Comorbid Anxiety and Alcohol or Substance Use Disorders: An Overview

The comorbidity between anxiety and alcohol or substance use disorders represents a common and serious clinical challenge, characterized by a high worldwide prevalence. The co-occurrence of these disorders complicates treatment, management, and prognosis of both disorders, but it remains often unrecognized and untreated. Mental health professionals should accurately assess and evaluate the comorbidity, although related etiological links and temporal relationships are still unclear and, probably, heterogeneous and multifactorial. Alcohol and substances may be misused by individuals to self-medicate their anxiety, avoidant, and phobic symptoms, but also anxiety disorders may be consequences of alcohol and/or substance misuse. Integrated treatment appears the most promising approach, but there is paucity of evidence on pharmacological and non-pharmacological treatments addressed to both anxiety and substance use disorders. This chapter provides a comprehensive overview of main epidemiological and clinical issues, etiological/temporal links hypotheses, and treatment options for the comorbidity between anxiety and addictive behaviors.