severe anxiety symptoms.

RESULTS

Although the additional therapy clearly reduced the anxiety symptoms, it had no significant effect on the alcohol relapse rates.

CONCLUSION

Anxiety treatment for alcohol-dependent patients with a comorbid anxiety disorder can alleviate anxiety symptoms, but it has no significant effect on the outcome of alcohol treatment programs.

Marital predictors of symptom severity in panic disorder with agoraphobia

Twenty-six to forty percent of individuals suffering from panic disorder with agoraphobia (PDA) do not benefit significantly from cognitive-behavior therapy. Marital problems are among risk factors that may explain this limited impact. Some studies suggest that PDA treatment outcome is related to the couple's ability to communicate and solve problems during and after treatment. It may be also useful to further clarify the interplay of marital interpersonal variables with PDA severity before any intervention. This study aims at specifying the links between PDA symptom severity on the one hand and, on the other hand, marital adjustment, attachment style and personal problem-solving skills in both spouses. Results obtained from a group of 67 PDA patients (44 women and 23 men) and their partners showed that some PDA symptoms or comorbid depressive symptoms were more severe when both spouses independently scored low on problem-solving skills or marital adjustment, and when attachment style of PDA patients was insecure. Marital adjustment and difficulties in problem-solving, more specifically, avoidance of problem-solving activities in PDA patients, were the best predictors of PDA symptom severity. In light of these findings, a more complete program of problem-solving and acceptance strategies could be developed as part of a cognitive-behavior treatment of PDA. Other theoretical and clinical implications are discussed.

Conceptual framework for the etiology of alcoholism: a "kindling"/stress hypothesis

RATIONALE

The rationale for proposing the "kindling"/stress hypothesis is to provide a conceptual basis for the insidious development and maintenance of alcohol abuse.

OBJECTIVE AND RESULTS

An objective of the hypothesis is to emphasize how continued alcohol abuse is linked to progressive neural adaptation. Work has shown that repeated withdrawals from chronic low levels of alcohol sensitize ("kindle") anxiety-like behavior ("anxiety") in rats, a finding consistent with multiple withdrawal kindling of seizure activity. Additionally, stress substitutes for initial cycles of the multiple withdrawal protocol to sensitize withdrawal-induced anxiety, which is indicative that stress is capable of facilitating neuroadaptive processes related to withdrawal. The persistence of adaptation caused by stress and multiple withdrawals is revealed by the appearance of withdrawal-induced anxiety following a future re-exposure to a single 5-day period of alcohol. This persisting adaptation also permits stress to induce anxiety during a period of abstinence--a response not observed in animals without previous exposure to alcohol. Furthermore, stress interacts with repeated withdrawals to enhance voluntary alcohol drinking. Results of other preclinical and clinical studies reported in the literature are integrated with these investigations in support of the proposed hypothesis.

CONCLUSIONS

The "kindling"/stress hypothesis is based on the premise that repeated withdrawals from cycles of chronic alcohol exposure contribute to a progressive development of persisting adaptive change that sensitizes withdrawal-induced anxiety and allows stress to evoke symptoms associated with negative affect during abstinence. Thus, these consequences of repeated withdrawals account for the evolution of major characteristics of alcoholism, which include worsened acute withdrawal symptoms and increased stress-induced negative affect during abstinence, both of which enhance the likelihood of relapse--and with relapse an inability to limit an abusive pattern of alcohol intake. The "kindling"/stress hypothesis provides a clear strategy for future studies to explore the advancing neural adaptation proposed to contribute to the pathogenesis of alcoholism.

Cognitive versus behavioral treatment of concurrent alcohol dependence and agoraphobia: a pilot study

With the growing awareness of the prevalence of anxiety disorders among alcohol abusers there is a need for effective cognitive--behavioral treatments (CBTs). This study is a pilot investigation comparing two treatments for concurrent alcohol dependence and panic disorder with agoraphobia. A 10-session behavioral treatment (BT), consisting of five sessions treating alcohol dependence and five sessions treating panic disorder with agoraphobia, was compared to a 10-session cognitive treatment (CT) that addressed the dysfunctional cognitions mediating the alcohol problem and anxiety symptoms. There were no group differences in frequency or quantity of alcohol consumption or in anxiety symptoms posttreatment or at a 1-year follow-up in a sample of 14 subjects who completed the study. Both groups showed within-group improvements on measures of both alcohol and anxiety symptomatology. Approximately one-third of the subjects made clinically relevant gains on both alcohol and anxiety symptoms. A brief BT for concurrent alcohol dependence and agoraphobia appears encouraging.

