Psychology

Literature Review
Substance abuse of alcohol is known to affect people to control anxiety that involves fearful apprehension that is mainly out of proportion to external circumstances accompanied by hyperactivity symptoms such as sweating, palpitations, and other indicators.  The notion of people suffering from anxiety have a tendency to consume alcohol in an effort to relieve symptoms is supported by reports showing a high comorbidity rates of alcohol and anxiety problems.  The high co-occurrence of anxiety and substance abuse disorders is an explanatory mechanism of self-medication with the use of alcohol or drugs to attempt to reduce anxiety (Robinson, J., Sareen, J., Cox, B.,  Bolton, J. 2009).  It is hypothesized that alcohol dependence are though to be related to anxiety disorders.  The following five literature reviews attempt to demonstrate and support the hypothesis. 

In a critical review by Schukit and Hesselbrock (1994), the authors evaluated studies regarding the relationship between lifelong DSM-III-R anxiety disorders and alcohol dependence. The review was based on studies made about children of alcoholics, alcohol-dependent individuals, and people with lifelong anxiety disorders.  The selection of the subjects were based on the premise that if alcohol dependence and anxiety disorders are closely tied together, the children of alcohol-dependent parents are at high risk for the future development of alcoholism, that demonstrates a high rate of anxiety disorders.  A sample size of 786 was gathered as subjects who were people who are alcohol dependent and another group were children of alcoholics.  The results showed that the majority of alcoholics do not have major lifelong disorders.  It was further concluded that the relationship between symptoms of anxiety and alcohol use disorders is complex.  It did not prove a close relationship between alcohol dependence and anxiety disorders.  In addition to, the children of alcoholics and individuals from the general population did not indicate a high rate of anxiety disorders before the period of dependence on alcohol.    The critical review found out that the studies had several limitations namely (1) documenting symptoms is not equivalent to establishing a diagnosis, (2) assertive mating wherein alcoholic choose their mates and are more likely to select a partner who also has major behavioral or psychiatric problems, (3) many alcohol-dependent men and woman have comorbid drug use and associated disorders, and (4) combination of other life stressors covers the independent anxiety disorders.  The authors developed a hypothesis that there is an interaction between anxiety disorders and alcohol dependence exists, which wasnt supported when results did not prove a close relationship but a complex interaction between lifelong anxiety disorders and alcohol dependence. 

Kushner, Sher,  Beitman did another critical review (1990) on the relation between alcohol problems and anxiety disorders.   The authors reviewed relevant epidemiologic surveys, family studies, and field studies.  The study concluded that the relationship between alcohol problems and anxiety appears to be variable among the anxiety disorder similar to the study done by Schukit and Hesselbrock.  Several studies were analyzed having met the criteria that the studies dealt with anxiety disorders including agoraphobia, social phobia, phobic disorder, obsessive-compulsive disorder, generalized anxiety disorder, social phobia, panic disorder, and simple phobia.  The diagnostic methods employed by these several studies were self-reports, psychiatric diagnostic interview, structured clinical interview, lifetime history, and DSM-III.  The review found out that alcohol problems, along with agoraphobia and social phobia, appear more likely to follow attempts to self-medicate of anxiety symptoms while panic disorder and generalized anxiety disorder may be more likely to follow from pathological alcohol consumption.  The analysis of the studies had limitations such as the difficulty to evaluate the basis of the studies reviewed, inability to separately analyze multiple anxiety disorders, and a lack of differentiation of findings based on different reference populations. In the review, the authors found out that the studies combined individuals with different anxiety disorders into one group reported that anxiety problems most often begin before alcohol problems.  In addition to, the review of the studies concluded that the evidence for a simple causal relation between alcohol problems and clinical anxiety was not established.  Thus, the authors found out that increased alcohol consumption motivated by the short-term relief of anxiety may result to increased anxiety thus leading to more alcohol consumption to relieve symptoms.

