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Social anxiety disorder and alcohol use disorder co-morbidity in the National Epidemiologic Survey on Alcohol and Related Conditions

Published online by Cambridge University Press:  15 September 2009

F. R. Schneier ,
T. E. Foose ,
D. S. Hasin ,
R. G. Heimberg ,
S.-M. Liu ,
B. F. Grant  and
C. Blanco
F. R. Schneier
Affiliation:
New York State Psychiatric Institute, New York, New York, USA Departments of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
T. E. Foose
Affiliation:
New York State Psychiatric Institute, New York, New York, USA Departments of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
D. S. Hasin
Affiliation:
New York State Psychiatric Institute, New York, New York, USA Departments of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
R. G. Heimberg
Affiliation:
Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
S.-M. Liu
Affiliation:
New York State Psychiatric Institute, New York, New York, USA
B. F. Grant*
Affiliation:
Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
C. Blanco
Affiliation:
New York State Psychiatric Institute, New York, New York, USA Departments of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
*
*Address for correspondence: Dr B. F. Grant, Laboratory of Epidemiology and Biometry, Room 3077, Division of Intramural Clinical and Biological Research, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, MS 9304, 5635 Fishers Lane, Bethesda, MD 20892–9304, USA. (Email: bgrant@willco.niaaa.nih.gov)
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Abstract

Background

To assess the prevalence and clinical impact of co-morbid social anxiety disorder (SAD) and alcohol use disorders (AUD, i.e. alcohol abuse and alcohol dependence) in a nationally representative sample of adults in the United States.

Method

Data came from a large representative sample of the US population. Face-to-face interviews of 43093 adults residing in households were conducted during 2001–2002. Diagnoses of mood, anxiety, alcohol and drug use disorders and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV version.

Results

Lifetime prevalence of co-morbid AUD and SAD in the general population was 2.4%. SAD was associated with significantly increased rates of alcohol dependence [odds ratio (OR) 2.8] and alcohol abuse (OR 1.2). Among respondents with alcohol dependence, SAD was associated with significantly more mood, anxiety, psychotic and personality disorders. Among respondents with SAD, alcohol dependence and abuse were most strongly associated with more substance use disorders, pathological gambling and antisocial personality disorders. SAD occurred before alcohol dependence in 79.7% of co-morbid cases, but co-morbidity status did not influence age of onset for either disorder. Co-morbid SAD was associated with increased severity of alcohol dependence and abuse. Respondents with co-morbid SAD and alcohol dependence or abuse reported low rates of treatment-seeking.

Conclusions

Co-morbid lifetime AUD and SAD is a prevalent dual diagnosis, associated with substantial rates of additional co-morbidity, but remaining largely untreated. Future research should clarify the etiology of this co-morbid presentation to better identify effective means of intervention.

Keywords

Alcohol dependencealcohol abuseanxiety disordersepidemiologysocial phobia
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 6 , June 2010 , pp. 977 - 988
Copyright
Copyright © Cambridge University Press 2009