Incorporating social anxiety into a model of college student problematic drinking

College problem drinking and social anxiety are significant public health concerns with highly negative consequences. College students are faced with a variety of novel social situations and situations encouraging alcohol consumption. The current study involved developing a path model of college problem drinking, including social anxiety, in 316 college students referred to an alcohol intervention due to a campus alcohol violation. Contrary to hypotheses, social anxiety generally had an inverse relationship with problem drinking. As expected, perceived drinking norms had important positive, direct effects on drinking variables. However, the results generally did not support the hypotheses regarding the mediating or moderating function of the valuations of expected effects and provided little support for the mediating function of alcohol expectancies in the relations among social anxiety and alcohol variables. Therefore, it seems that the influence of peers may be more important for college students than alcohol expectancies and valuations of alcohol's effects are. College students appear to be a unique population in respect to social anxiety and problem drinking. The implications of these results for college prevention and intervention programs were discussed.

Predictors of benzodiazepine discontinuation in subjects manifesting complicated dependence

We described characteristics of subjects with benzodiazepine dependence that was typically complicated by harmful and hazardous alcohol use or high benzodiazepine doses, and assessed predictors of successful discontinuation of benzodiazepines for this group. Seventy-six patients who participated in a randomized clinical trial of two different gradual withdrawal treatment approaches were assessed. The trial was conducted between February 1995 and July 1999. The mean age +/- SD of subjects was 40.0 +/- 9.6 years, 55% were male, 38% were married or cohabiting, and 70% had received more than nine years of education. The median benzodiazepine dose was 35 mg/day (range 2.5-180) in diazepam equivalents. The median duration of benzodiazepine use was 84 (range 8-360) months. Subjects with lower benzodiazepine doses and no previous withdrawal attempts were more successful at benzodiazepine discontinuation. Cluster B personality/borderline personality disorder was associated with an inability to stop benzodiazepine use and with "dropping out" of treatment. Alcohol use-related disorders or other psychiatric diagnoses were not associated with outcome. Further studies on predictors of successful benzodiazepine discontinuation in different populations are required. Patients manifesting cluster B personality/borderline personality disorder and benzodiazepine dependence may need concomitant treatment for their personality disorders to benefit from benzodiazepine discontinuation treatment.

Antidepressants attenuate both the enhanced ethanol intake and ethanol-induced anxiolytic effects in diazepam withdrawn rats

We have recently shown that the abrupt discontinuation of chronic diazepam (DZM) administration facilitated ethanol consumption and enhanced the anxiolytic properties of ethanol. Tricyclic antidepressants such as desipramine and the selective serotonin reuptake inhibitor fluoxetine have been shown to reduce alcohol intake in rodent models of alcoholism and in alcoholics who are depressed. In the present study, we tested whether desipramine (1.25; 2.5 and 5 mg/kg, i.p.) and fluoxetine (5 mg/kg, i.p.) treatment affect both ethanol intake in a free-choice test and the anxiolytic effect induced by ethanol in DZM withdrawn rats. Adult male Wistar rats were submitted to a chronic DZM treatment (2 mg/kg per day) or vehicle (VEH) for 21 days. Twenty-four hours after the last DZM injection, rats were subjected to a free-choice paradigm between water and increasing ethanol concentrations with or without concurrent desipramine or fluoxetine administration (ethanol concentration (v/v) was increased every 4 days as follows: 2, 4, 6, 8 and 10% for the final 8 days). Chronic treatment with desipramine (24 days, twice a day, 2.5 and 5 mg/kg, i.p.) and fluoxetine (24 days, once a day; 5 mg/kg, i.p.) significantly reduced the amount of ethanol intake in DZM withdrawn rats. Furthermore, subchronic treatments with desipramine (4 days, twice a day, 2.5 and 5 mg/kg) and fluoxetine (4 days, once a day, 5 mg/kg, i.p.) blocked the anxiolytic-like behavior in the elevated plus maze induced by ethanol (1 g/kg; i.p.) in DZM withdrawn rats at day 5 of withdrawal. The present findings suggest that desipramine and fluoxetine could be effective pharmacological tools to prevent the subsequent development of ethanol dependence in rats previously exposed to DZM withdrawal.

