People who self-medicate — that is, to use alcohol or drugs to reduce unwanted feelings or anxiety — are at greater risk for a later substance abuse problem, according to a new study.

Self-medicating also appears to up the risk for social phobia in people with anxiety. People typically self-medicate in an effort to avoid more formal treatment, whether it be with psychotherapy or medications.

Canadian researchers led by Jennifer Robinson examined data collected through the National Institute on Alcohol Abuse and Alcoholism survey. Their study was designed to measure the occurrence of substance use disorders in individuals with anxiety disorders, as well as new anxiety disorders in those with substance use disorders.

A total of 34,653 U.S. adults completed the survey. Participants were then separated into three categories by the researchers: no self-medication, self-medication with alcohol only, or self-medication with drugs (with or without the use of alcohol also).

Researchers found that over 12 percent of individuals who met criteria for an anxiety disorder and self-medicated with alcohol later developed an alcohol use disorder. Only 4.7 percent of those who did not self-medicate later develop an alcohol use disorder.

In participants with a baseline alcohol use disorder, the prevalence of anxiety disorders (including panic, social phobia, specific phobias, generalized anxiety disorder or any anxiety disorder) ranged from 5.7 percent (panic disorder) to nearly 10 percent (specific phobia) for those who self-medicated with alcohol.

For participants who self-medicated with other drugs, prevalence rates ranged from 8 percent (panic disorder) to 13.5 percent (specific phobia). While nearly 7 percent of new social phobia was attributable to self-medication with alcohol, over 20 percent was attributable to self-medication with drugs.

Of the subjects in the study who reported any substance use during the prior year, 12.5 percent reported self-medicating with alcohol and 24.4 percent with other drugs. Those with diagnosable substance use disorders fare much worse, with 23.3 percent who self-medicated with alcohol and 32.7 percent with drugs.

The authors also found that in participants with preexisting anxiety and alcohol use or drug use disorders, reported self-medication was associated with the persistence of alcohol use and drug use disorders, but not anxiety.

“Given the high percentage of incident substance use disorders and social phobia that can be attributed to self-medication, the reduction of self-medicating behavior may lead to a significant decrease in incident comorbidity in the general population,” the authors conclude.

“These results not only clarify several pathways that may lead to the development of comorbidity but also indicate at-risk populations and suggest potential points of intervention in the treatment of comorbidity.”

The study appears in the August issue of Archives of General Psychiatry.

Source: Archives of General Psychiatry

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