The next topic of attachment is a cross-sectional study on self-medication of anxiety disorders with alcohol and drugs.  Robinson, Sareen, Cox,  Bolton (2007) investigated on the use of alcohol or drugs in an attempt to lessen anxiety to explain the high co-occurrence of anxiety and substance use disorders.  The results were derived from the National Epidemiologic survey on Alcohol and Related Conditions (NESARC) or a nationwide, household comorbidity survey.  The NESARC administered the survey face-to-face through 1800 experienced lay interviewers who finished 10 days of training prior to data collection. The NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule IV (AUDADIS-IV) were used to come up with the DSM-IV Axis I and II diagnoses.  The diagnoses were composed of mood, anxiety, personality and substance use disorders.  The results indicated that the highest rates of self-medication were found among those diagnosed with generalized anxiety disorder.  Next to GAD, were social phobia, and panic disorder with agoraphobia.  Panic disorder with agoraphobia had the highest rate of self-medication with both drugs and alcohol.  Participants of each anxiety disorder type self medicate with alcohol.  It can be theorized that people diagnosed with GAD are likely to encounter anxiety-provoking stimuli with considerable frequency and will likely self medicate.  Gender differences among self-medication for anxiety disorders were paralleled wherein individuals who did not self-medicate were women.  The majority of people who opted to self-medicate with drugs and alcohol were male.  In regards to this finding, it supported the theory that anxiety increases the likelihood of abuse on alcohol as a coping means.  The cross-sectional study revealed a general pattern of increasing comorbidity starting from anxiety with no self-medication to self-medication with alcohol, and then finally to self-medication using both drugs and alcohol.  Furthermore, the authors found that individuals who use multiple substance (i.e. alcohol and drugs) to control anxiety symptoms as more at risk for psychiatric comorbidity.  The limitation of the study, however, was the lack of assessment on the frequency of self-medication and amount of substances.  It raised the question of whether to include participants who have self-medicated infrequently or in small amount under the same category. 

Hasin, Stinson, Ogburn, and Grant (2007) examined the prevalence, correlates disability and comorbidity of alcohol abuse and dependence in the US.   It also provided an update and evaluation of treatment rates and medical attention for alcoholic use disorders.   The target population was those residing in households and group quarters aged 18 years and older.  A sample size of 43,093 was interviewed face-to-face. The questions were structured using the extensive AUDADIS-IV in the DSM-IV criteria for alcohol abuse and dependence.  The AUDADIS-IV alcohol diagnosis has a high test-pretest reliability ranging from good to excellent. During the 12-month prevalences of DSM-IV alcohol abuse and dependence, men participants had higher odds of alcohol abuse more among whites compared to blacks, Asian, and Hispanics.  For lifetime abuse and dependence, the odds were higher among men and lower among black, Asians and Hispanics compared to whites.  The odds of lifetime alcohol abuse were greater among respondents aged 30 to 64 years old.  The study revealed a disappointing lack of progress of the treatment rates for alcoholic use disorders in 2001-2002 in comparison with 1991-1992.  Medical attention to alcohol problems also has declined given that people with alcohol disorders expressed lack of confidence in alcoholism treatment.  The study posed limitations that may have directly or indirectly affected the findings such as bias and pseudocomorbidity due to age at onset of the comorbid disorders, small sample size for stable 12-month comorbidity estimates. 

Grant, Dawson, Stinson, Chou, Kay and Pickering (2003) spoke to the reliability and findings of the AUDADIS-IV related to alcohol consumption, tobacco use, and family history of depression among others in the general population.  The tests evaluated were the National Institute of Mental Healths Diagnostic Interview Schedule (NIMH-DIS) and the World Health Organizations Composite International Diagnostic Interview.  The sample consisted of 60 respondents in Germany conducted by Grant, Dawson, Stinson, Chou, Kay  Pickering (2003).  Results showed that AUDADIS-IV has a high degree of reliability as a diagnostic tool in clinical and research settings.  The authors recommended AUDADIS IV to treat the general population samples having demonstrated fair to excellent reliabilities, as well as for continued and sustained research to construct and evaluate diagnostic classification in the DSM-IV.  The limitations of the study was the small population size of 60 thus noncases or those who failed to endorse the relevant diagnostic stem questions were excluded from the study.    The instrument was administered in a test interview or face-to-face interviews and retest interview or telephone interviews.  Thus, the mode of administration of test was a form of blinding when respondents were reminded of their responses during the pretest. 

When taken together into one, the related research articles showed that the theories on how anxiety, specifically generalized anxiety disorder, can be a precursor to a dependence on alcohol as a form of self-medication of alcohol and drugs.  The relationship between anxiety and alcoholism were found to be complex and variable.   Researchers in the past research articles also found correlations on the findings but lack of differentiation between types of anxiety and how these disorders causes or do not cause dependence on alcohol.    Some of the limitations that should be avoided are small sample size, multiple anxiety diagnosis of the sample size, less longitudinal studies, and the blindness where participants are aware of the study and their role in the study.  It is important to note the findings done on the area similar to the current research. The current research examines the relationship between the levels of anxiety symptoms to long-term sobriety as well as to evaluate symptoms of anxiety that may impact sobriety.  It has a significant potential to create a positive impact on how to better manage anxiety and fear of a person without the need for alcohol.