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Depress Anxiety. 2019 Jun;36(6):522-532. doi: 10.1002/da.22886. Epub 2019 Mar 5.

Explaining the association between anxiety disorders and alcohol use disorder: A twin study.

Author information

1
Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.
2
Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
3
Department of Psychology, University of Oslo, Norway.
4
PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Norway.
5
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.
6
Department of Human and Molecular Genetics and Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia.
7
Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Brumunddal, Norway.
8
Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
9
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Abstract

BACKGROUND:

It is unknown whether social anxiety disorder (SAD) has a unique association with alcohol use disorder (AUD) over and beyond that of other anxiety disorders, how the associations develop over time, and whether the associations are likely to be causal.

METHODS:

Diagnoses of AUD, SAD, generalized anxiety disorder, panic disorder, agoraphobia, and specific phobias were assessed twice using the Composite International Diagnostic Interview among 2,801 adult Norwegian twins. The data were analyzed using logistic regression analyses and multivariate biometric structural equation modeling.

RESULTS:

SAD had the strongest association with AUD, and SAD predicted AUD over and above the effect of other anxiety disorders. In addition, SAD was prospectively associated with AUD, whereas other anxiety disorders were not. AUD was associated with a slightly elevated risk of later anxiety disorders other than SAD. Biometric modeling favored a model where SAD influenced AUD compared to models where the relationship was reversed or due to correlated risk factors. Positive associations between AUD and other anxiety disorders were fully explained by shared genetic risk factors.

CONCLUSIONS:

Unlike other anxiety disorders, SAD plausibly has a direct effect on AUD. Interventions aimed at prevention or treatment of SAD may have an additional beneficial effect of preventing AUD, whereas interventions aimed at other anxiety disorders are unlikely to have a similar sequential effect on AUD.

KEYWORDS:

agoraphobia; alcohol use disorder; anxiety disorders; social anxiety disorder; social phobia; specific phobia; twin studies

PMID:
30838764
PMCID:
PMC6548587
[Available on 2020-06-01]
DOI:
10.1002/da.22886

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