Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature

Abstract

BackgroundThe comorbidity of mood and anxiety disorders (MD and AD) with substance use disorders (SUD) is common. One explanation for this comorbidity is the self‐medication hypothesis, which posits that individuals with MD or AD use substances to cope with the difficult symptoms associated with the disorder. Over time, self‐medication (SM) can develop into an independent SUD. This narrative review will present the prevalence and correlates of SM with alcohol and/or drugs for MD and AD and the relationship between SM and subsequent SUD using both cross‐sectional and longitudinal epidemiological data.MethodsScopus and PsycINFO were searched from January 1997 to April 2018 to identify original research articles that examined the prevalence and correlates of SM and the temporal relationship between MD/AD and SUD in the general population (n = 22).ResultsThe prevalence of SM with alcohol and/or drugs among those with MD or AD ranged from 21.9% to 24.1%. Male sex, younger age, being separated, divorced or widowed, and being Caucasian were characteristics associated with higher proportions of respondents endorsing SM with alcohol/drugs for MD and AD. Longitudinal data supports the temporal onset of primary MD/AD and secondary SUD among those who self‐report SM.ConclusionProviding and promoting alternate coping strategies for those with MD/AD may reduce SM, the development of SUD, and the comorbidity of MD/AD with SUD. The concurrent treatment of MD/AD and substance use is the current “gold standard” model of care, and the results of this review support its use.

CRISPR disruption and UK Biobank analysis of a highly conserved polymorphic enhancer suggests a role in male anxiety and ethanol intake

“…Because of the known link between anxiety and alcohol abuse in men 5 we further investigated the interaction of these variables with respect to the rs2513280 using a subset of the UK Biobank that also contained information relating to anxiety 15 . There was an effect of male sex on AUDIT score with males having significantly higher AUDIT scores than females (b=0.34, S.E.=0.005, p < 2 x 10 -16 ).…”

“…Understanding the processes that modulate preference for ethanol is particularly pressing in men where 7.6% of all male deaths globally is attributable to alcohol (4% in women) through cardiovascular disease, liver damage and cancer 30 . Anxiety remains one of the most frequent co-morbidities associated with excessive alcohol intake 31 and identifying and understanding the genomic mechanisms that link anxiety with excessive alcohol intake will be an important component in understanding and combating alcohol abuse 5 . A previous haplotype analysis of polymorphisms around the GAL gene in two different populations (Finns and Plains Native Americans) identified robust associations with alcohol intake and specific haplotypes 32 .…”

“…Previous studies have shown that the galanin neuropeptide (encoded by the GAL gene) influences alcohol intake 2, 3 and mood 4 . Moreover, genetic analyses of different haplotypes within the GAL locus succeeded in identifying an association with excess alcohol intake that was influenced by sex and axiety 5 . Unfortunately, these studies were unable to define a mechanism to explain these interactions as the GAL coding region lacks non-synonymous polymorphisms 5 .…”

“…Moreover, genetic analyses of different haplotypes within the GAL locus succeeded in identifying an association with excess alcohol intake that was influenced by sex and axiety 5 . Unfortunately, these studies were unable to define a mechanism to explain these interactions as the GAL coding region lacks non-synonymous polymorphisms 5 . Although there is a possibility that mis-regulation of GAL may affect alcohol intake and anxiety, little is known of the genomic mechanisms that modulate the expression of the GAL gene in the brain.…”

Psychological Morbidity among Psychoactive Substance Users in a Rehabilitation Centre in Nigeria

“…Depression is one of the most common psychiatric disorder found among psychoactive substance users [6]. Conway et al reported a prevalence of 29.9% for anxiety and 40.9% for depression [7].…”