Vorspan Florence, Mehtelli Wajdi, Dupuy Gaël, Bloch Vanessa, Lépine Jean-Pierre
Service de Médecine Addictologique, Hôpital Fernand Widal, AP-HP, 200 rue du Faubourg Saint Denis, 75010, Paris, France,
Curr Psychiatry Rep. 2015 Feb;17(2):4. doi: 10.1007/s11920-014-0544-y.
The co-occurrence of substance use disorders (SUDs) and anxiety disorders has been now well established. This association is frequent and can be explained by three models: the shared vulnerability factors model, the self-medication model, and the substance-induced model. General population epidemiological studies provide strong evidence of the frequency of the association for the most used substances: tobacco, alcohol, cannabis, and to a lesser extent sedatives, opiates, and cocaine. For substances that are less commonly used in the general population, the frequency of the co-occurrence can more precisely be studied in clinical samples. We provide the most recent literature results on the association of SUDs and anxiety, and evidence for one explicative model or the other when available. For substances with sedative properties (alcohol, benzodiazepines, cannabis, opioids), both evidence for a self-medication and for a toxic effect exist. For substances with psychostimulant properties (tobacco, cocaine, and amphetamines), the literature favors the toxic hypothesis to explain the association with anxiety disorders. We give practical steps for the recognition of these dual diagnoses and present therapeutic issues, although the strategies are rarely evidence based.
物质使用障碍（SUDs）与焦虑症的共病现象现已得到充分证实。这种关联很常见，可由三种模型来解释：共同易感性因素模型、自我药疗模型和物质诱发模型。普通人群流行病学研究为最常用物质（烟草、酒精、大麻，以及程度较轻的镇静剂、阿片类药物和可卡因）的关联频率提供了有力证据。对于普通人群中较少使用的物质，共病频率可在临床样本中更精确地进行研究。我们提供了关于SUDs与焦虑症关联的最新文献结果，以及在有可用证据时支持某一解释模型的证据。对于具有镇静特性的物质（酒精、苯二氮䓬类药物、大麻、阿片类药物），既有自我药疗的证据，也有中毒效应的证据。对于具有精神兴奋特性的物质（烟草、可卡因和苯丙胺），文献支持用中毒假说解释与焦虑症的关联。我们给出了识别这些双重诊断的实际步骤，并提出了治疗问题，尽管这些策略很少有循证依据。
