Comorbid Alcohol Dependence and Anxiety Disorders: A National Survey

Abstract

Objective: The goal of this study was to describe onset of comorbid anxiety disorders and alcohol dependence based on a large national survey of the U.S. adult population and to explore and describe these patterns by gender. Methods: Using Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data, we compared age at onset and temporal ordering of onset of comorbid alcohol dependence and anxiety disorders. Analyses were stratified by gender. Mean ages at onset were calculated, and Wald F-tests were used to assess differences in ages at onset, accounting for the complex survey design of the NESARC. Weighted estimates were used, adjusted to be representative of the U.S. population on various sociodemographic variables based on the 2000 Decennial Census. Results: Differences in temporal ordering were observed but varied by disorder combination. The majority (65%) had a primary (earliest onset) anxiety disorder, while the remaining 35% had a primary alcohol dependence diagnosis. Age at onset for some individuals with an anxiety disorder comorbid with alcohol dependence was earlier than for those with an anxiety disorder alone. Among individuals with comorbid social phobia and alcohol dependence and with comorbid specific phobia and alcohol dependence, it was more common to experience anxiety disorder as the primary diagnosis. Conversely, among individuals with comorbid panic disorder and alcohol dependence and with generalized anxiety disorder and alcohol dependence, it was more common to experience alcohol dependence as the primary diagnosis. Women were more likely to report having multiple comorbid anxiety disorders. No gender differences were found in terms of age at onset or temporal ordering of onset of comorbid disorders. Conclusions: Subsets of individuals with comorbid disorders exist, some whose primary diagnosis is alcohol dependence, and a majority of individuals whose primary diagnosis is an anxiety disorder with significant variability in age and temporal ordering of onset and few gender differences. Improved understanding of patterns of comorbidity and lag time between the onsets of specific disorders may enable us to identify potential groups for early intervention.

Keywords:

• alcohol dependence
• anxiety disorders
• comorbidity
• age at onset
• panic disorder
• social phobia
• generalized anxiety disorder
• specific phobia

ACKNOWLEDGMENTS

Portions of this research were funded by the National Institute on Drug Abuse grant F31 DA033873 (Pacek), National Institute on Alcohol Abuse and Alcoholism grants K23 AA020316-01A1 (Alvanzo), F31 AA018935 (La Flair), and R01 AA016346 (Crum) and a Johns Hopkins School of Medicine Clinician Scientist Award (Alvanzo).