About 20 percent of the 19.4 million American adults with a substance use
disorder meet diagnostic criteria for at least one type of mood disorder, and
about 18 percent of this group also meet criteria for an anxiety disorder.
A significant proportion of those diagnosed with a mood or anxiety disorder
also turn out to have a substance use disorder, according to data from the
2001-02 National Epidemiologic Survey on Alcohol and Related Conditions
(NESARC), which was conducted by the National Institute on Alcohol Abuse and
The data from the survey appeared in the August Archives of General
Of the 19.3 million adults estimated to have a mood disorder, almost 20
percent had a substance use disorder as well, and of the 23 million adults
estimated to have an anxiety disorder, almost 15 percent had a substance use
"These results highlight the need for all individuals in treatment to
be fully assessed for the presence or absence of a range of psychiatric
disorder," the authors stated.
Primary investigator Bridget Grant, Ph.D., used the NIAAA Alcohol Use
Disorder and Associated Disabilities Interview Schedule—DSM-IV
Version to detect drug and alcohol abuse and dependence, major depression,
dysthymia, mania, hypomania, panic disorder with and without agoraphobia,
social phobia, specific phobia, and generalized anxiety disorder.
Grant is chief of the Laboratory of Epidemiology and Biometry in NIAAA's
Division of Intramural Clinical and Biological Research.
The sample used for the 2001-02 NESARC was based on the sampling frame of
the U.S. Census 2000/2001 Supplemental Survey.
Approximately 1,800 lay interviewers with the U.S. Census Bureau
administered the NIAAA Alcohol Use Disorder and Associated Disabilities
Interview Schedule-DSM-IV Version to 43,093 adults aged 18 and older
to assess the prevalence and co-morbidity of a number of mental illnesses.
Respondents also answered questions about whether they received treatment
during the preceding year for drug and/or alcohol abuse or dependence, as well
as for a mood or anxiety disorder.
Grant assessed whether respondents met criteria for independent or
substance-induced mood and anxiety disorders during the year prior to the
Respondents were classified as having an independent mood or anxiety
disorder if none or only some of the episodes were induced by drugs or
alcohol. They were classified as having a substance-induced disorder if all
episodes of mood and anxiety were induced by drugs or alcohol over the prior
These were among the findings:
"We found a high prevalence of alcohol and drug use disorders among
people who went to seek treatment for a mood or anxiety disorder and vice
versa," Grant told Psychiatric News.
She pointed out that a large majority of those disorders are independent."
In the clinical literature, the general consensus in the past was that
for those who were alcohol or drug dependent, nearly 60 percent of all mood
and anxiety disorders, particularly mood disorders, were substance
induced," she said.
"However, we found a very small percentage of people who have
substance-induced disorders—most of them are independent or what the
DSM calls primary."
Grant pointed out that when clinicians falsely assumed that mood or anxiety
disorders were substance induced, patients would not receive treatment for
their mood or anxiety disorder because it was believed that once the drinking
or drug abuse stopped, the disorder would vanish.
The NESARC findings indicate that mood and anxiety disorders should be more
thoroughly addressed by substance abuse treatment specialists, and substance
use disorders better addressed by mental health and primary care clinicians,
An abstract of the study, "Prevalence and Co-occurrence of
Substance Use Disorders and Independent Mood and Anxiety Disorders" is
posted online at<http://archpsyc.ama-assn.org/cgi/content/abstract/61/8/807>.▪
Arch Gen Psychiatry200461807