Substance-Related Risks in People With Anxiety Disorders

Posted on October 18th, 2013

Anxiety Disorders TreatmentAnxiety disorders are a group of nearly a dozen mental health conditions that produce symptoms such as excessive or debilitating worry, dismay, or fear in a range of different circumstances. These conditions are officially recognized and defined in the U.S. by the American Psychiatric Association (APA). People with an anxiety disorder have unusually high risks for developing problems with substance abuse or addiction and qualifying for diagnosis of a condition called substance use disorder. Mental health professionals can pinpoint specific risks with the help of several different screening procedures.

Anxiety Disorder Basics

The APA sets the terms for all officially diagnosable anxiety disorders in a physicians’ guide called the Diagnostic and Statistical Manual of Mental Disorders. The most recent version of this guide (DSM 5) lists the following anxiety-related conditions: panic disorder, agoraphobia, generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, specific phobia, selective mutism, substance/medication-induced anxiety disorder, “other” specified anxiety disorder, “unspecified” anxiety disorder, and anxiety disorder due to another medical condition. One of the most well-known mental health conditions—post-traumatic stress disorder (PTSD)—once belonged to the anxiety disorders category, but now forms the basis for a separate category of mental disorders.

Substance Use Disorder Basics

Substance use disorder is the new collective term that the mental health community uses to describe symptoms related to alcohol, drug, or medication abuse (non-addicted misuse) and alcohol, drug or medication dependence (addiction). This term entered official use in 2013 with the publication of DSM 5. The APA cites two reasons for creating the substance use disorder category. First, issues of abuse and dependence commonly intermingle in ways that make it difficult for doctors and researchers to maintain strict divisions between the two problems; the new change in terms reflects this fact. Second, the change also allows doctors to more accurately indicate the severity of abuse- and addiction-related problems in any given patient .

Substance-Related Risks

Compared to the general population, people diagnosed with an anxiety disorder develop drug addiction roughly six times more often, according to an extensive report published in 2011 in Psychiatric Times. (This report was created before substance use disorder replaced the separate definitions for substance abuse and substance dependence.) Anxiety disorder patients also develop alcohol addiction about two to three times as often as the adult general public.  People with the highest risks for drug addiction are those diagnosed with agoraphobia or generalized anxiety disorder, while the highest risks for alcohol addiction occurs in people diagnosed with agoraphobia or panic disorder.

On its own, the presence of an anxiety disorder increases the chances that an individual will develop a substance use disorder. Other known risk factors for serious substance-related problems in people diagnosed with an anxiety disorder include self-medication with drugs or alcohol to relieve anxiety symptoms, the presence of multiple anxiety-related issues, the combination of anxiety with diagnosable depression, participation in an abusive pattern of alcohol consumption called binge drinking, a family history of substance use disorder, being male, and being a teenager or young adult.

Screening Procedures

Doctors can screen for substance-related issues in anxiety disorder patients using several different procedures, including the Alcohol Use Disorders Identification Test (known as the AUDIT), a shortened version of this test called the AUDIT-C, and a third test called the CAGE questionnaire. The AUDIT contains 10 questions designed to identify problematic patterns of alcohol use such as binge drinking, an inability to control alcohol intake, or an alcohol-related inability to fulfill one’s social or personal responsibilities. The AUDIT-C contains three questions designed to identify the same patterns. The CAGE questionnaire contains four alcohol use-related questions that focus more on psychology and motivation than the AUDIT or the AUDIT-C.

The authors of the report in Psychiatric Times recommend that every patient diagnosed with an anxiety disorder also receive alcohol and drug screening as part of the diagnostic process. They also recommend that doctors follow up this initial testing periodically to identify any substance-related problems that occur during the course of anxiety disorder treatment.

Considerations

Substance use or misuse can trigger the onset of problems that mimic or strongly resemble a range of anxiety-related symptoms. The APA accounts for these situations with the diagnosis of substance/medication-induced anxiety disorder. Up to 50 percent of people diagnosed with an anxiety disorder already have problems with substance abuse or addiction. However, not all of them meet the standards for substance/medication-induced anxiety, which strictly limit the circumstances in which doctors can identify a substance use problem as the actual cause of an anxiety disorder, rather than an independently existing condition.

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