The treatment of anxiety in patients with alcoholism.

The high incidence and the high comorbidity of alcohol and anxiety problems make the relationship between these two disorders one of the most important issues clinicians have to address. However, many general psychiatrists have had minimal training in treating patients with addictions, and many experts on alcoholism have not fully mastered the armamentarium of approaches to treating anxiety. In general, special problems exist in treating anxiety in patients with alcoholism, particularly in those patients with anxiety disorders. The clinician must analyze and treat the complicated interaction between these disorders and target the right combination and sequences of treatment fitting the specific needs of the case. The effects of intoxication, withdrawal, and chronic use on anxiety and need to be taken into account and the primary vs. secondary nature of the disorders needs to be determined. Parameters for choosing setting, modality, pharmacologic approaches, and issues in treating special populations will be discussed. Decisions about treatment should be based on sound knowledge of the epidemiology, diagnostic issues, genetics, pathophysiology, biological aspects, clinical course, complications, and treatment-outcome studies of anxiety and alcohol disorders. The wise clinician also needs to show flexibility in approaching treatment-resistant cases.