Genetic epidemiology of anxiety disorders

This chapter reviews the genetic epidemiology of the major subtypes of anxiety disorders including panic disorder, phobic disorders, generalized anxiety disorder, and obsessive-compulsive disorder. Controlled family studies reveal that all of these anxiety subtypes are familial, and twin studies suggest that the familial aggregation is attributable in part to genetic factors. Panic disorder and, its spectrum have the strongest magnitude of familial clustering and genetic underpinnings. Studies of offspring of parents with anxiety disorders an increased risk of mood and anxiety disorders, but there is far less specificity of the manifestations of anxiety in children and young adolescents. Although there has been a plethora of studies designed to identify genes underlying these conditions, to date, no specific genetic loci have been identified and replicated in independent samples.

Panic attacks, depression and anxiety symptoms, and substance use behaviors during late adolescence

This study examines panic attacks and substance use in a sample of incoming college freshman (n = 399 ) using questionnaires. Panickers (n = 47 ) were significantly more likely than nonpanickers (n = 290) to report having ever used sedatives, stimulants, opiods, and other drugs, but not tobacco, alcohol, cocaine, or hallucinogens. Gender and race did not substantially moderate the associations between substance use and panic attacks. Sedative, stimulant, opiod, and other drug use was not associated with panic attack frequency or the occurrence of unexpected attacks. The relationships of anxiety and depression with substance use were larger for panickers than nonpanickers. These results are consistent with the idea that self-medication and symptom exacerbation play a role in the development of co-occurring substance use disorders and mood and anxiety disorders.

Effectiveness of complementary and self-help treatments for anxiety disorders

OBJECTIVES

To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders.

DATA SOURCES

Systematic literature search using PubMed, PsycLit, and the Cochrane Library.

DATA SYNTHESIS

108 treatments were identified and grouped under the categories of medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes. We give a description of the 34 treatments (for which evidence was found in the literature searched), the rationale behind the treatments, a review of studies on effectiveness, and the level of evidence for the effectiveness studies.

CONCLUSIONS

The treatments with the best evidence of effectiveness are kava (for generalised anxiety), exercise (for generalised anxiety), relaxation training (for generalised anxiety, panic disorder, dental phobia and test anxiety) and bibliotherapy (for specific phobias). There is more limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety; for inositol in the treatment of panic disorder and obsessive-compulsive disorder; and for alcohol avoidance by people with alcohol-use disorders to reduce a range of anxiety disorders.

Substantial decrease of psychiatric comorbidity in chronic alcoholics upon integrated outpatient treatment - results of a prospective study

It is far from clear how comorbidity changes during alcoholism treatment. This study investigates: (1) the course of comorbid Axis I disorders in chronic alcoholics over 2 years of controlled abstinence in the outpatient long-term intensive therapy for alcoholics (OLITA) and (2) the effect of comorbid Axis I and II disorders in this group of patients on subsequent drinking outcome over a four-year follow-up. This prospective treatment study evaluates psychiatric variables of 89 severely affected chronic alcohol dependent patients on admission (t(1)), month 6 (t(2)), 12 (t(3)) and 24 (t(4)). Drinking outcomes have been analyzed from 1998 to 2002. On admission, 61.8% of the patients met criteria for a comorbid Axis I disorder, 63.2% for a comorbid personality disorder. Axis I disorders remit from t(1) (59.0% ill), t(2) (38.5%), t(3) (28.2%) to t(4) (12.8%) (p < 0.0001). Anxiety disorders remit more slowly from t(1) (43.6%) to t(3) (20.5%, p = 0.0086), whereas mood disorders remit early between t(1) (23.1%) and t(2) (5.1%, p = 0.0387) with a slight transient increase at t(3) (10.3%). During the four-year follow-up, the cumulative probability of not having relapsed amounts to 0.59. Two predictors have a strong negative impact on abstinence probability: number of inpatient detoxifications (p = 0.0013) and personality disorders (p = 0.0106). The present study demonstrates a striking remission of comorbid Axis I disorders upon abstinence during comprehensive long-term outpatient alcoholism treatment. The presence of an Axis II rather than an Axis I disorder on admission strongly predicts drinking outcome over a four-year follow-up.

