Anxiety and Substance Use Disorders: Co-occurrence and Clinical Issues

Abstract

The co-occurrence of substance use disorders (SUDs) and anxiety disorders has been now well established. This association is frequent and can be explained by three models: the shared vulnerability factors model, the self-medication model, and the substance-induced model. General population epidemiological studies provide strong evidence of the frequency of the association for the most used substances: tobacco, alcohol, cannabis, and to a lesser extent sedatives, opiates, and cocaine. For substances that are less commonly used in the general population, the frequency of the co-occurrence can more precisely be studied in clinical samples. We provide the most recent literature results on the association of SUDs and anxiety, and evidence for one explicative model or the other when available. For substances with sedative properties (alcohol, benzodiazepines, cannabis, opioids), both evidence for a self-medication and for a toxic effect exist. For substances with psychostimulant properties (tobacco, cocaine, and amphetamines), the literature favors the toxic hypothesis to explain the association with anxiety disorders. We give practical steps for the recognition of these dual diagnoses and present therapeutic issues, although the strategies are rarely evidence based.

Buspirone reduces sexual risk-taking intent but not cocaine self-administration.

“…Buspirone also has low abuse potential, a favorable side-effect profile, and might have beneficial effects on outcomes other than cocaine use and sexual risk-taking behavior. Specifically, buspirone is indicated for the treatment of anxiety and there is an association between cocaine/stimulant use and co-morbid anxiety disorder (e.g., Bolton & Sareen, 2006; see Vorspan et al, 2015 for review), so it could be useful in that regard as well. Whether or not to prescribe buspirone to an individual with cocaine-use disorder in the absence of demonstrated efficacy at reducing cocaine use, however, is a clinical decision that would need to be made in consultation with the patient and guided by a careful assessment of the potential risks and probable benefits.…”

Anxiety and Nicotine Dependence: Emerging Role of the Habenulo-Interpeduncular Axis

“…While these clinical data reveal that there are still gaps in our approach towards identifying what triggers an anxiety episode, it remains essential to unveil why, once anxiety is initiated, an individual becomes susceptible to experiencing subsequent anxiety events. Noticeably, ADs represent a risk factor for developing other psychiatric conditions, such as drug addiction [5]. ADs are highly comorbid with drug abuse, particularly with nicotine dependence [6, 7].…”

Partial mGlu5 Negative Allosteric Modulators Attenuate Cocaine-Mediated Behaviors and Lack Psychotomimetic-Like Effects

“…Comorbidity with other psychiatric conditions, including depression and anxiety disorders, is commonly seen in substance use disorders, including cocaine abuse (Volkow, 2004;Vorspan et al, 2015). Pharmacotherapies developed for treating cocaine abuse have been largely unsuccessful (Shorter et al, 2015) and some purported treatment mechanisms elicit or exacerbate unwanted symptoms (eg, depression, anxiety, increased impulsivity, cognitive impairments, or psychosis) (Homayoun et al, 2004;Kishi et al, 2013;Moore et al, 2014).…”