CONTEXT: Self-medication of anxiety symptoms with alcohol, other drugs, or both has been a plausible mechanism for the co-occurrence of anxiety disorders and substance use disorders. However, owing to the cross-sectional nature of previous studies, it has remained unknown whether self-medication of anxiety symptoms is a risk factor for the development of incident substance use disorder or is a correlate of substance use. OBJECTIVE: To examine whether self-medication confers risk of comorbidity. DESIGN: A longitudinal, nationally representative survey was conducted by the National Institute on Alcohol Abuse and Alcoholism. The National Epidemiologic Survey on Alcohol and Related Conditions assessed DSM-IV psychiatric disorders, self-medication, and sociodemographic variables at 2 time points. SETTING: The United States. PARTICIPANTS: A total of 34 653 US adults completed both waves of the survey. Wave 1 was conducted in 2001-2002, and wave 2 interviews occurred 3 years later (2004-2005). MAIN OUTCOME MEASURES: Incident substance use disorders in participants with baseline anxiety disorders and incident anxiety disorders in those with baseline substance use disorders. RESULTS: Logistic regression analyses revealed that self-medication conferred a heightened risk of new-onset substance use disorders in those with baseline anxiety disorders (adjusted odds ratios [AORs], 2.50-4.99 [P < .01]). Self-medication was associated with an increased risk of social phobia (AOR in baseline alcohol use disorders, 2.13 [P = .004]; AOR in baseline drug use disorders, 3.17 [P = .001]). CONCLUSIONS: Self-medication in anxiety disorders confers substantial risk of incident substance use disorders. Conversely, self-medication in substance use disorders is associated with incident social phobia. These results not only clarify several pathways that may lead to the development of comorbidity but also indicate at-risk populations and suggest potential points of intervention in the treatment of comorbidity.
CONTEXT: Self-medication of anxiety symptoms with alcohol, other drugs, or both has been a plausible mechanism for the co-occurrence of anxiety disorders and substance use disorders. However, owing to the cross-sectional nature of previous studies, it has remained unknown whether self-medication of anxiety symptoms is a risk factor for the development of incident substance use disorder or is a correlate of substance use. OBJECTIVE: To examine whether self-medication confers risk of comorbidity. DESIGN: A longitudinal, nationally representative survey was conducted by the National Institute on Alcohol Abuse and Alcoholism. The National Epidemiologic Survey on Alcohol and Related Conditions assessed DSM-IV psychiatric disorders, self-medication, and sociodemographic variables at 2 time points. SETTING: The United States. PARTICIPANTS: A total of 34 653 US adults completed both waves of the survey. Wave 1 was conducted in 2001-2002, and wave 2 interviews occurred 3 years later (2004-2005). MAIN OUTCOME MEASURES: Incident substance use disorders in participants with baseline anxiety disorders and incident anxiety disorders in those with baseline substance use disorders. RESULTS: Logistic regression analyses revealed that self-medication conferred a heightened risk of new-onset substance use disorders in those with baseline anxiety disorders (adjusted odds ratios [AORs], 2.50-4.99 [P < .01]). Self-medication was associated with an increased risk of social phobia (AOR in baseline alcohol use disorders, 2.13 [P = .004]; AOR in baseline drug use disorders, 3.17 [P = .001]). CONCLUSIONS: Self-medication in anxiety disorders confers substantial risk of incident substance use disorders. Conversely, self-medication in substance use disorders is associated with incident social phobia. These results not only clarify several pathways that may lead to the development of comorbidity but also indicate at-risk populations and suggest potential points of intervention in the treatment of comorbidity.
Authors: Maria E Pagano; Alexandra R Wang; Brieana M Rowles; Matthew T Lee; Byron R Johnson Journal: Alcohol Clin Exp Res Date: 2015-05 Impact factor: 3.455
Authors: Stephanie M Gorka; Stewart A Shankman; Thomas M Olino; John R Seeley; Derek B Kosty; Peter M Lewinsohn Journal: Drug Alcohol Depend Date: 2014-05-04 Impact factor: 4.492
Authors: Arpana Agrawal; Rebecca Tillman; Richard A Grucza; Elliot C Nelson; Vivia V McCutcheon; Lauren Few; Kenneth R Conner; Michael T Lynskey; Danielle M Dick; Howard J Edenberg; Victor M Hesselbrock; John R Kramer; Samuel Kuperman; John I Nurnberger; Marc A Schuckit; Bernice Porjesz; Kathleen K Bucholz Journal: J Affect Disord Date: 2017-02-03 Impact factor: 4.839