“Trinken wegen sozialer Angst“ und “Soziale Angst wegen Trinken“:

Zusammenfassung. Theoretischer Hintergrund: Zur Erfassung von Aspekten sozialer Ängste bei Alkoholabhängigkeit wurden die beiden Fragebögen “Trinken wegen sozialer Angst“ (TWSA) und “Soziale Angst wegen Trinken“ (SAWT) entwickelt. TWSA erfasst Trinken zur Reduzierung von sozialen Ängsten. SAWT misst alkoholinduzierte soziale Ängste. Fragestellung: Es wurden die Reliabilität, faktorielle Validität und Konstruktvalidität überprüft. Methode: Psychometrische Analysen wurden an zwei Stichproben (n = 116 und n = 205) von alkoholabhängigen Patienten durchgeführt. Ergebnisse: Cronbachs a von TWSA ist .97 und von SAWT .95. Die Ergebnisse zweier Hauptkomponentenanalysen stützen die faktorielle Validität der Fragebögen, und die Korrelationen zu anderen Maßen sprechen für ihre Konstruktvalidität. Schlussfolgerungen: Die Ergebnisse ergeben erste Hinweis dafür, daß Alkoholkonsum zur “Selbstmedikation“ sozialer Ängste durch den TWSA und alkoholinduzierte soziale Ängste durch den SAWT reliabel und valide erfasst werden können.

Does a U-shaped relationship exist between alcohol use and DSM-III-R mood and anxiety disorders?

BACKGROUND

In recent community surveys, abstainers and heavy drinkers of alcohol have reported more mood and anxiety symptoms than moderate drinkers (U-shaped relationship). The present study was aimed at extending this finding by investigating this potential U-shaped relationship using structured diagnostic interviews to assess mood and anxiety disorders.

METHODS

Data came from two contemporaneous surveys, the National Comorbidity Survey (NCS; N=6780) and the Mental Health Supplement of the Ontario Health Survey (OHS-MHS; N=7001). The University of Michigan Revision of the Composite International Diagnostic Interview (UM-CIDI) was used to make DSM-III-R psychiatric diagnoses in both surveys. Three mutually exclusive lifetime alcohol use categories were compared: (1) Alcohol abstainers-individuals reporting no alcohol use or less than 12 drinks in any year throughout their life. (2) Moderate drinkers-individuals that did not meet criteria for alcohol abstainers or problem drinkers. (3) Problem drinkers-DSM-III-R lifetime alcohol abuse, dependence or hazardous levels of alcohol use.

RESULTS

After controlling for demographic variables, alcohol abstainers were not found to have significantly higher rates of mood and anxiety disorders in comparison with moderate drinkers. However, problem drinking was significantly associated with mood and anxiety disorders.

CONCLUSIONS

Across both surveys, there was no evidence of a U-shaped relationship between lifetime alcohol consumption and lifetime mood and anxiety disorders.

Abnormal EEG synchronisation in heavily drinking students

OBJECTIVE

In alcoholics, grey and white brain matter is damaged. In addition, functional brain connectivity as measured by EEG coherence is abnormal. We investigated whether heavily drinking students, although drinking for a shorter period than alcoholics, already show differences in functional connectivity compared to light-drinking controls.

METHODS

EEG was recorded in 11 light and 11 heavy male student drinkers during eyes closed, and eyes closed plus mental rehearsal of pictures. Functional connectivity was assessed with the Synchronisation Likelihood method.

RESULTS

Heavily drinking students had more synchronisation in the theta (4-8 Hz) and gamma (30-45 Hz) band than lightly drinking students during eyes closed, both with and without a mental-rehearsal task.

CONCLUSIONS

Heavy student drinkers have increases in EEG synchronisation that are indicative of changes in hippocampal-neocortical connectivity.

SIGNIFICANCE

Heavy student drinkers show differences in functional connectivity as compared to their lightly drinking counterparts, even though they have a relatively short drinking history.

Psychiatric comorbidity and substance use treatment outcomes of adolescents

Treatment outcomes of 126 adolescents (13-18 years old) with comorbid substance use disorders (SUDs) and Axis I psychiatric disorders (mood, anxiety, conduct, and attention-deficit/hyperactivity disorders) were compared to 81 SUD adolescents with no additional Axis I disorder. Participants completed structured interviews and symptom measures while participating in an adolescent treatment program and at 6 months following treatment. Results indicated that comorbid youth received more treatment during the outcome period; despite this, more comorbid SUD-Axis I disordered adolescents used substances following treatment than SUD-only youth, even after controlling for socioeconomic status and ethnicity. Among comorbid youth, internalizing disordered adolescents were less likely to use substances during the follow-up period, and externalizing disordered youth returned to substance use most rapidly after discharge from treatment.

