Risk for Future Substance Abuse for Anxious Patients Who Self-Medicate

Kate Johnson

October 01, 2010

October 1, 2010 (Toronto, Ontario) — People with anxiety disorders face an increased risk of developing substance abuse if they self-medicate their symptoms with drugs or alcohol, according to a study presented at the Canadian Psychiatric Association 60th Annual Conference.

"It's important for patients to know the effects that self-medication can have," said Jennifer Robinson, MA, one of the investigators, who is a research associate in the Department of Psychiatry and a PhD student in the Department of Psychology at the University of Manitoba, Winnipeg, Canada.

Although drugs and alcohol may alleviate symptoms of anxiety in the short term, there is evidence to show that in the long term they can exacerbate symptoms — particularly panic, she said.

It is also likely that those who believe they are effectively "treating" their anxiety with alcohol would be less likely to seek out clinical treatment, she said, emphasizing that the study did not formally measure this.

The study analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions, a longitudinal survey that included 34,653 community-dwelling American adults.

Looking at a subgroup of subjects with any Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) anxiety disorder at baseline, the investigators examined whether self-medication with drugs or alcohol predicted substance abuse disorder 3 years later.

Self-medication was defined as the use of either illicit substances or prescription medications at higher doses or frequencies or for a longer duration than prescribed.

None of the subjects reported substance abuse disorders at baseline.

Does Substance Use Mimic Anxiety?

"We wanted to see if we could explain the comorbidity of anxiety disorders and substance abuse," she explained. "Some people think that people with anxiety tend to drink in order to reduce their anxiety, but the other hypothesis is that substance use has effects on the brain and neurotransmitters such that it mimics anxiety."

After adjusting for sociodemographic variables (sex, age, income, marital status, education, ethnicity, region, and urbanicity) and lifetime substance use, as well as baseline mood and personality disorders, the analysis showed that self-medication with drugs was associated with incident drug abuse (adjusted odds ratio [AOR], 4.33) and drug dependence (AOR, 2.44).

In addition, self-medication with alcohol was associated with incident alcohol abuse (AOR, 2.08) and alcohol dependence (AOR, 3.35).

"Most people who are using substances are using alcohol as well, so there's a lot of overlap," explained Ms. Robinson.

"These are people who at baseline were just drinking enough to self-medicate but not enough to be diagnosed with alcohol use disorder, so it might seem relatively safe, but we found it is a risk. Maybe if they treat the anxiety adequately the need for substances will be lessened."

In another group of people who reported substance abuse disorders at baseline and who acknowledged self-medication for subthreshold anxiety symptoms, the odds of developing an incident anxiety disorder were nonsignificant for most anxiety disorders examined, she reported, although further details of this analysis were not available.

"This situation could start with subclinical anxiety, you start to drink, you feel more anxious, and you continue to drink — and it could just spiral in that way," she explained.

Proactive Detection of Underlying Anxiety Disorders

"The dissemination of these findings to both clinicians and the general public would be of significant educational value," said Arun V. Ravindran, MB, PhD, FRCPC, FRCPsych, professor in the Departments of Psychiatry and Psychology at University of Toronto and clinical director of the Mood and Anxiety Disorders Program at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

"The relationship of anxiety disorders and substance use, including alcohol, is a mental health issue of high relevance, which has not been carefully studied," he said. 

"As such, this data will significantly enhance the literature. The common comorbidity of these conditions is well known, and although it is intuitive and commonly believed that people self-medicate with alcohol for anxiety disorders, there are few systematic investigations that confirm this observation. The findings are also useful to clinicians to recognize vulnerable populations who are self-medicating with substances and to proactively detect and treat the underlying anxiety disorders."

Neither the investigators nor the commenter has disclosed any relevant financial relationships.

Canadian Psychiatric Association (CPA) 60th Annual Conference: Abstract P32. Presented September 24, 2010.


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