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It has long been known that mental disorders such as anxiety can exist with other illnesses. We refer to that as co-morbidities — for example, anxiety as one morbidly and alcohol and substance abuse as the other. This week, in the, is a study looking at whether those who self-medicate with alcohol and other substances have a higher risk of having a substance abuse problem and anxiety disorders.

We do know that substance abuse and anxiety disorders co-exist and the prevalence of one disorder among those having the other disorder is greater than rates of the individual disorders alone. The potential explanations include that self-medicating is an attempt to reduce tension or anxiety BUT that self-medicating can then lead to the development of a co-morbid substance abuse disorder. Other studies have reported that the onset of anxiety occurs BEFORE the substance abuse use. As well, it is known that alcohol and some drugs can act to decrease anxiety and encourage its ongoing use.

On the other hand, some researchers think the direction of these two illnesses is the opposite. In other words, it is the substance abuse that then leads to the development of an anxiety disorder. Substance abuse can worsen psychiatric symptoms and withdrawal from substances can mimic anxiety disorders by impacting on brain neurotransmitters. There are reports that a protracted abstinence syndrome is associated with anxiety disorders and these symptoms can last up to TEN years. Then, the withdrawal symptoms would lead back to self-medication with substances.

In this study, the researchers looked at those who had a baseline anxiety disorder and the future development of a substance abuse problem as well as those with baseline substance abuse disorders and the development of anxiety disorders. What was found was that those who self-medicated with an anxiety disorder had a substantial risk of developing a substance use disorder. Those who self-medicated with an existing substance use disorder were at greater risk of developing a new social phobia.

Each of these disorders — anxiety and substance abuse — puts one at significantly increased risk of developing the other. Using alcohol and drugs as self-medication puts one at risk for developing a substance disorder and more so if you had anxiety as a baseline event. Self-medication as well put the user at significant future risk for developing a social anxiety disorder. That may be because alcohol unmasks an otherwise present but undiagnosed social anxiety disorder OR because they don’t want to stop the substance and therefore avoid social contact so that they are not judged by others and this may then develop into an abstinence phobia. They don’t want to stop and would rather avoid people.

What was most important was that even with a known co-morbid illness, substance abuse predicted the persistence of a substance abuse disorder rather than an anxiety disorder. This study highlights the importance of diagnosing and treating substance abuse. Treating self-medicating behaviour can lead to decreasing both morbidities.

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