CO(2) hypersensitivity in recently abstinent alcohol dependent individuals:; A possible mechanism underlying the high risk for anxiety disorder among alcoholics

Alcohol, administered acutely, is known to cause CO(2) hyposensitivity. CO(2) hypersensitivity associated with anxiogenic hyperventilation (HV) could reasonably be expected to emerge as an opponent process upon withdrawal from chronic alcohol use. To test this hypothesis, we applied two well-known methods to quantify CO(2) sensitivity in recently detoxified alcohol-dependent individuals and never alcohol-disordered individuals who are social drinkers. We found that the alcoholic group exhibited significantly greater CO(2) sensitivity than did controls in response to both challenges. Indirect evidence of chronic HV was also obtained. These findings implicate the effect of chronic alcohol use on CNS-based CO(2) sensitivity in heightening the vulnerability to disturbing anxiety symptoms and syndromes exhibited by alcoholic individuals. Future work must verify that pathological drinking actually causes the dysregulated respiratory responding observed in this study as is inferred in our conclusions.

Long-term ethanol self-administration by cynomolgus macaques alters the pharmacology and expression of GABAA receptors in basolateral amygdala

We have recently demonstrated that chronic ethanol ingestion alters the functional and pharmacological properties of GABAA receptors measured in acutely isolated rat lateral/basolateral amygdala neurons, a limbic forebrain region involved with fear-learning and innate anxiety. To understand relevance of these results in the context of primates, we have examined the effects of long-term ethanol self-administration on basolateral amygdala GABAA receptor pharmacology and expression in cynomolgus macaques (Macaca fascicularis). The impact of this 18-month-long exposure on GABAA receptor function was assessed in acutely isolated neurons from basolateral amygdala with whole-cell patch-clamp electrophysiology. Neurons from control animals expressed maximal current densities that were not significantly different from the maximal current densities of neurons from ethanol-treated animals. However, the GABA concentration-response relationships from ethanol-exposed neurons were significantly right-shifted compared with control neurons. These adaptations were associated with significant alterations in some characteristics of macroscopic current desensitization. To understand the mechanism governing these adaptations, we quantified GABAA alpha subunit mRNAs in basolateral amygdala from the same animals. mRNA levels of the alpha2 and alpha3 subunits were significantly decreased, whereas decreases in alpha1 expression only approached statistical significance. There were no changes in alpha4 mRNA levels. These findings indicate that ethanol-induced alterations in GABAA function may be regulated in part by selective changes in the expression of particular alpha subunits. We conclude that adaptations of basolateral amygdala GABAA receptors after long-term ethanol self-administration by the cynomolgus macaque are similar, but not identical, to those described in rodents after a brief forced ethanol exposure.

Anxiety and substance use disorders: introduction to the special series

The interplay between anxiety pathology and substance use disorders is increasingly recognized in empirical and clinical work. The present article serves as a general introduction to the special series highlighting the relationship between a number of anxiety conditions and a variety of substance use disorders. In this overview, we first discuss the importance of better understanding the association between anxiety and substance use and abuse followed by a brief review of each study and their major findings. This set of studies has implications for our understanding of the nature of these conditions as well as their treatment. We hope that this body of work will inspire future research in this important area.

Association between anxiety disorders and substance use disorders among young persons: results of a 21-year longitudinal study

OBJECTIVE

To examine the linkages between anxiety disorders and the development of substance use disorders in a birth cohort of young people studied to young adulthood.

METHOD

Data were gathered over the course of a longitudinal study of a birth cohort of over 1000 New Zealand born young people. Over the course of the study, data were gathered on: (a) anxiety disorders and substance use disorders at ages 16-18 and 18-21; (b) a range of potential confounding factors including measures of childhood, social, and family factors.

RESULTS

Young people with anxiety disorders had odds of substance dependence that were between 1.3 and 3.9 times higher than young people without anxiety disorders. These associations were largely explained by a series of covariate factors relating to: (a) childhood and family factors; (b) prior substance dependence; (c) comorbid depression; (d) peer affiliations. After adjustment for these factors, anxiety disorder was unrelated to all measures of substance use.

