Elsevier

Addictive Behaviors

Volume 37, Issue 8, August 2012, Pages 982-985
Addictive Behaviors

Short Communication
Longitudinal investigation of the impact of anxiety and mood disorders in adolescence on subsequent substance use disorder onset and vice versa

https://doi.org/10.1016/j.addbeh.2012.03.026Get rights and content

Abstract

Objective

A large body of epidemiological research indicates that anxiety and mood disorders are highly comorbid with substance use disorders (SUDs). However, longitudinal research regarding their temporal relations is limited. The goal of this study was to assess whether emotional disorders (i.e., anxiety and mood disorders) predict the onset of SUDs, whether SUDs predict the onset of emotional disorders, or both.

Method

The current study used data from baseline assessment (N = 627) and four years of follow-up assessments from the NU/UCLA Youth Emotion Project to examine this question.

Results

In line with the self-medication hypothesis of emotional disorder/SUDs comorbidity, anxiety and unipolar mood disorders at baseline assessment were associated with later onsets of SUDs. In particular, social anxiety disorder (SAD) at baseline predicted onset of alcohol use disorders and PTSD predicted the onset of all SUDs. SUDs did not predict any anxiety or unipolar mood disorders with the exception that alcohol use disorders predicted the onset of obsessive compulsive disorder (OCD).

Conclusions

These findings, as well as the clinical implications and future directions for research, are discussed.

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.

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