Anxiety Disorder and Substance Use Disorder Co-Morbidity: Common Themes and Future Directions

Abstract

(from the chapter) In this concluding chapter to the volume, we first provide a theoretical integration of the material contained in the initial two sections of the book. We review models, theories, and mechanisms to account for the high co-morbidity of anxiety and substance use disorders including notions involving self-medication, substance-induced anxiety, and third variable (e.g., anxiety sensitivity) explanations. Which particular pathway is most likely to be at play in explaining comorbidity onset appears to vary as a function of the precise anxiety disorder involved as well as the specific substance being abused. We then move on to a consideration of processes involved in the maintenance of co-morbidity, as this knowledge may prove most useful in treatment. We consider recent evidence as to whether the presence of a co-morbid anxiety disorder impacts recovery from a substance use disorder. Regardless of the specific pathway to the onset of comorbidity, once both disorders are present, they may serve to maintain one another or even exacerbate one another to create a vicious cycle such that the presence of one disorder can impede recovery from the other. In this chapter, we present an adaptation of Marlatt and Gordon's (1985) cognitive behavioral model to understand the factors and processes involved in the maintenance of anxiety disorder—substance use disorder co-morbidity. We conclude with a review of promising new approaches to the treatment and prevention of comorbid anxiety and substance use disorders. We contrast sequential, parallel, and integrated approaches and present a theoretical argument for the superiority of integrated interventions, setting an agenda for future clinical trials in this area. Finally, various practical issues around the provision of treatment for co-morbid anxiety disorder—substance use disorder patients are considered. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (chapter)