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Both Barrels:
The Devastating Comorbidity of Anxiety Disorders and Substance Abuse

(Released May 2012)

  by J. Erick Sinkhorn  


Key Citations




Resources News Articles
Historical Newspapers

News Articles

  1. Comorbidity of alcoholism and anxiety disorders.

    Merikangas, Kathleen R.; Stevens, Denise; Fenton, Brenda, Alcohol Health & Research World, 03-01-1996

    Numerous clinical and epidemiological studies(1) have demonstrated the comorbidity of alcoholism(2) and anxiety disorders (reviewed in Wesner 1990; Kushner et al. 1990; George et al. 1990; Crowley and Riggs 1995; Schuckit and Hesselbrock 1994). The confirmation of an association between alcoholism and anxiety disorders in large-scale epidemiological studies suggests that the observed frequent comorbidity is not attributable to the fact that patients with both disorders may be more likely to enter treatment and thus be overrepresented in clinical studies (Regier et al. 1990a; Kessler et al. 1996). The mechanisms underlying this comorbidity remain unknown, largely because of the highly variable manifestations (i.e., the heterogeneity) of both disorders and the disparate methodologies employed in the various studies. In general, however, the comorbidity of alcoholism and anxiety appears to be far more common in women than in men, in individuals diagnosed with alcohol dependence rather than alcohol abuse, and among people with phobic states rather than panic or generalized anxiety states (for a definition of these terms, see the following section).

    This article provides an overview of the prevalence and the potential mechanisms underlying the comorbidity of alcoholism and anxiety disorders. The article also describes how family studies may help elucidate the association between these disorders and presents data from a recent family study conducted at Yale University...

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    Sprang, Ronald W, Infantry, 04-01-2011

    There has been a lot of discussion throughout American society and the military culture of late on post-traumatic stress disorder (PTSD) and resiliency. After experiencing it firsthand, I realized there are still many misperceptions and a definite stigma related to those who experience PTSD. This article is by no means an all-inclusive look, but I would like to provide an account of my experiences in the hopes of encouraging others to get help if they believe they may be suffering from PTSD as well.

    Post-traumatic stress disorder is defined by the Department of Veteran Affairs' National Center for PTSD as, "an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening."

    There are four primary symptoms of PTSD as defined by the National Center for PTSD: 1. Reliving the event (also called reexperiencing symptoms) 2. Avoiding situations that remind you of the event 3. Feeling numb 4. Feeling keyed up (also called hyperarousal) It is possible to experience some or all of those symptoms, or as in my case, to feel them all very vividly...

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  3. Uncovering an Epidemic – Screening for Mental Illness in Teens

    Friedman, Richard A, The New England Journal of Medicine, 12-28-2006

    Courtney, a 15-year-old from Portland, Oregon, always knew she was different from the other kids. "I had a sense that something was going on, but I was afraid to say anything because I didn't know anyone else had a similar problem," she said. Like thousands of U.S. teens, Courtney participated in a mental health screening program that was offered in her school. "Teenagers have a hard time asking for help," she explained. "Without the screening, I'm not sure how I would have gotten the help I needed."

    Before screening, Courtney was part of a silent epidemic of mental illness among teenagers. We know from the National Comorbidity Survey that half of all serious adult psychiatric illnesses – including major depression, anxiety disorders, and substance abuse – start by 14 years of age, and three fourths of them are present by 25 years of age (see table).1 Yet the majority of mental illness in young people goes unrecognized and untreated, leaving them vulnerable to emotional, social, and academic impairments during a critical phase of their lives. Even those who receive treatment tend to do so only after a long delay: 6 to 8 years for patients with mood disorders and 9 to 23 years for those with anxiety disorders

    But it is not psychiatric morbidity that makes headlines; rather, it is the most extreme consequence of psychiatric illness: suicide. In the United States, suicide is the third-leading cause of death among persons 15 to 19 years of age. In 2005 alone, according to the Centers for Disease Control and Prevention, 16.9% of U.S. high school students seriously considered suicide, and 8.4% had attempted suicide at least once during the preceding year...

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Historical Newspapers
  1. Almost One in 5 May Have Mental Disorder; Almost One in 5 U.S. Adults May Have Mental Disorder

    By HAROLD M. SCHMECK Jr., New York Times (1923-Current file). New York, N.Y.: Oct 3, 1984. pg. A1, 2 pgs

    Abstract (Summary) Almost one adult American in five has a mental disorder and the rates are about equal for men and women, according to a federally sponsored survey, the most comprehensive ever done of psychiatric problems in the United States.

    Original Newspaper Image (PDF)

  2. Dramatic Overlap of Addiction, Mental Illness

    Sandy Rovner Washington Post Staff Writer, The Washington Post (1974-Current file). Washington, D.C.: Nov 27, 1990. pg. 10, 2 pgs

    Abstract (Summary) Finally the largest, most definitive population study of mental illness in this country has demonstrated what many have suspected for years: Many people who drink or who abuse drugs have an underlying mental illness—and many people suffering from a mental disorder also become alcoholics and drug...

    Original Newspaper Image (PDF)

  3. ANXIETY; New Research Suggests That It's More Than Just a State of Mind

    JOAN SWEENEY, Los Angeles Times (1923-Current File). Los Angeles, Calif.: Oct 25, 1982. pg. B3, 1 pgs

    Abstract (Summary) Accumulating evidence indicates that crippling anxiety attacks in some people are caused by a metabolic defect for which they have an inherited vulnerability, a weekend psychiatric symposium on the diagnosis and treatment of anxiety disorders was told.

