Schuckit M A, Hesselbrock V
Department of Psychiatry, School of Medicine, University of California, San Diego.
Am J Psychiatry. 1994 Dec;151(12):1723-34. doi: 10.1176/ajp.151.12.1723.
In this critical review the authors evaluate the literature regarding the relationship between lifelong DSM-III-R anxiety disorders and alcohol dependence. Many alcohol-dependent individuals demonstrate severe anxiety symptoms in the context of acute or protracted abstinence syndromes, but it is unclear whether these anxiety conditions are independent psychiatric disorders or temporary syndromes likely to disappear on their own.
Reports since 1975 describing the relationship between alcoholism and anxiety disorders were reviewed to determine whether 1) lifelong anxiety disorders are unusually prevalent among alcohol-dependent individuals, 2) children of alcoholics are more likely to develop anxiety disorders than comparison populations, 3) anxiety syndromes are likely to disappear with abstinence, 4) the rate of alcohol dependence among subjects with lifelong anxiety disorders is higher than normal, 5) there is familial crossover between alcohol dependence and anxiety disorders, and 6) alcoholism is often preceded by anxiety disorders in groups from the general population studied prospectively.
The interaction between alcohol use and anxiety disorders is complex. The available data, while imperfect, do not prove a close relationship between life-long anxiety disorders and alcohol dependence. Further, prospective studies of children of alcoholics and individuals from the general population do not indicate a high rate of anxiety disorders preceding alcohol dependence.
The high rates of comorbidity in some studies likely reflect a mixture of true anxiety disorders among alcoholics at a rate equal to or slightly higher than that for the general population, along with temporary, but at times severe, substance-induced anxiety syndromes.
在这篇批判性综述中，作者评估了关于终生 DSM-III-R 焦虑症与酒精依赖之间关系的文献。许多酒精依赖者在急性或长期戒酒综合征的背景下表现出严重的焦虑症状，但尚不清楚这些焦虑状况是独立的精神障碍还是可能自行消失的临时综合征。
对 1975 年以来描述酒精中毒与焦虑症之间关系的报告进行了综述，以确定：1）终生焦虑症在酒精依赖者中是否异常普遍；2）酗酒者的子女比对照组人群更易患焦虑症；3）焦虑综合征是否可能随着戒酒而消失；4）患有终生焦虑症的受试者中酒精依赖的发生率是否高于正常水平；5）酒精依赖与焦虑症之间是否存在家族交叉现象；6）在对普通人群进行前瞻性研究的群体中，酒精中毒之前是否经常出现焦虑症。
酒精使用与焦虑症之间的相互作用很复杂。现有数据虽然不完美，但并未证明终生焦虑症与酒精依赖之间存在密切关系。此外，对酗酒者子女和普通人群个体的前瞻性研究并未表明在酒精依赖之前焦虑症的发生率很高。
一些研究中高共病率可能反映了酗酒者中真正焦虑症的比例与普通人群相当或略高，同时还存在暂时但有时严重的物质所致焦虑综合征。
