Anxiety disorders and addictions
文摘
Alcohol abuse/dependence has been found the most common psychiatric diagnosis in the Epidemiologic Catchment Area (ECA) study, the largest ever personal interview general population survey in the United States. Therefore, it is not surprising that alcoholism and anxiety disorders overlap, although with little compelling evidence of a higher rate of alcoholism in groups of anxious patients. According to different studies, a great variety exists in the prevalence of the occurrence of both pathological states. Several reasons are responsible for this. First of all, denial is typical of alcoholics and they may find more acceptable (especially if female confronting male doctors) to attribute heavy drinking to a cause (like anxiety) that may elicit sympathy. Another reason is the loose definition of anxiety which has been used in the past (comprehensive of fear, irritability, restlessness and any kind of unpleasant mood state). Still more important is the timing of interview. Most alcoholics undergo a mild withdrawal syndrome including feeling of tension and anxiety, which is over in one week. The first two weeks after entering treatment, alcoholics are also realistically anxious and worried about their personal situation. For this reason, attention should be paid only to symptoms occurring after two weeks of abstinence. An accurate history to document the chronology of development of both alcoholism and anxiety states is also negatively affected by the gradual onset of alcohol problems (5-20 years), and cognitive disturbances. Specialists under-report alcoholism also for their own attitudes and drinking patterns. A limited exposure to a formal substance-abuse curriculum make them reluctant to treat alcohol withdrawal. They may be discouraged also by the time demands to their busy practice to maintain abstinence, and by the family pressure to identify a psychological cause to alcohol problems. As a result psychiatrists over-prescribe benzodiazepines or antidepressants instead of using drugs to inhibit drinking behavior. Abstinent subjects with an anxiety disorder are actually less than 10 % .