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References

Bakken, K, Landheim, AS, Vaglum, P (2005). Substance-dependent patients with and without social anxiety disorder: occurrence and clinical differences. A study of a consecutive sample of alcohol-dependent and poly-substance-dependent patients treated in two counties in Norway. Drug and Alcohol Dependence 80, 321–328.CrossRefGoogle ScholarPubMed
Balon, R, Mufti, R, Arfken, CL (1999). A survey of prescribing practices for monoamine oxidase inhibitors. Psychiatric Services 50, 945–947.CrossRefGoogle ScholarPubMed
Blanco, C, Antia, SX, Liebowitz, MR (2002). Pharmacotherapy of social anxiety disorder. Biological Psychiatry 51, 109–120.CrossRefGoogle ScholarPubMed
Blanco, C, Schneier, FR, Schmidt, A, Blanco-Jerez, CR, Marshall, RD, Sanchez-Lacay, A, Liebowitz, MR (2003). Pharmacological treatment of social anxiety disorder: a meta-analysis. Depression and Anxiety 18, 29–40.CrossRefGoogle ScholarPubMed
Book, SW, Thomas, SE, Dempsey, JP, Randall, PK, Randall, CL (2009). Social anxiety impacts willingness to participate in addictions treatment. Addictive Behaviors 34, 474–476.CrossRefGoogle Scholar
Book, SW, Thomas, SE, Randall, PK, Randall, CL (2008). Paroxetine reduces social anxiety in individuals with a co-occurring alcohol use disorder. Journal of Anxiety Disorders 22, 310–318.Google Scholar
Brady, KT, Tolliver, BK, Verduin, ML (2007). Alcohol use and anxiety: diagnostic and management issues. American Journal of Psychiatry 164, 217–221; quiz 372.Google Scholar
Buckner, JD, Ledley, DR, Heimberg, RG, Schmidt, NB (2008 a). Treating comorbid social anxiety and alcohol use disorders: Combining motivation enhancement therapy with cognitive-behavioral therapy. Clinical Case Studies 7, 208–223.CrossRefGoogle ScholarPubMed
Buckner, JD, Schmidt, NB, Lang, AR, Small, J, Schlauch, RC, Lewinsohn, PM (2008 b). Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. Journal of Psychiatric Research 42, 230–239.Google Scholar
Buckner, JD, Timpano, KR, Zvolensky, MJ, Sachs-Ericsson, N, Schmidt, NB (2008 c). Implications of comorbid alcohol dependence among individuals with social anxiety disorder. Depression and Anxiety 25, 1028–1037.Google Scholar
Burns, L, Teesson, M (2002). Alcohol use disorders comorbid with anxiety, depression and drug use disorders. Findings from the Australian National Survey of Mental Health and Well Being. Drug and Alcohol Dependence 68, 299–307.Google Scholar
Cameron, OG, Liepman, MR, Curtis, GC, Thyer, BA (1987). Ethanol retards desensitisation of simple phobias in non-alcoholics. British Journal of Psychiatry 150, 845–849.Google Scholar
Chambers, RA, Taylor, JR, Potenza, MN (2003). Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability. American Journal of Psychiatry 160, 1041–1152.CrossRefGoogle ScholarPubMed
Chambless, DL, Fydrich, T, Rodebaugh, TL (2008). Generalized social phobia and avoidant personality disorder: meaningful distinction or useless duplication? Depression and Anxiety 25, 8–19.Google Scholar
Chick, J, Aschauer, H, Hornik, K (2004). Efficacy of fluvoxamine in preventing relapse in alcohol dependence: a one-year, double-blind, placebo-controlled multicentre study with analysis by typology. Drug and Alcohol Dependence 74, 61–70.CrossRefGoogle ScholarPubMed
Cohen, E, Feinn, R, Arias, A, Kranzler, HR (2007). Alcohol treatment utilization: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence 86, 214–221.Google Scholar
Compton, WM, Thomas, YF, Stinson, FS, Grant, BF (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 64, 566–576.CrossRefGoogle ScholarPubMed
Crum, RM, Pratt, LA (2001). Risk of heavy drinking and alcohol use disorders in social phobia: a prospective analysis. American Journal of Psychiatry 158, 1693–1700.CrossRefGoogle ScholarPubMed
Dai, X, Thavundayil, J, Santella, S, Gianoulakis, C (2007). Response of the HPA-axis to alcohol and stress as a function of alcohol dependence and family history of alcoholism. Psychoneuroendocrinology 32, 293–305.Google Scholar
