Short CommunicationLongitudinal investigation of the impact of anxiety and mood disorders in adolescence on subsequent substance use disorder onset and vice versa
Highlights
► This longitudinal study examined whether emotional disorders predict SUD onset and vice versa. ► Baseline data and 4 years of follow-up were included for 627 participants. ► Anxiety and mood disorders predicted onset of SUDs. ► Social anxiety disorder predicted onset of alcohol use disorders and PTSD predicted onset of SUDs. ► SUDs did not predict emotional disorders in general but they did predict OCD onset.
Introduction
Epidemiological, cross-sectional studies have documented elevated prevalence of substance use disorders (SUDs) in individuals with emotional disorders (i.e., mood and anxiety disorders), and vice versa (e.g., Conway et al., 2006, Grant et al., 2004, Kessler, Berglund, et al., 2005). This comorbidity is present across various emotional disorders and with different primary substances (e.g., Chilcoat and Breslau, 1998, Compton et al., 2007, Conway et al., 2006, Schneier et al., 2010).
Several theories of comorbidity patterns among emotional disorders and SUDs have been proposed. The “self-medication” theory suggests that individuals with emotional disorders use substances to alleviate distress (Kushner et al., 1990, Smith and Book, 2010). Indeed, drinking motives among those with mood or anxiety symptoms include escape from negative emotions and reduction of tension (Goldstein and Flett, 2009, Kuntsche et al., 2006). The theory is also supported by some of the age of onset research (e.g., Buckner et al., 2008, Kuo et al., 2006, Schneier et al., 2010) including treatment-seeking samples where anxiety disorders preceded alcohol use disorders (AUD) in the large majority of those with generalized anxiety disorder/AUD and social anxiety disorder/AUD comorbidity (Smith and Book, 2010, Terra et al., 2006).
In contrast, the substance-induced enhancement theory suggests that multiple intoxication and withdrawal experiences engender anxiety, thus contributing to anxiety disorder onset (Kushner et al., 1990, Zvolensky and Schmidt, 2003). Indeed, cocaine and marijuana use increase risk for panic attacks, and cocaine use is associated with panic disorder onset (Anthony, Tien, & Petronis, 1989). Also, some studies show SUDs confer risk for MDD and not vice versa (e.g., Fergusson et al., 2009, Rao et al., 2000). Further, neurobiological perspectives suggest that repetitive episodes of alcohol intoxication and withdrawal alter key inhibitory (GABAnergic) and excitatory (glutamatergic) neuronal circuits that modulate fear circuits, thereby inducing anxiety (Breese, Overstreet, & Knapp, 2005). Studies supporting either of these two theories have mostly used designs involving retrospective recall of ages of onset, leaving open the possibility of recall biases.
The current prospective study examined comorbidity of unipolar mood disorders (UMDs) and anxiety disorders (ADs) with SUDs using data from the NU/UCLA Youth Emotion Project, a prospective study of risk for emotional disorders. We tested the two models described above: (1) the self-medication theory, which predicts that emotional disorders confer risk for SUDs; and (2) the substance-induced enhancement theory, which predicts that SUDs confer risk for emotional disorders. A third possibility is that the relations of UMDs and ADs with SUDs are bi-directional.
Section snippets
Participants
High school juniors recruited from a school in suburban Chicago and a school in suburban Los Angeles were screened with the Neuroticism subscale from the revised Eysenck Personality Questionnaire (EPQ-R-N; Eysenck & Eysenck, 1975). Recruitment oversampled participants high in neuroticism to increase the likelihood of new onsets of emotional disorders (Clark et al., 1994, Krueger et al., 1996). There were 627 participants (68.9% female) who completed the baseline assessment. Participants were on
Do anxiety disorders predict the subsequent onset of SUDs?
ADs at T1 predicted SUD onset over the follow-up period, OR = 1.98, p < .05, 95% CI: 1.07–3.65. This effect was due to AUD onset (OR = 2.71, p < .01, 95% CI: 1.39–5.29) whereas ADs did not predict non-alcohol SUDs (OR = 1.66, p > .19, 95% CI: 0.77–3.56). PTSD at T1 was the only specific anxiety disorder to predict the onset of SUDs in general (in a positive direction), OR = 7.29, p < .05, 95% CI: 1.18–45.25 (all other ps > .13). Social anxiety disorder at T1 was the only specific anxiety disorder to predict AUDs
Discussion
In line with the self-medication hypothesis, emotional disorders robustly predicted the onset of SUDs, whereas SUDs predicted the onset of emotional disorders in only one case. This is the first prospective study to our knowledge examining the role of both ADs and UMDs in the subsequent onset of SUDs. Emotional disorders predicted the onset of alcohol use disorders but not other SUDs. The heterogeneous group of drugs represented in non-alcohol SUDs may have obscured effects that would be
Role of funding sources
The research reported and the preparation of this article was supported by National Institute of Mental Health Grants R01 MH65651 and R01 MH65652 to Michelle G. Craske, Susan Mineka, and Richard E. Zinbarg.
Contributors
Kate Wolitzky-Taylor took part in data collection, data analysis, and a major role in manuscript preparation. Lyuba Bobova took part in manuscript preparation. Richard Zinbarg took part in study design, assisting with data analysis, and substantial editing the manuscript. Susan Mineka and Michelle Craske took part in study design and substantial editing of the manuscript. All authors have approved the final version of the manuscript.
Conflict of interest
There are no conflicts of interest.
References (30)
- et al.
Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence
Journal of Psychiatric Research
(2008) - et al.
Investigations of causal pathways between PTSD and drug use disorders
Addictive Behaviors
(1998) - et al.
Relationship between anxiety disorders and opiate dependence — A systematic review of the literature: Implications for diagnosis and treatment
Journal of Substance Abuse Treatment
(2010) - et al.
Relationship between depression and substance use disorders in adolescent women during the transition to adulthood
Journal of the American Academy of Child and Adolescent Psychiatry
(2000) - et al.
Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment
Addictive Behaviors
(2010) - et al.
Social anxiety disorder in 300 patients hospitalized for alcoholism in Brazil: High prevalence and undertreatment
Comprehensive Psychiatry
(2006) - et al.
The Northwestern-UCLA youth emotion project: associations of cognitive vulnerabilities, neuroticism and gender with past diagnoses of emotional disorders in adolescents
Behaviour Research and Therapy
(2010) - et al.
Epidemiologic evidence on cocaine use and panic attacks
American Journal of Epidemiology
(1989) - et al.
Conceptual framework for the etiology of alcoholism: A “kindling”/stress hypothesis
Psychopharmacology
(2005) - et al.
Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma
Archives of General Psychiatry
(2003)
Temperament, personality, and the mood and anxiety disorders
Journal of Abnormal Psychology
Psychiatric disorders among drug dependent subjects: Are they primary or secondary?
The American Journal on Addictions
Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States. Results from the National Epidemiologic Survey on Alcohol and Related Conditions
Archives of General Psychiatry
Reinforcement theory and the dynamics of alcoholism
Quarterly Journal of Studies on Alcohol
Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
The Journal of Clinical Psychiatry
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