The bidirectional relationship between anxiety disorders and alcohol use disorders in adults: Findings from a longitudinal population-based study
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BACKGROUND: Anxiety disorders (AD) and alcohol use disorder (AUD) frequently co-occur, but the temporal order of the association is unclear. We have determined the association between AD and the presence and first-onset of AUD, and vice versa. METHODS: Data were used from n = 6.646 participants and four measurement waves (baseline, 3-, 6- and 9-years) of the Netherlands Mental Health Survey and Incidence Study 2 (NEMESIS-2), a cohort study of the Dutch general population aged 18-64 years. AD and AUD were assessed with the Composite International Diagnostic Interview 3.0. Multilevel logistic autoregressive models were controlled for previous-wave AD or AUD, sociodemographics (Model 1), smoking and clinical factors (Model 2). RESULTS: People with AUD had a higher risk of present (OR = 1.65, 95 % CI 1.11-2.43; Model 2) and first-onset (OR = 2.03, 95 % CI 1.17-3.51; Model 2) AD in 3-years follow-up intervals than people without AUD. Vice versa, people with AD also had a higher sociodemographics-adjusted risk of present and first-onset AUD over 3-years follow-up intervals, but these associations attenuated into insignificance after adjustment for smoking and clinical variables. Limitations For statistical power reasons we were not able to analyze 9-year follow-up data or distinguish between AD and AUD types. CONCLUSIONS: Our results indicate a bidirectional relationship between AD and AUD; especially those with severe AD (medication use, comorbid depression) are at risk of developing AUD. Health care professionals should focus on prevention of AD in AUD patients and prevention of AUD in patients with (more severe) AD. Further research should investigate the mechanisms underlying the observed associations.
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Anxiety is an important treatment target for addressing mechanisms of substance use and numerous models suggest that substances are often used to mitigate anxiety.
“Anxiety is an important treatment target for addressing mechanisms of substance use and numerous models (e.g., self-medication, tension reduction and negative reinforcement) suggest that substances are often used to mitigate anxiety.(Baker et al., 2004; Conger, 1956; Ummels et al., 2022)”
From A systematic review and meta-analysis of psychosocial interventions for persons with comorbid anxiety and substance use disorders (2024) · cites this paper as Ummels et al., 2022
In §4.2, Main findings (page unavailable), the paper says its findings are consistent with people using alcohol to decrease anxiety symptoms, as proposed by the self-medication hypothesis. It does not establish that anxiety is an important treatment target, and its discussion concerns alcohol rather than substances generally or all three named models. (LLM, conf=0.86)
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- Authors
- Ummels, S. A., Seldenrijk, A., Bos, E. H., de Graaf, R., Batelaan, N. M., & ten Have, M.
- Affiliations
- GGZ inGeest (NL)
- Amsterdam Public Health (NL)
- University of Groningen (NL)
- Corresponding author
- Ummels, Sophie A.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2022-10
- Volume
- 314
- Pages
- 126-132
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W4283729547
- Cited by
- 50
- References
- 36
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 16 · 2023: 4
- FWCI
- 7.07
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Ministerie van Volksgezondheid, Welzijn en Sport
- ZonMw
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- anxiety disorders, alcoholism, bidirectional relationship, comorbidities, temporal order, smoking, depression, psychiatric medication use, general adult population
- MeSH terms
- Adult, Alcohol Drinking, Alcoholism, Anxiety Disorders, Humans, Cohort Studies, Comorbidity
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