    Original Newspaper Image (PDF)

Taken from ProQuest's Historical Newspapers.


  1. Anxiety and Alcohol Involvement Across the Substance Use Continuum

    by Tomlinson, Kristin Leigh, Ph.D., University of California, San Diego, 2011 , 140 pages; AAT 3474151

    Abstract (Summary)
    The link between anxiety disorders and alcohol abuse and dependence has been established in adults, but the relationship between anxiety and adolescent alcohol involvement is less clear. In this dissertation, we compared explanatory models of substance use including the self-medication hypothesis, the social learning model, and the rebound hypothesis to characterize the association between anxiety and alcohol use in groups with various levels of experience with drinking. Additionally, we included depression symptoms in our studies to assess whether the relationships we found between anxiety and alcohol were unique or similar to those found with other forms of negative affect. In chapter 1, we investigated the relationships between several types of social anxiety symptoms and the onset of alcohol use in middle school students. We found that social anxiety significantly predicted initiation of drinking at both extremely high and low levels, and sex differences were observed. Chapter 2 follows with an analysis of the impact of social anxiety, depression, and alcohol expectancies on youths' drinking. We found that the self-medication hypothesis characterized the relationship between depression symptoms and drinking behavior, while the relationship between social anxiety and alcohol use was explained by social learning theory. Chapters 3 and 4 examined alcohol and drug use relapse characteristics in an adolescent substance use disordered treatment sample. In chapter 3 we found that compared to youth with only a substance use disorder, comorbid youth relapsed more often and more rapidly after treatment. In chapter 4, anxiety symptoms were more likely reported to improve than worsen immediately after relapse and in the two weeks following the relapse episode, indicating support for the self-medication hypothesis, while depression symptoms worsened in youth who relapsed with stimulants, which is consistent with a rebound effect. Chapter 5 is a replication of the study in chapter 4 with adults post-treatment for substance use disorders, with and without comorbid psychopathology. Unlike in the adolescent sample, almost no adults reported improvements in any psychiatric symptoms following relapse, however depression symptoms were rated as worsening more than anxiety symptoms.

    For full-text documents see ProQuest's Dissertations & Theses Database

  2. An analysis of the relationships among trauma, posttraumatic stress, health risk behaviors and physical health using the National Comorbidity Survey Replication data

    by Del Gaizo, Ariel Lynn, Ph.D., University of South Dakota, 2010 , 94 pages; AAT 3429604

    Abstract (Summary)
    Both experiencing a traumatic event and PTSD are related to physical health problems (e.g., Schnurr & Spiro, 1999) and an increased risk for engaging in health risk behaviors such as drinking alcohol, using drugs, and smoking tobacco (e.g., Springs & Friedrich, 1992). Most research has found that PTSD mediates the relationship between traumatic event exposure and physical health. However, it is unclear if there is an indirect/mediational relationship between traumatic event exposure and health risk behaviors through PTSD. In addition, Schnurr and Jankowski (1999) proposed a model that consisted of mechanisms through which PTSD may lead to poor physical health, including engaging in health risk behaviors as one such mechanism. However, research has not adequately evaluated this relationship. This study used archival data from the National Comorbidity Survey Replication (NCS-R, Kessler, et al., 2004), which was conducted between February 2001 and April 2003. This nationally representative sample was used to investigate the interrelationships among the frequency of traumatic event exposure, PTSD diagnosis, overall physical health, and health risk behaviors involving substance abuse with structural equation modeling. Results provide limited evidence that PTSD mediates the relationship between frequency of traumatic event exposure and poor physical health because the effect was modest in size. It was also found that PTSD mediates the relationship between frequency of traumatic event exposure and engaging in health risk behaviors involving substance abuse, but this was also a modest effect size. There were mixed findings with regards to engaging in health risk behaviors involving substance abuse as a mediator of the relationship between PTSD diagnosis and poor physical health. The results provide little support for engagement of health risk behaviors as a mediator.

    For full-text documents see ProQuest's Dissertations & Theses Database

  3. Examination of anxiety and substance use symptoms in trauma exposed versus environmentally stressed college students

    by Souza, Theresa M., Ph.D., Western Michigan University, 2011 , 57 pages; AAT 3492982

    Abstract (Summary)
    Anxiety is a common problem among the college population, which rarely occurs in isolation. Oftentimes, an individual abuses substances in an attempt to eliminate the short term affect of these conditions. Post Traumatic Stress Disorder (PTSD), is the most persistent and severe type of anxiety disorder. It has been a long-standing belief within the psychological community that in order for PTSD to develop, the individual must first experience a traumatic event which meets certain criteria and must evidence a definable emotional response during the event. A recent study found PTSD in individuals who had not experienced the type of trauma described in the DSM-IV-TR, but had experienced long-term general life stressors. The purpose of the present pilot study was to determine if people with substance abuse disorder, who also reported high levels of anxiety and who had been excluded from a previous study based on enrollment criteria, also showed qualifying PTSD symptoms without a qualifying trigger event. The purpose was to determine if a larger scale study was merited. Participants completed a series of questionnaires on life stressors, trauma history, anxiety, depression, and substance use. They also completed a semi-structured clinical interview to evaluate PTSD symptoms. The results indicated that on most depression and anxiety measures, the groups were not significantly different from each other despite the presence or absence of a DSM-IV-TR trauma qualifying event. Furthermore, clinical levels of PTSD symptoms were found among several individuals who had not experienced a traumatic event, indicating that a larger scale study is warranted.

    For full-text documents see ProQuest's Dissertations & Theses Database