Substance-Induced Anxiety and Co-occurring Anxiety Disorders

Abstract

Anxiety is an unpleasant emotional state with psychological and physiological symptoms, typically experienced as a normal response to stress, but also occurring pathologically in anxiety disorders, and as a symptom of medical or other psychi- atric conditions, including substance use disorders (SUDs). Anxiety disorders are relatively common in the general population, with a 12-month prevalence of 11% and lifetime prevalence of 16.6% [1, 2]. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) suggest the prevalence of substance-induced anxiety (SIA) disorders is around 1% of all anxiety disorders [1]. While some studies suggest a higher prevalence of SIA versus independent anxi- ety disorders among substance users, these are limited by diagnostic methods that do not conform to DSM criteria [1]. Though the prevalence of SIA in those using substances is relatively low, co-occurring anxiety disorders and SUDs are common, with one study suggesting nearly 15% of those with a known anxiety disorder had at least one independent co-occurring SUD and 17% of those with a known SUD had at least one independent co-occurring anxiety disorder over a single 12-month period [1]. These findings may explain why anxiety is a frequent clinical complaint in substance-using ED patients.