Explaining the association between anxiety disorders and alcohol use disorder: A twin study

Abstract

Background: It is unknown whether social anxiety disorder (SAD) has a unique association with alcohol use disorder (AUD) over and beyond that of other anxiety disorders, how the associations develop over time, and whether the associations are likely to be causal.Methods: Diagnoses of AUD, SAD, generalized anxiety disorder, panic disorder, agoraphobia, and specific phobias were assessed twice using the Composite International Diagnostic Interview among 2,801 adult Norwegian twins. The data were analyzed using logistic regression analyses and multivariate biometric structural equation modeling.Results: SAD had the strongest association with AUD, and SAD predicted AUD over and above the effect of other anxiety disorders. In addition, SAD was prospectively associated with AUD, whereas other anxiety disorders were not. AUD was associated with a slightly elevated risk of later anxiety disorders other than SAD. Biometric modeling favored a model where SAD influenced AUD compared to models where the relationship was reversed or due to correlated risk factors. Positive associations between AUD and other anxiety disorders were fully explained by shared genetic risk factors.Conclusions: Unlike other anxiety disorders, SAD plausibly has a direct effect on AUD. Interventions aimed at prevention or treatment of SAD may have an additional beneficial effect of preventing AUD, whereas interventions aimed at other anxiety disorders are unlikely to have a similar sequential effect on AUD. K E Y W O R D S agoraphobia, alcohol use disorder, anxiety disorders, social anxiety disorder, social phobia, specific phobia, twin studies Depress Anxiety. 2019;36:522-532. wileyonlinelibrary.com/journal/da 522 |

Substance use among patients in specialized mental health services in Norway: prevalence and patient characteristics based on a national census

“…Also in line with previous reports [4,8], the use of illegal substances, particularly cannabis, occurred more frequently among inpatients than outpatients, and among patients with schizophrenia and other psychoses compared to patients with other mental disorders. Although the association between the use of illicit drugs and severe mental illness is frequently recognized in the literature, the basis for the link is still being discussed [25][26][27]. For example, research concerning the association between schizophrenia and SUD has suggested a common genetic risk [28], or that patients with a genetic risk for schizophrenia are more vulnerable to substance use [29].…”

Substance use among patients in specialized mental health services in Norway: prevalence and patient characteristics based on a national census

“…Also in line with previous reports [7,10], use of illegal substances, particularly cannabis, occurred more frequently among in-patients than outpatients, and, as hypothesized, among patients with the most severe mental disorders (e.g., schizophrenia and other psychoses). Although the association between use of illicit drugs and severe mental illness is frequently recognized in the literature, the basis for the link is still being discussed [30][31][32]. For example, research concerning the association between schizophrenia and SUD has suggested a common genetic risk [33], or that patients with a genetic risk for schizophrenia are more vulnerable to substance use [34].…”

Substance use among patients in specialized mental health services in Norway: prevalence and patient characteristics based on a national census

“…Also in line with previous reports [8,4], use of illegal substances, particularly cannabis, occurred more frequently among inpatients than outpatients, and among patients with the most severe mental disorders (e.g., schizophrenia and other psychoses). Although the association between use of illicit drugs and severe mental illness is frequently recognized in the literature, the basis for the link is still being discussed [25][26][27]. For example, research concerning the association between schizophrenia and SUD has suggested a common genetic risk [28], or that patients with a genetic risk for schizophrenia are more vulnerable to substance use [29].…”