Role of Self-medication in the Development of Comorbid Anxiety and Substance Use Disorders: A Longitudinal Investigation

Robinson, Jennifer

doi:10.1001/archgenpsychiatry.2011.75

Cited by 208Substance Abuse Treatment and OutcomesAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Role of Self-medication in the Development of Comorbid Anxiety and Substance Use Disorders: A Longitudinal Investigation

Robinson, Jennifer·2011·Archives of General Psychiatry

DOI 10.1001/archgenpsychiatry.2011.75

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Abstract

CONTEXT: Self-medication of anxiety symptoms with alcohol, other drugs, or both has been a plausible mechanism for the co-occurrence of anxiety disorders and substance use disorders. However, owing to the cross-sectional nature of previous studies, it has remained unknown whether self-medication of anxiety symptoms is a risk factor for the development of incident substance use disorder or is a correlate of substance use. OBJECTIVE: To examine whether self-medication confers risk of comorbidity. DESIGN: A longitudinal, nationally representative survey was conducted by the National Institute on Alcohol Abuse and Alcoholism. The National Epidemiologic Survey on Alcohol and Related Conditions assessed DSM-IV psychiatric disorders, self-medication, and sociodemographic variables at 2 time points. SETTING: The United States. PARTICIPANTS: A total of 34 653 US adults completed both waves of the survey. Wave 1 was conducted in 2001-2002, and wave 2 interviews occurred 3 years later (2004-2005). MAIN OUTCOME MEASURES: Incident substance use disorders in participants with baseline anxiety disorders and incident anxiety disorders in those with baseline substance use disorders. RESULTS: Logistic regression analyses revealed that self-medication conferred a heightened risk of new-onset substance use disorders in those with baseline anxiety disorders (adjusted odds ratios [AORs], 2.50-4.99 [P < .01]). Self-medication was associated with an increased risk of social phobia (AOR in baseline alcohol use disorders, 2.13 [P = .004]; AOR in baseline drug use disorders, 3.17 [P = .001]). CONCLUSIONS: Self-medication in anxiety disorders confers substantial risk of incident substance use disorders. Conversely, self-medication in substance use disorders is associated with incident social phobia. These results not only clarify several pathways that may lead to the development of comorbidity but also indicate at-risk populations and suggest potential points of intervention in the treatment of comorbidity.

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The high incidence of substance use disorders in individuals with anxiety and stress-related disorders has been strongly associated with self-medication.
“The high incidence of substance use disorders in individuals with anxiety and stress-related disorders has been strongly associated with self-medication, suggesting that individuals with stress-related conditions may be more vulnerable to misuse substances to cope with aversive affective states (J. Robinson, Sareen, Cox, & Bolton, 2011).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as J. Robinson, Sareen, Cox, & Bolton, 2011

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Self-medication for Anxiety Increases Risk for Substance Use Disorders
Kaplan, A. (2011)
ORIGINAL ARTICLES Use of Alcohol and Drugs to Self-Medicate Anxiety Disorders in a Nationally Representative Sample
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Use of Alcohol and Drugs to Self-Medicate Anxiety Disorders in a Nationally Representative Sample
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Authors: Robinson, J.
Affiliations: University of Manitoba (CA)
Corresponding author: Robinson, Jennifer
ORCID: Robinson, Jennifer
Venue: Archives of General Psychiatry
Publisher: American Medical Association (AMA)
Published: 2011-08-01
Volume: 68
Issue: 8
Pages: 800
ISSN: 0003-990X (ISSN-L)
DOI: 10.1001/archgenpsychiatry.2011.75
OpenAlex: W1967264302
Semantic Scholar: 1181fba0ae8d4c3a570f204950c7306709f54330
Cited by: 208
References: 51
Citations by year: 2026: 7 · 2025: 15 · 2024: 12 · 2023: 9 · 2022: 16 · 2021: 14 · 2020: 16 · 2019: 11 · 2018: 8 · 2017: 15 · 2016: 15 · 2015: 11 · 2014: 30 · 2013: 15 · 2012: 12
FWCI: 14.08
Type: journal article
Language: en
Open access: closed
Locations: Archives of General Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: self-medication, anxiety disorders, substance use disorders, comorbidities, social anxiety disorder, alcoholism, drug use disorders
MeSH terms: Adolescent, Adult, Aged, Anxiety, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Risk Factors, Self Medication, Diagnosis, Dual (Psychiatry), Substance-Related Disorders

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Role of Self-medication in the Development of Comorbid Anxiety and Substance Use Disorders: A Longitudinal Investigation

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