Anxiety in alcoholics

Alcoholism and anxiety disorders are concomitant far more frequently than might be expected. The great prevalence of anxiety disorders in alcoholics constitutes an important clinical issue because alcoholic subjects with a coexisting anxiety disorder suffer more frequent and more severe relapses than nonalcoholic control subjects. The former also show greater liability to psychotropic drug abuse and overdose behaviour, and are at greater risk of suicide. The type of relationship between alcohol dependence and anxiety disorders has considerable theoretical meaning. Four possible non-mutually exclusive ways of association are discussed: 1. the ingestion of alcohol may be an attempt at self-medication of anxiety symptoms; 2. anxiety and alcohol abuse may, independent of each other, be based on a third underlying, possibly genetic, factor; 3. anxiety may be a toxic effect of alcohol abuse or of withdrawal; 4. anxiety may result from cognitive processes in connection with alcohol abuse or withdrawal. Clinical guidelines for the pharmacotherapy of anxiety in patients suffering from alcoholism are outlined.