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IBH In-Depth: Anxiety Disorders and Alcohol Abuse

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    Moderate alcohol consumption—a glass of wine with dinner or a few drinks at a party—is no cause for concern for many people.

    However those with anxiety disorders may find that alcohol or other substances can make their anxiety symptoms worse. And they are two to three times more likely to have an alcohol or other substance abuse disorder at some point in their lives than the general population.

    About 20% of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance abuse disorder, and about 20% of those with an alcohol or substance abuse disorder also have an anxiety or mood disorder.

Anxiety Disorder or Substance Abuse: Which Comes First?

    Most people with alcohol or substance abuse and an anxiety disorder experience them independently, but having both can be a vicious cycle.

    The symptoms of one disorder can make the symptoms another worse; an anxiety disorder may lead to using alcohol or other substances to self-medicate or alleviate anxiety symptoms.

Social Anxiety Disorder

    The co-occurrence of substance abuse, particularly alcohol abuse, is common among people who have social anxiety disorder. People with this disorder report that alcohol helps lessen their social anxiety, although it often makes it worse. Alcohol abuse usually develops after the onset of this disorder.

Post-traumatic Stress Disorder (PTSD)

    PTSD and substance abuse commonly occur together. People suffering from this disorder often use alcohol or drugs to try to ease their anxiety, but substance abuse can exacerbate PTSD symptoms.
    Many mental health professionals treat PTSD and substance abuse together because symptoms of PTSD (intrusive thoughts and sleep disturbance) can cause a substance abuse relapse.

Panic Disorder

    Alcohol or drugs often cause panic attacks, and having panic disorder is a risk factor for a relapse among people with a substance abuse disorder. Alcohol abuse commonly begins before or at the same time as panic disorder symptoms.


    Treating substance abuse will not eliminate an anxiety disorder, so it's usually necessary to treat both together, particularly to lessen the chance of relapse.

    People with anxiety and substance abuse disorders are at an increased risk for abuse as well as potentially dangerous interactions when they use prescription medication. Doctors prescribe medications with low abuse potential that are considered safe should a relapse occur. The choice of medication always depends on a person's individual circumstances. Many therapists will use therapy for people with both anxiety and substance abuse disorders.

    A well-established, highly effective, and lasting treatment is cognitive-behavioral therapy, or CBT, which focuses on identifying, understanding, and changing thinking and behavior patterns. Benefits are usually seen in 12-16 weeks, depending on the individual. Joining a support group may also be a good additional treatment option.

The Employee Assistance Program

    A good first step for Lehigh employees and their family members struggling with anxiety and substance abuse is to contact the university’s Employee Assistance Program (EAP), which is managed by Integrated Behavioral Health (IBH).

    The EAP provides confidential access to professional counseling services for help in confronting such personal problems as alcohol and other substance abuse, marital and family difficulties, financial or legal troubles, and emotional distress. It offers problem assessment, short-term counseling, and referral to appropriate community and private services. IBH can be reached at 800-395-1616.

Anxiety Disorders Association of America. (2010). Substance abuse. Retrieved March 11, 2011, from reprinted with permission.

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