Which to treat first; Comorbid anxiety or alcohol disorder?

Therapies that target just one problem are in sufficient for patients who have both.

Men and women with anxiety disorders are at three times the general population’s risk of being alcohol-dependent, and those who seek treatment for an anxiety disorder are at even higher risk of alcohol disorder. This comorbidity can complicate treatment attempts if either disorder remains unaddressed, leading to increased relapse risk and multiple treatment episodes.

Based on our research and clinical work in helping patients with comorbid alcohol dependence and anxiety disorders, this article describes:

  • potential relationships between anxiety disorders and alcohol disorder
  • pros and cons of 3 approaches to treating this comorbidity
  • how to identify and address alcohol disorder in patients with anxiety disorders, depending on available resources.

Comorbidity rates of anxiety disorders and alcohol dependence*

Anxiety disorder

Odds ratio for having alcohol dependence
Men Women
Any 3.2 3.3
Panic disorder 3.8 3.7
Social phobia 2.6 3.6
Generalized anxiety disorder 3.6 3.4
Specific phobia 2.8 2.9
* Numbers indicate odds of having alcohol dependence when the anxiety disorder is present vs absent.

Research by; Matt G. Kushner, Brenda Frye, Christopher Donahue, Sarah W. Book and Carrie L. Randall.

From; Current Psychiatry, Vol. 6, No. 8 / August 2007