Anxiety disorders can compromise success of alcohol-dependence treatment

Individuals who have an anxiety disorder when starting treatment for alcohol dependence have a significantly greater risk for relapse to drinking within four months, according to researchers at the University of Minnesota.

The study also finds that two of the most common anxiety disorders found among alcoholics--social phobia and panic disorder--are more strongly associated with this relapse than other anxiety disorders.

The results of this study will be published in the August issue of Alcoholism: Clinical & Experimental Research.

Researchers and clinicians have long observed that the rate of anxiety disorders among those suffering with alcohol dependence is two to four times greater than that found in the general population.

This study also showed that problematic anxiety remains in many sufferers after treatment for alcohol dependence. About 50 percent of those suffering from anxiety disorders had some form of relapse following treatment for alcohol dependence compared with only about 20 percent who had no form of anxiety disorder.

"At a practical level our study tells clinicians that they should screen for co-occurring anxiety disorders, which is not typically done at this time, and that identifying these disorders, especially social phobia and panic disorder, should serve as a red flag for heightened relapse risk," said Matt G. Kushner, Ph.D., associate professor of psychiatry at the University of Minnesota. "In the past, many clinicians assumed that co-occurring anxiety problems were simply a product of excessive drinking and would stop as soon as the drinking stopped. Our study, on the other hand, suggests that the chances that drinking will stop for as little as four months after treatment is severely undermined by the presence of an active anxiety disorder."

Approximately 15 percent of all adults have anxiety disorders, but the rate of anxiety disorders among alcohol-disordered individuals can be 50 percent or higher.

Different anxiety disorders predicted different aspects of alcohol relapse at alcoholism-treatment follow-up. Having social phobia--significant social fears and avoidance of social situations--at the outset of alcoholism treatment was the best predictor of a return to any drinking at treatment follow-up. Having panic disorder--persistent panic attacks or episodes of intense anxiety and arousal--at the outset of alcoholism treatment was the best predictor of a relapse to dependence at treatment follow-up. This pattern suggests that panic disorder is a risk factor for a major relapse, and social phobia a risk factor for a minor relapse, following alcoholism treatment. The minor relapses associated with social phobia, however, may ultimately have led to major relapses outside of the time-frame of the four-month follow-up.

Kushner and his colleagues examined the diagnostic status and daily drinking patterns of 82 (53 males, 29 females) individuals one week after they entered treatment for alcoholism and again 120 days later (53 individuals participated in the follow-up). Results indicate that screening for co-existing anxiety disorders in an alcoholism-treatment setting is clearly warranted and suggest the need to treat anxiety as part of the alcohol treatment process.