Don’t Blame Substance Use for Mood and Anxiety Disorders

Mood
and anxiety disorders produce symptoms similar to those of substance
intoxication and withdrawal, and therefore may be difficult to
diagnose among patients who use substances. To tease out mood and
anxiety disorders that are substance-induced from those that are
independent of use, researchers analyzed data from a nationally
representative survey of 43,093 adults in the United States.

• The
  12-month prevalences of independent mood and anxiety disorders
  were 9.2% and 11.1%, respectively.
• Less
  than 1% of adults with a mood or anxiety disorder had episodes
  that were substance-induced (i.e., episodes that began after
  withdrawal or intoxication but either were not associated with
  at least 1 month of abstinence or did not persist for more than
  1 month after the cessation of withdrawal or intoxication).
• Independent
  mood and anxiety disorders were strongly and consistently associated
  with substance dependence (odds ratios from 2.2 to 13.9), and
  less consistently associated with substance abuse (odds ratios
  from 0.8 to 4.2).

Comments:

This study suggests
that most mood and anxiety disorders—despite being associated
with substance dependence—are independent of substance intoxication
and withdrawal. This finding challenges the assumption that mood and
anxiety symptoms will resolve with abstinence from substance use.
The implication, for which there is growing empirical support, is
that mood and anxiety disorders in patients with substance use disorders,
especially substance dependence, should be treated early and comprehensively.

Peter
D. Friedmann, MD, MPH

Reference:

Grant BF, Stinson FS,
Dawson DA, et al. Prevalence and co-occurrence

of substance use disorders and independent mood and anxiety

disorders: results from the National Epidemiologic Survey

on Alcohol and Related Conditions. Arch Gen Psychiatry.
2004;61(8):807–816.
(view
abstract)