Comorbidity of Alcoholism and Anxiety Disorders: The Role of Family Studies.

People with alcoholism frequently also suffer from an anxiety disorder. The mechanisms underlying this comorbidity remain unclear. Clinical findings indicate that anxiety disorders may lead to the development of alcoholism. Conversely, alcoholism may contribute to the development of anxiety symptoms. Family studies have reported elevated rates of anxiety disorders in the relatives of patients with alcoholism and vice versa, suggesting that both disorders may share some susceptibility factors. The Yale Family Study of the comorbidity of alcoholism and anxiety confirmed these observations. The study also found gender-specific differences in the risk for some comorbid anxiety disorders. Moreover, the relatives of people with alcohol dependence or anxiety were at increased risk for alcohol dependence but not alcohol abuse. KEY WORDS: comorbidity; AOD dependence; anxiety state; family study; prevalence; hereditary factors; risk factors; gender differences; treatment Numerous clinical and epidemiological studies' have demonstrated the comorbidity of alcoholism2 and anxiety disorders (reviewed in Wesner 1990; Kushner et al. 1990; George et al. 1990; Crowley and Riggs 1995; Schuckit and Hesselbrock 1994). The confirmation of an association between alcoholism and anxiety disorders in large-scale epidemiological studies suggests that the observed frequent comorbidity is not attributable to the fact that patients with both disorders may be more likely to enter treatment and thus be overrepresented in clinical studies (Regier et al. 1990a; Kessler et al. 1996). The mechanisms underlying this comorbidity remain unknown, largely because of the highly variable manifestations (i.e., the heterogeneity) of both disorders and the disparate methodologies employed in the various studies. In general, however, the comorbidity of alcoholism and anxiety appears to be far more common in women than in men, in individuals diagnosed with alcohol dependence rather than alcohol abuse, and among people with phobic states rather than panic or generalized anxiety states (for a definition of these terms, see the following section). This article provides an overview of the prevalence and the potential mechanisms underlying the comorbidity of alcoholism and anxiety disorders. The article also describes how family studies may help elucidate the association between these disorders and presents data from a recent family study conducted at Yale University. ANXIETY DISORDERS The anxiety disorders of adulthood compose one of the most common groups of psychiatric disorders in the general population, with prevalence rates in the community as high as 25 percent (Kessler et al. 1994). Anxiety is medically defined as "the apprehension of danger and dread accompanied by restlessness, tension, tachycardia3 and dyspnea4 unattached to a clearly identified stimulus" (Stedman 1996, p.187). Several different subtypes of anxiety exist that are defined by differences in the specific stimulus (or lack thereof) and the nature of the anxiety. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) specifies 12 major categories of anxiety disorders, such as panic disorder with or without agoraphobia, specific or social phobia, generalized anxiety disorder, or substance-induced anxiety disorder. Some of the more common anxiety disorders and their symptoms include the following: Panic disorders with or without agoraphobia are characterized by panic attacks-sudden episodes of intense fearfulness or terror that are accompanied by autonomic nervous system reactions, such as palpitations (i.e., a pounding or racing of the heart), sweating, or shortness of breath. Agoraphobia with and without accompanying panic disorder involves the avoidance of places or situations from which escape might be difficult-for example, being in a crowd of people, or traveling on a bridge or in an elevator. …