Behm. Res. Thu. Vol. 24, No. 3, pp. 357-359, 1986 0005-7967/86 63.00 + 0.00 Printed in Great Britain. All rightsreserved Copyright c 1986Pergamon Press Ltd CASE HISTORIES AND SHORTER COMMUNICATIONS Alcohol abuse among clinically anxious patients BRUCE A. THYER School of Social Work, Florida State University, Tallahassee, FL 32306, U.S.A. RICHARD T. PARRISH,JOSEPH HIMLE, OLIVERG. CAMERON, GEORGEC. CURTIS and RANDOLPH M. NESSE Department of Psychiatry, University of Michigan Hospitals, Ann Arbor, MI 48109, U.S.A. (Received 4 September 1985) Summaryaf 156 patients meeting DSM-III criteria for either agoraphobia with panic attacks, panic disorder, simple or social phobia, or generalized anxiety disorder, 27 (17.3%) were found to score in the alcoholic range ( > 5) on the Michigan Alcoholism Screening Test. This pattern of alcohol abuse was primarily associated with the diagnosis of agoraphobia. Agoraphobic patients with a concurrent affective disorder were especially prone to abuse alcohol. INTRODUCIION “Wine drunk with an equal quantity of water puts away anxiety and terrors” Hippocrates, Aphorisms The tension-reduction theory of alcohol abuse (Cappell and Herman, 1972) has received indirect support from studies of the potential concordance between alcohol abuse and the anxiety disorders. Most of these studies have examined diagnosed alcoholics who were subsequently evaluated for the presence of a clinical anxiety disorder. For example, in a study of 102 alcoholics consecutively admitted to an English hospital, Mullaney and Trippett (1979) found that one-third were clinically rated as having disabling agoraphobia and or social phobia, and another third were rated as borderline agoraphobic or socially phobic. These clinical ratings were confirmed by questionnaire and self-report symptom scales, and the onset of the phobic disorder was found to significantly precede the onset of alcohol-related problems. More recently, Smail, Stockwell. Canter and Hodgson (1984) found that 32 of 60 diagnosed alcoholics were suffering from mild (n = 21) to severe (n = 11) agoraphobia or social phobia. Almost all of these phobic patients reported that their alcohol use was exacerbated in phobic situations. Twenty-four of these alcoholic patients with at least a moderate degree of agoraphobia and/or social phobia were selected for in-depth interviews assessing the developmental history of the alcoholism and the anxiety disorder (Stockwell, Smail, Hodgson and Canter, 1984). The median reported age of onset for the phobic disorders was 28 yr, whereas the median reported age of onset of problem drinking was age 30 yr. Of 84 inpatient alcoholics studied by Weiss and Rosenberg (1985), 19 (23%) met criteria for one or more of the DSM-III anxiety disorders. As in the previous studies, a majority of these anxious patients (12) reported that the onset of regular drinking followed the onset of the anxiety disorder. Another method to study the relationship between alcohol abuse and anxiety is to examine the prevalence of alcohol abuse among patients with a primary diagnosis of one of the anxiety disorders. Quitkin, Rilkin, Kaplan and Klein (1972) described 10 anxious patients addicted to alcohol, sedative drugs or both. These authors reported that most alcoholics with a history of anxiety attacks or phobias respond well to pharmacological treatment (e.g. imipramine) targeted to anxiety and they clearly suggested that in such cases an anxiety disorder precipitates alcoholism. Munjack and Moss (1981) questioned phobic patients as to a possible family history of alcoholism in first-degree relatives, and found a positive family historv for 27% of aaoranhobic nrobands. 20% of socially nhobic nrobands and 9% of 35 nrobands with simple phobias. In a recent study on the prevalence of alcohol abuse among 254 agoraphobic outpatients, Bibb and Chambless (1986) found that 21% of their sample scored 3 5 on the Michigan Alcoholism Screening Test (MAST, Seizer, 1971). reflective of probable alcoholism. Although analyses of the mean ages of onset for alcohol problems and agoraphobia indicated that alcohol problems preceded agoraphobia, respondent-by-respondent comparisons indicated that the agoraphobia came first in 56% of the 22 identified alcoholic agoraphobics. Major depression was common in both alcoholic (77%) and nonalcoholic (52%) agoraphobics. Data on the patterns of alchol abuse for patients with other anxiety disorders was not presented. There thus appears to be a consistent finding that agoraphobic and socially phobic individuals are predisposed toward the development of concurrent alcohol abuse. Such studies lend credence to the social anxiety model of alcoholism proposed by Kraft (1971) and Klein’s (1980) contention that “Once we began to distinguish among panic attacks, anticipatory anxiety, and chronic anxiety, we understood the patients’ use, and frequent abuse, of sedatives and alcohol. These agents reduce anticipatory anxiety, but are useless against the spontaneous panic.. .The patients, finding some relief of their anticipatory anxiety from alcohol, follow an implicit, quantitative, continuity theory and drink that much more to deal with their panic, which may induce an escalation into alcoholism or sedative abuse.” (P. 413) In the absence of appropriately controlled prospective studies, this hypothesis about the chronological relationship between alcohol abuse and anxiety disorders remains speculative. Given that post hoc studies of patients who have already developed 357