REPORTS OF DRINKING TO SELF-MEDICATE ANXIETY SYMPTOMS: LONGITUDINAL ASSESSMENT FOR SUBGROUPS OF INDIVIDUALS WITH ALCOHOL DEPENDENCE

Authors

  • Rosa M. Crum M.D., M.H.S.,

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
    2. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Lareina La Flair M.P.H.,

    1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Carla L. Storr Sc.D.,

    1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    2. Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, Maryland
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  • Kerry M. Green Ph.D.,

    1. Department of Behavioral and Community Health, University of Maryland College Park School of Public Health, College Park, Maryland
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  • Elizabeth A. Stuart Ph.D.,

    1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    2. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Anika A. H. Alvanzo M.D., M.S.,

    1. Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Samuel Lazareck M.D., M.Sc.,

    1. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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  • James M. Bolton M.D., F.R.C.P.C.,

    1. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
    2. Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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  • Jennifer Robinson M.A.,

    1. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
    2. Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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  • Jitender Sareen M.D., F.R.C.P.C.,

    1. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
    2. Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
    3. Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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  • Ramin Mojtabai M.D., Ph.D.

    1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
    2. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Correspondence to: Rosa M. Crum, Johns Hopkins Health Institutions, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21205. E-mail: rcrum@jhsph.edu

Abstract

Background

Self-medication with alcohol is frequently hypothesized to explain anxiety and alcohol dependence comorbidity. Yet, there is relatively little assessment of drinking to self-medicate anxiety and its association with the occurrence or persistence of alcohol dependence in population-based longitudinal samples, or associations within demographic and clinical subgroups.

Methods

Hypothesizing that self-medication of anxiety with alcohol is associated with the subsequent occurrence and persistence of alcohol dependence, we assessed these associations using data from the National Epidemiologic Survey on Alcohol and Related Conditions, and examined these associations within population subgroups. This nationally representative survey of the US population included 43,093 adults surveyed in 2001–2002, and 34,653 reinterviewed in 2004–2005. Logistic regression incorporating propensity score methods was used.

Results

Reports of drinking to self-medicate anxiety was associated with the subsequent occurrence (adjusted odds ratio (AOR) = 5.71, 95% confidence interval (CI) = 3.56–9.18, P < .001) and persistence (AOR = 6.25, CI = 3.24–12.05, P < .001) of alcohol dependence. The estimated proportions of the dependence cases attributable to self-medication drinking were 12.7 and 33.4% for incident and persistent dependence, respectively. Stratified analyses by age, sex, race-ethnicity, anxiety disorders and subthreshold anxiety symptoms, quantity of alcohol consumption, history of treatment, and family history of alcoholism showed few subgroup differences.

Conclusions

Individuals who report drinking to self-medicate anxiety are more likely to develop alcohol dependence, and the dependence is more likely to persist. There is little evidence for interaction by the population subgroups assessed. Self-medication drinking may be a useful target for prevention and intervention efforts aimed at reducing the occurrence of alcohol dependence.

Ancillary