Dawson, DA, Grant, BF, Li, TK (2007). Impact of age at first drink on stress-reactive drinking. Alcoholism, Clinical and Experimental Research 31, 69–77.CrossRefGoogle ScholarPubMed
Duka, T, Townshend, JM, Collier, K, Stephens, DN (2002). Kindling of withdrawal: a study of craving and anxiety after multiple detoxifications in alcoholic inpatients. Alcoholism, Clinical and Experimental Research 26, 785–795.Google Scholar
Gandek, B, Ware, JE Jr., Aaronson, NK, Alonso, J, Apolone, G, Bjorner, J, Brazier, J, Bullinger, M, Fukuhara, S, Kaasa, S, Leplege, A, Sullivan, M (1998). Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology 51, 1149–1158.Google Scholar
Gerlach, AL, Schiller, A, Wild, C, Rist, F (2006). Effects of alcohol on the processing of social threat-related stimuli in socially phobic women. British Journal of Clinical Psychology 45, 279–295.CrossRefGoogle ScholarPubMed
Grant, BF, Dawson, DA, Hasin, DS (2001). The Alcohol Use Disorder and Associated Disabilities Schedule-DSM-IV Version. National Institute on Alcohol Abuse and Alcoholism: Bethesda, MD.Google Scholar
Grant, BF, Dawson, DA, Stinson, FS, Chou, PS, Kay, W, Pickering, R (2003). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence 71, 7–16.Google Scholar
Grant, BF, Hasin, DS, Blanco, C, Stinson, FS, Chou, SP, Goldstein, RB, Dawson, DA, Smith, S, Saha, TD, Huang, B (2005). The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 66, 1351–1361.Google Scholar
Grant, BF, Moore, T, Shepard, J, Kaplan, K (2003). Source and Accuracy Statement: Wave I National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). National Institute on Alcohol Abuse and Alcoholism: Bethesda, MD.Google Scholar
Ham, LS, Bonin, M, Hope, DA (2007). The role of drinking motives in social anxiety and alcohol use. Journal of Anxiety Disorders 21, 991–1003.Google Scholar
Hasin, DS, Liu, X, Alderson, D, Grant, BF (2006). DSM-IV alcohol dependence: a categorical or dimensional phenotype? Psychological Medicine 36, 1695–1705.Google Scholar
Hasin, DS, Stinson, FS, Ogburn, E, Grant, BF (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 64, 830–842.Google Scholar
Johnston, AL, Thevos, AK, Randall, CL, Anton, RF (1991). Increased severity of alcohol withdrawal in in-patient alcoholics with a co-existing anxiety diagnosis. British Journal of Addictions 86, 719–725.Google Scholar
Kashdan, TB, McKnight, PE, Richey, JA, Hofmann, SG (2009). When social anxiety disorder co-exists with risk-prone, approach behavior: investigating a neglected, meaningful subset of people in the National Comorbidity Survey-Replication. Behaviour Research and Therapy 47, 559–568.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929–937.Google Scholar
Kessler, RC (2003). The impairments caused by social phobia in the general population: implications for intervention. Acta Psychiatrica Scandinavica (Suppl.), 19–27.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005 a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.Google Scholar
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005 b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.Google Scholar
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921–926.Google Scholar
Kushner, MG, Abrams, K, Borchardt, C (2000). The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings. Acta Psychiatrica Scandinavica 20, 149–171.Google Scholar
Kushner, MG, Abrams, K, Thuras, P, Hanson, KL, Brekke, M, Sletten, S (2005). Follow-up study of anxiety disorder and alcohol dependence in comorbid alcoholism treatment patients. Alcoholism, Clinical and Experimental Research 29, 1432–1443.CrossRefGoogle ScholarPubMed
Lecrubier, Y (1998). Comorbidity in social anxiety disorder: impact on disease burden and management. Journal of Clinical Psychiatry 59 (Suppl.), S33–S38.Google Scholar
Lecrubier, Y, Weiller, E (1997). Comorbidities in social phobia. International clinical psychopharmacology 12 (Suppl.), S17–S21.CrossRefGoogle ScholarPubMed
Lepine, JP, Pelissolo, A (1998). Social phobia and alcoholism: a complex relationship. Journal of Affective Disorders 50 (Suppl.), S23–S28.CrossRefGoogle ScholarPubMed