CONCLUSIONS

Young people with anxiety disorders are at increased risk of substance dependence. However, this association appears to be largely or wholly non causal and reflects the associations between childhood factors, prior substance dependence, comorbid depression, peer affiliations and the development of anxiety disorders.

An integrative review of separation in the context of victimization: consequences and implications for women

Given the number of divorces that occur each year as well as the high rates of intimate partner violence, it is critical that divorce/separation and victimization be considered in research and in clinical practice with women. However, the separation/divorce research and victimization research has often been conducted independently, with limited attention to integration. The integration of these two domains is critically important in facilitating the understanding of these issues for women. This article has 5 main purposes: (a) to review the research on the general consequences of separation; (b) to review the research on the consequences of separation when children are involved; (c) to review the research on the consequences of victimization; (d) to integrate the separation and victimization research to examine separation in the context of victimization; and (e) to discuss the implications of separation in the context of victimization for practice and research.

Alcohol and anxiety: subtle and obvious attributes of abuse in adults with social anxiety disorder and panic disorder

Previous research has found a relation between social anxiety disorder and alcoholism but recent work found no differences in drinking levels among socially anxious individuals, dysthymics, and normal controls. Using a more sophisticated measure of substance abuse may further explicate the relation between social anxiety and drinking. We examined aspects of substance abuse in treatment-seeking individuals with social anxiety disorder or panic disorder (psychiatric control group) as well as nondisordered individuals (normal control group). We used the Substance Abuse Subtle Screening Inventory-3 because it includes both face valid and subtle items to control for social desirability. Contrary to the hypotheses, there were few obvious or subtle aspects of substance abuse significantly greater for individuals with social anxiety disorder than those with panic disorder or normal controls. Implications for understanding the social anxiety-alcohol relationship, assessment of substance abuse in socially anxious populations, and the construct of social anxiety-are discussed.

Prevalence and correlates of mental disorders among Native American women in primary care

OBJECTIVES

We examined the lifetime and the past-year prevalence and correlates of common mental disorders among American Indian and Alaska Native women who presented for primary care.

METHODS

We screened 489 consecutively presenting female primary care patients aged 18 through 45 years with the General Health Questionnaire, 12-item version. A subsample (n = 234) completed the Composite International Diagnostic Interview. We examined associations between psychiatric disorders and sociodemographic variables, boarding school attendance, and psychopathology in the family of origin.

RESULTS

The study participants had high rates of alcohol use disorders, anxiety disorders, and anxiety/depression comorbidity compared with other samples of non-American Indian/Alaska Native women in primary care settings.

CONCLUSIONS

There is a need for culturally appropriate mental health treatments and preventive services.

Alcohol use disorders and psychological distress: a prospective state-trait analysis

The present study examined the association between alcohol use disorders (AUDs) and psychological distress over an 11-year period using a sample of 378 young adults (46% men, 54% women: baseline age = 18.5; 51% with paternal history of alcoholism). The authors examined this relation using a state-trait model, which decomposes variance in a given construct into a general traitlike factor that spans measurement occasion and more situational, occasion-specific variability. Trait AUD and trait distress were correlated (r =.43), suggesting that the tendency to meet criteria for an AUD is associated with the tendency to experience psychological distress. Much of this association was due to 3rd variables (primarily neuroticism but also childhood stressors and behavioral undercontrol), supporting a common 3rd-variable influence model of comorbidity.

Drinking to Cope in Socially Anxious Individuals: A Controlled Study

BACKGROUND

Several hypotheses exist to account for the higher than normal rate of alcoholism in individuals with high trait anxiety (or anxiety disorders). Most of these suggest that the practice of drinking alcohol to reduce anxiety leads to an increased risk of alcoholism in vulnerable individuals. The first assumption of the hypothesis is that anxious individuals use alcohol to cope with their anxiety. Few studies have examined this issue systematically, and none have used a nonanxious matched control group.

METHODS

Twenty-three individuals with high social anxiety and 23 nonsocially anxious matched controls were included in the study. Groups were similar on demographic variables and alcohol use. All participants were queried regarding the use of alcohol to cope, the practice of avoiding social situations if alcohol was not available, and the degree of relief attained by alcohol. Participants also were asked about using alcohol in 11 specific situations.

