Anxiety and substance use: layers of complexity

Abstract

Anxiety and substance use disorders occur together much more commonly than would be expected by chance, as shown in both general population and clinical samples. The clinical importance of this is that the outcome for each type of disorder is worse across clinical and psychosocial domains than for the disorders that occur noncomorbidly. This review explores explanatory models for comorbidity, outlines assessment protocols that can be employed in both screening and in treatment planning, as well as assessing the efficacy of applied interventions. Treatment options are presented, and the evidence base for various psychosocial and biological treatments are reviewed.

Keywords::

• anxiety disorder
• comorbidity
• substance abuse
• substance dependency
• treatment

Financial & competing interests disclosure

David J Castle has received grant monies from Eli Lilly, Janssen Cilag, Roche, Allergen and Bristol-Myers Squibb; travel support and honoraria for talks and consultancy from Eli Lilly, Bristol-Myers Squibb, Astra Zeneca, Lundbeck, Janssen Cilag, Pfizer, Organon, Sanofi-Aventis and Wyeth. David J Castle is an advisory board member for Lexapro (Lundbeck), Zyprexa (Eli Lilly), Abilify (Bristol-Myers Squibb) and Seroquel (Astra Zeneca). The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this m-anuscript.