Background. This study examined the patterns of
familial aggregation and co-morbidity of
alcoholism and anxiety disorders in the relatives of 165 probands
selected for alcoholism and/or
anxiety disorders compared to those of 61 unaffected controls.
Methods. Probands were either selected from treatment
settings or at random from the community.
DSM-III-R diagnoses were obtained for all probands and their 1053
first-degree relatives, based on
direct interview or family history information.
Results. The findings indicate that: (1) alcoholism
was associated with anxiety disorders in the
relatives, particularly among females; (2) both alcoholism and
anxiety disorders were highly
familial; (3) the familial aggregation of alcoholism was
attributable to alcohol dependence rather
than to alcohol abuse, particularly among male relatives; and (4)
the pattern of co-aggregation of
alcohol dependence and anxiety disorders in families differed
according to the subtype of anxiety
disorder; there was evidence of a partly shared diathesis underlying
panic and alcoholism, whereas
social phobia and alcoholism tended to aggregate independently.
Conclusions. The finding that the onset of social phobia
tended to precede that of alcoholism, when
taken together with the independence of familial aggregation of
social phobia and alcoholism
support a self-medication hypothesis as the explanation for the
co-occurrence of social phobia and
alcoholism. In contrast, the lack of a systematic pattern in the
order of onset of panic and
alcoholism among subjects with both disorders as well as evidence
for shared underlying familial
risk factors suggests that co-morbidity between panic disorder and
alcoholism is not a consequence
of self-medication of panic symptoms. The results of this study
emphasize the importance of
examining co-morbid disorders and subtypes thereof in identifying
sources of heterogeneity in the pathogenesis of alcoholism.