TREATING ANXIETY IN PATIENTS WITH ALCOHOLISM

The clinical management of patients who present with anxiety syndromes combined with alcohol abuse or dependence is reviewed. A critical ste p is to make the differential diagnosis between alcohol-induced anxiet y (principally alcohol withdrawal) and anxiety disorders per se. Inter view and examination techniques useful in making this differential are presented. Clinical management of and pharmacotherapy for alcohol wit hdrawal are outlined. Anxiety disorders that can be comorbid with alco holism include panic disorder, social phobia, obsessive compulsive dis order, generalized anxiety disorder, and posttraumatic stress disorder . Psychotherapeutic and pharmacotherapeutic measures for each of these in the setting of alcoholism are suggested, and various possible inte rrelationships between anxiety disorders and alcoholism are considered . Although anxiety disorders may contribute to the underlying etiology of alcoholism in some cases, alcohol abuse tends to take on a life of its own. Treatment of an anxiety disorder can rarely, if ever, be exp ected to cure alcoholism. Therefore, the need to institute simultaneou s treatment aimed at establishing and maintaining sobriety is emphasiz ed. Research on anxiety disorders and alcoholism is as yet inadequate to fully answer many clinical questions about their relationship and t heir appropriate diagnosis and management. More research is needed in this area.