As with many situations of comorbidity, there are many possible explanations for the relationship between anxiety disorders and substance-use disorders:1
- an anxiety disorder may promote pathological substance use
- pathological substance use may promote anxiety
- or, a third factor may drive both conditions.
Whatever the reason, comorbid substance-use disorder in a person with an anxiety disorder can complicate the treatment of both conditions.8
References:
1.Kushner MG, Abrams K, Borchardt C. The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings. Clin Psychol Rev 2000; 20 (2): 149–171.
2.Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2004; 61 (8): 807–816.
3.Volkow ND, Li TK. Drug addiction: the neurobiology of behaviour gone awry. Nat Rev Neurosci 2004; 5 (12): 963–970.
4.Kendler KS, Prescott CA, Myers J, Neale MC. The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Arch Gen Psychiatry 2003; 60 (9): 929–937.
5.Baker TB, Piper ME, McCarthy DE, et al. Addiction motivation reformulated: an affective processing model of negative reinforcement. Psychol Rev 2004; 111 (1): 33–51.
6.DuPont RL. Panic disorder and addiction: The clinical issues of comorbidity. Bull Menninger Clin 1997; 61 (2 Suppl A): A54–A65.
7.Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14 (4): 245–258.
8.McHugh RK. Treatment of co-occurring anxiety disorders and substance use disorders. Harv Rev Psychiatry 2015; 23 (2): 99–111.
