Anxiety disorders and substance use disorders: Different associations by anxiety disorder

Anxiety disorders (ADs) and substance use disorders (SUDs) often occur together, but the strength of this association and their apparent order of onset differ across studies. The goals of this study were to examine: (1) which ADs were associated with which SUDs, and (2) among people who experienced both an AD and a SUD, which disorder had an earlier onset. Lifetime diagnoses from the National Comorbidity Survey-Replication (n = 9282) were used. Social phobia, generalized anxiety disorder, panic disorder, and agoraphobia were positively associated with all SUDs. Among people with both an AD and a SUD, the order of onset differed by anxiety type: social phobia nearly always had an onset prior to any SUD; panic disorder and agoraphobia tended to occur prior to some SUDs; and generalized anxiety disorder tended to occur after the onset of at least one SUD. Therefore, all ADs are positively associated with SUDs, but ADs differ in the timing of their onset relative to comorbid SUDs.

► All anxiety disorders are positively associated with all substance use disorders (SUDs).
► Anxiety disorders differ in the timing of their onset relative to comorbid SUDs.
► Among people with both social phobia and a SUD, social phobia nearly always has an onset prior to any SUDs.
► Among people with panic disorder or agoraphobia and a SUD, panic disorder and agoraphobia tend to occur prior to some SUDs.
► Among people with generalized anxiety disorder and a SUD, generalized anxiety disorder tends to occur after the onset of at least one SUD.