RESULTS

The socially anxious group was significantly more likely than controls to report using alcohol to feel more comfortable in social situations and to avoid social situations if alcohol was unavailable. They also reported a greater degree of relief of anxiety from alcohol. Exploratory analyses revealed that socially anxious individuals reported using alcohol more to cope with social interactions than with social performance situations.

CONCLUSIONS

Individuals high in social anxiety deliberately drink alcohol to cope with their social fears. They report that alcohol is moderately effective at reducing their anxiety, which is seemingly sufficient to allow them to endure social situations. The data support the first assumption of the self-medication hypothesis-that alcohol is used to reduce social discomfort in socially anxious individuals; however, the study was not designed to address the veracity of the self-medication hypothesis as a whole. Results can help guide future studies that examine the relationship between social anxiety and alcohol.

College students and problematic drinking: a review of the literature

Problem drinking during the college years is a significant public health concern. The goal of the current review was to examine the primary psychosocial factors that predict problem drinking in college students. Variables examined included demographic variables, personality, drinking history, alcohol expectancies, drinking motives, stress and coping, activity involvement, and peer and family influence. Evidence from studies of college drinking indicated that the variables associated with college drinking seem to vary at levels dealing with one's personality and coping mechanisms, one's thought processes about drinking, and the environment. It seems that expectancies and drinking motives may serve as explanations for the pathways from certain personality types (i.e., sensation seeking and neurotic) to problem drinking in the college setting. Factors that predicted future drinking problems after college were also examined. Overall, it seems that interventions and prevention programs would need to reach college students at all three levels--the environment, individual personality traits, and cognitive processes. Future research should address the limitations in the previous research as well as test comprehensive models of college drinking.

Cross cultural evaluation of smokers risk for panic and anxiety pathology: a test in a Russian epidemiological sample

The present study evaluated the main and interactive effects of level of smoking (cigarettes per day) and anxiety sensitivity (fear of anxiety and anxiety related sensations) in predicting panic and anxiety variables in an epidemiologically-defined sample of smokers from Moscow (n=95). The combination of high levels of anxiety sensitivity and smoking predicted agoraphobic avoidance, but not frequency of panic attacks during the past week. These findings suggest anxiety sensitivity may moderate the relation between level of smoking and prototypical panic psychopathology variables (panic attacks and agoraphobic avoidance) even after controlling for the theoretically-relevant factors of alcohol abuse and negative affect.

Anxiety and alcohol abuse disorders: a common role for CREB and its target, the neuropeptide Y gene

It has been hypothesized that anxiety disorders play an important role in the initiation and maintenance of alcohol drinking behaviors. However, the molecular mechanisms for the association between anxiety and alcohol abuse are not well understood. Structures of the extended amygdala, particularly the central nucleus of amygdala, are involved in anxiety and in motivational aspects of alcohol drinking behaviors. Here, I propose that cAMP response element-binding protein (CREB) has a role in anxiety and alcohol drinking behaviors. The CREB gene transcription factor regulates the expression of the gene encoding neuropeptide Y (NPY), and decreased concentrations of NPY are implicated in anxiety and alcohol drinking behaviors. Therefore, decreased function of CREB in the central nucleus of the amygdala might regulate anxiety and alcohol intake via decreased expression of NPY, and might provide a common link between anxiety and alcohol abuse disorders. I also suggest that, via CREB, NPY might interact with other CREB target genes, such as the gene encoding brain-derived neurotrophic factor, and that this CREB-mediated interaction might be important in the regulation of anxiety and alcohol drinking behaviors.

Affect and peer context interactively impact adolescent substance use

Risk factors, such as emotional distress and peer substance involvement, are often tested as competing influences on adolescent substance use. However, the current study examined how affect (both positive and negative) and peers (both in terms of relationship quality and substance involvement) are interactive influences on adolescent substance use. A sample of 398 high school juniors and seniors completed surveys assessing each of these domains. Results of hierarchical regression analyses showed strong associations between an adolescent's and his or her best friend's substance use. Complex interactions supported the study hypothesis in that relations between affect and adolescent substance use were context dependent, with some peer contexts enhancing risk for substance use and others dampening this risk. Implications of these findings for interventions and preventions concerning adolescent substance use are discussed.

Anxiety and substance use comorbidity among inpatients with schizophrenia

OBJECTIVE

To determine the association between lifetime anxiety symptoms and anxiety disorders and substance use disorders among patients with schizophrenia.

