A Comorbid Relationship: Anxiety and Chemical Dependency

Patients presenting with some type of chemical dependency (alcoholism, drug use/abuse, and so forth) are often given what is known as a dual diagnosis. A differential diagnosis consists of ruling out various alternative diagnoses, ruling out an etiological general medical condition, determining the specific primary disorder, and ultimately establishing boundaries between disorders or no disorders (DSM-IV-TR, 2008). A dual diagnosis, in contrast, refers to a case in which an individual presents with an emotional/psychiatric problem along with an alcohol or drug problem (Mental Health America, 2008).

Dual diagnoses are extremely common and the presence of the symptoms and antecedents of alcohol, sedative-hypnotics, stimulants, and hallucinogen abuse complicate the diagnosis of a psychiatric disorder by obscuring their causes and symptoms. At issue herein is the linkage between chemical dependency and anxiety, one of the more common disturbances of mood and affect suffered by individuals. Identification of the co-morbidity of such diagnoses and interventions will be presented.

According to Mental Health America (2008), it is difficult to determine whether or not substance abuse occurs before the onset of an emotional or psychiatric problem or as a consequence of that problem. Both problems must be treated simultaneously with the diagnosis of the comorbid psychiatric problem often determining treatment. The National Alliance o

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ded that the BAI was found to have high internal consistency and test-retest reliability and was able to discriminate homogenous and heterogeneous anxious diagnostic groups from other psychiatric groups." In addition, Beck, et al (1988) commented that while the factor structure of the BAI was different from the Beck Depression Inventory (BDI) (a self-report instrument found extremely useful in assessing depression and also developed by Beck), results from the BAI correlate well with the BDI. The primary value of the BAI is that it permits clinicians to differentiation between anxiety and depression and thus better structure treatment and interventions (Beck, et al, 1988). Osman, Kopper, Barrios, Osman, and Wade (1997, p. 12) tested the reliability and validity of the BAI and found that "the BAI total and subscale scores correlated significantly with all related anxiety measures." Johnson (1992) suggested that clinicians presented with patients evidencing some type of chemical dependency should test for anxiety disorders and vice-versa. A dual diagnosis of anxiety disorder and chemical dependency, with the later potentially predisposing the patient for the former is common (Transitions Recovery Program, 2008). Burke, Burke,

Category: Medical - A