Merikangas, KR, Stevens, DE, Fenton, B, Stolar, M, O'Malley, S, Woods, SW, Risch, N (1998). Co-morbidity and familial aggregation of alcoholism and anxiety disorders. Psychological Medicine 28, 773–788.Google Scholar
Moggi, F, Ouimette, PC, Moos, RH, Finney, JW (1999). Dual diagnosis patients in substance abuse treatment: relationship of general coping and substance-specific coping to 1-year outcomes. Addiction 94, 1805–1816.Google Scholar
Olfson, M, Guardino, M, Struening, E, Schneier, FR, Hellman, F, Klein, DF (2000). Barriers to the treatment of social anxiety. American Journal of Psychiatry 157, 521–527.CrossRefGoogle Scholar
Piazza, PV, Le Moal, M (1998). The role of stress in drug self-administration. Trends in Pharmacological Sciences 19, 67–74.Google Scholar
Randall, CL, Thomas, S, Thevos, AK (2001). Concurrent alcoholism and social anxiety disorder: a first step toward developing effective treatments. Alcoholism, Clinical and Experimental Research 25, 210–220.Google Scholar
Ruscio, AM, Brown, TA, Chiu, WT, Sareen, J, Stein, MB, Kessler, RC (2008). Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychological Medicine 38, 15–28.Google Scholar
Sayette, MA, Martin, CS, Perrott, MA, Wertz, JM, Hufford, MR (2001). A test of the appraisal-disruption model of alcohol and stress. Journal of Studies on Alcohol 62, 247–256.Google Scholar
Schneider, U, Altmann, A, Baumann, M, Bernzen, J, Bertz, B, Bimber, U, Broese, T, Broocks, A, Burtscheidt, W, Cimander, KF, Degkwitz, P, Driessen, M, Ehrenreich, H, Fischbach, E, Folkerts, H, Frank, H, Gurth, D, Havemann-Reinecke, U, Heber, W, Heuer, J, Hingsammer, A, Jacobs, S, Krampe, H, Lange, W, Lay, T, Leimbach, M, Lemke, MR, Leweke, M, Mangholz, A, Massing, W, Meyenberg, R, Porzig, J, Quattert, T, Redner, C, Ritzel, G, Rollnik, JD, Sauvageoll, R, Schlafke, D, Schmid, G, Schroder, H, Schwichtenberg, U, Schwoon, D, Seifert, J, Sickelmann, I, Sieveking, CF, Spiess, C, Stiegemann, HH, Stracke, R, Straetgen, HD, Subkowski, P, Thomasius, R, Tretzel, H, Verner, LJ, Vitens, J, Wagner, T, Weirich, S, Weiss, I, Wendorff, T, Wetterling, T, Wiese, B, Wittfoot, J (2001). Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany. Alcohol and Alcoholism 36, 219–223.Google Scholar
Schneier, FR, Martin, LY, Liebowitz, MR, Gorman, JM, Fyer, AJ (1989). Alcohol abuse in social phobia. Journal of Anxiety Disorders 3, 15–23.CrossRefGoogle Scholar
Terra, MB, Barros, HM, Stein, AT, Figueira, I, Jorge, MR, Palermo, LH, Athayde, LD, Goncalves, MS, Spanemberg, L, Possa, MA, Daruy Filho, L, Da Silveira, DX (2006). Social anxiety disorder in 300 patients hospitalized for alcoholism in Brazil: high prevalence and undertreatment. Comprehensive Psychiatry 47, 463–467.Google Scholar
Thomas, SE, Randall, CL, Carrigan, MH (2003). Drinking to cope in socially anxious individuals: a controlled study. Alcoholism, Clinical and Experimental Research 27, 1937–1943.Google Scholar
Thomas, SE, Thevos, AK, Randall, CL (1999). Alcoholics with and without social phobia: a comparison of substance use and psychiatric variables. Journal of Studies on Alcohol 60, 472–479.Google Scholar
Uhart, M, Oswald, L, McCaul, ME, Chong, R, Wand, GS (2006). Hormonal responses to psychological stress and family history of alcoholism. Neuropsychopharmacology 31, 2255–2263.Google Scholar
Vollebergh, WA, Iedema, J, Bijl, RV, de Graaf, R, Smit, F, Ormel, J (2001). The structure and stability of common mental disorders: the NEMESIS study. Archives of General Psychiatry 58, 597–603.Google Scholar
Wang, PS, Lane, M, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629–640.Google Scholar
Watkins, KE, Hunter, SB, Wenzel, SL, Tu, W, Paddock, SM, Griffin, A, Ebener, P (2004). Prevalence and characteristics of clients with co-occurring disorders in outpatient substance abuse treatment. American Journal of Drug and Alcohol Abuse 30, 749–764.Google Scholar
Zimmermann, P, Wittchen, HU, Hofler, M, Pfister, H, Kessler, RC, Lieb, R (2003). Primary anxiety disorders and the development of subsequent alcohol use disorders: a 4-year community study of adolescents and young adults. Psychological Medicine 33, 1211–1222.Google Scholar