Alcohol problems and anxiety disorders--a critical review.

The assumption that, within clinical populations, anxiety reduction is a major factor in the aetiology of drinking problems no longer appears to be a plausible explanation of the available data. There are many studies which document the occurrence of anxiety symptoms in problem drinkers but the difficulty lies in deciding which comes first, the alcohol problem or the anxiety. Evidence is reviewed which indicates that anxiety is likely, in most instances, to be a consequence rather than a cause of heavy drinking. This has implications for the treatment of patients with both disorders. The assessment and management of patients with a 'dual-diagnosis' of alcohol dependence and anxiety is discussed in the light of these findings.