METHOD

Participants were 184 inpatients with schizophrenia at the Schizophrenia Research Unit (SRU) at the New York State Psychiatric Institute (NYSPI). Multivariate logistic regression analyses were used to determine the relationship between specific anxiety symptoms and anxiety disorders and substance use disorders among inpatients with schizophrenia.

RESULTS

Anxiety symptoms and anxiety disorders were prevalent among 31.5% of the sample. Panic attacks were associated with a significantly increased odds (OR=7.4 (1.2, 47.1)) of comorbid alcohol or substance use disorders (lifetime). This association was specific to panic attacks and persisted after adjusting for differences in sociodemographic characteristics and comorbid anxiety symptoms and anxiety disorders.

CONCLUSIONS

These findings are consistent with and extend previous data by providing evidence of an association between panic attacks and increased likelihood of substance use disorders among inpatients with schizophrenia. Future studies that determine the nature of this relationship, the sequence of symptom onsets, and examine whether treatment of anxiety can influence the onset or outcome associated with substance use are needed.

Alcohol use among out-of-treatment crack using African-American women

OBJECTIVE

The purpose of this study was to categorize the quantity and frequency of alcohol use among African-American women who were abusing crack cocaine and to explore relationships between categories of alcohol use and demographic variables, cocaine use, comorbidity, and risky sexual behaviors.

METHOD

Data were collected from 635 out-of-treatment crack cocaine-abusing African-American women in the Raleigh/Durham area of North Carolina. The women were categorized as light (n = 272), moderate (n = 216), or heavy drinkers (n = 147).

RESULTS

Women classified as heavy drinkers were demographically similar to light and moderate drinkers. Heavy drinkers used more crack cocaine and were more likely to engage in sexual risk behaviors than were the other two drinking groups. The heavy drinkers also reported greater psychological distress, and they were more likely to report histories of physical, sexual, and emotional abuse.

CONCLUSIONS

Heavy alcohol use among crack-abusing African-American women may be a marker for a host of underlying problems that require special attention. The HIV prevention programs and substance abuse treatment programs that provide services to crack-abusing women should screen for heavy drinking. Women identified as heavy drinkers should undergo more in-depth assessments and receive additional referrals as appropriate.

Self-medication in social phobia: a review of the alcohol literature

It is well documented that many individuals endorse the belief that alcohol reduces social anxiety. Individuals with social phobia, therefore, might be expected to use alcohol as a coping strategy in an attempt at self-medication. The purpose of the present paper was to review the published literature on the relationship between alcohol use and social phobia to test the self-medication hypothesis (SMH). Support for one aspect of the SMH was found; individuals with social phobia use alcohol to reduce anxiety. Support for the second premise, that alcohol actually reduces social anxiety, was less conclusive.

Effects of chronic ethanol consumption on rat GABA(A) and strychnine-sensitive glycine receptors expressed by lateral/basolateral amygdala neurons

It is well known that the anxiolytic potential of ethanol is maintained during chronic exposure. We have confirmed this using a light-dark box paradigm following chronic ethanol ingestion via a liquid diet. However, cessation from chronic ethanol exposure is known to cause severe withdrawal anxiety. These opposing effects on anxiety likely result from neuro-adaptations of neurotransmitter systems within the brain regions regulating anxiety. Recent work highlights the importance of amygdala ligand-gated chloride channels in the expression of anxiety. We have therefore examined the effects of chronic ethanol exposure on GABA(A) and strychnine-sensitive glycine receptors expressed by acutely isolated adult rat lateral/basolateral amygdala neurons. Chronic ethanol exposure increased the functional expression of GABA(A) receptors in acutely isolated basolateral amygdala neurons without altering strychnine-sensitive glycine receptors. Neither the acute ethanol nor benzodiazepine sensitivity of either receptor system was affected. We explored the likelihood that subunit composition might influence each receptor's response to chronic ethanol. Importantly, when expressed in a mammalian heterologous system, GABA(A) receptors composed of unique alpha subunits were differentially sensitive to acute ethanol. Likewise, the presence of the beta subunit appeared to influence the acute ethanol sensitivity of glycine receptors containing the alpha(2) subunit. Our results suggest that the facilitation of GABA(A) receptors during chronic ethanol exposure may help explain the maintenance of ethanol's anti-anxiety effects during chronic ethanol exposure. Furthermore, the subunit composition of GABA(A) and strychnine-sensitive glycine receptors may ultimately influence the response of each system to chronic ethanol exposure.