University of Chicago
Type of paper: Thesis/Dissertation Chapter
Anxiety Among Alcoholics and Non-Alcoholics
Alcohol is one of the most widely used drug substances in the world. For many people, drinking alcohol is nothing more than a pleasant way to relax. People with alcohol use disorders, however, drink to excess, endangering both themselves and others. In the mental health area alcoholism is caused mostly by depression, anxiety and stress, on the other hand it also leads to depression and stress. The present study aims to compare depression and anxiety among alcoholics and non- alcoholics. It was assumed that depression and anxiety may be the risk factors for alcoholism. A sample of 100 people (50 alcoholics and 50 non-alcoholics) was randomly selected from Delhi. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to collect data on depression and anxiety. t-test was administered to compare two groups. The result of the study showed that alcoholic group was higher on depression as well as anxiety than the non alcoholic group, and it was also found that there is no clear cut casual relationship between alcoholism and depression and anxiety.
Alcoholism is perhaps most strongly associated with antisocial personality disorder and drug abuse, but its relationship to other forms of psychopathology has become increasingly evident. In particular, investigations of alcoholic samples indicate a strong co-occurrence of alcoholism with diverse form of anxiety and depressive disorder (Barbor et al, 1992; Chambless et al, 1987; Hasegawa 1991; keller 1994; Nunes, Quitkin & Berman, 1988; Penick, 1994; Schuckit, Irwin & Brown, 1990). ______________________________________________________________________ *Associate professor, Deptt. Of Psychology, Aligarh Muslim University, Aligarh **Research scholar, Aligarh Muslim University, Aligarh.
According to Nijhawan (1972) Anxiety, one of the most pervasive psychological phenomenons of the modern era refers to a “persistent distressing psychological state arising from an inner conflict”. Depression can be defined as “a state of mind, or more specifically, a mental disorder, characterized by lowering of the individual’s vitality, his mood, his desires, hopes, aspirations and of his self-esteem. It may range from no more than a mild feeling of tiredness and sadness to the most profound state of apathy with complete, psychotic disregard for reality.” (Mendelssohn, 1963). Alcoholism can lead people into serious trouble, and can be physically and mentally destructive.
Currently alcohol use is involved in half of all crimes, murders, accidental deaths, and suicides. There are also many health problems associated with alcohol use such as brain damage, cancer, heart disease, diseases of the liver, depression anxiety and other mental disorders. Results from community surveys and epidemiologic samples indicate that substantial comorbidity also exists for depression, anxiety and alcoholism in the general population (Regier et al, 1990; Helzer & Pryzbeck, 1988; Kendler et al, 1995). The high co-occurrence of these syndromes, therefore, represents a significant clinical and public health issue that is likely to affect a substantial proportion of the general population.
Although the comorbidity of alcoholism with anxiety and depressive disorders has been extensively documented in both clinical and epidemiologic investigations, the specific mechanisms underlying these associations remain a source of debate. One widely accepted hypothesis is that these forms of comorbidity reflect a causal relationship of alcoholism with anxiety and depression. Support for a causal association is based partly on observations that alcohol is commonly used to self- medicate symptoms of negative affect, and so, alcoholism often develops as a secondary diagnosis to anxiety and depression (Meyer & Kranzler,1990; Hesselbrock, Meyer & Keener,1985; Lader,1972; Merikangas et al,1985).
The 18-month follow-up of participants of the Psychiatric Morbidity among Adults Living in Private Households, 2000 survey (Singleton & Lewis, 2003) provides an opportunity to determine whether excessive alcohol consumption and abnormal patterns of use are risk factors for incident anxiety and depression in the general population. The study also examined the reverse relationship, considering whether anxiety and depression are risk factors for the development of abnormal patterns of alcohol consumption.
However, evidence for a causal relationship is not unidirectional as alcoholism is often observed as a primary disorder, and the presence of problem drinking itself may generate severe anxiety or depressive syndromes (Mendelson & Mello, 1979, Nathan, O’Brien & Lowenstein, 1971; Schuckit, Irwin & Smith, 1994; Stockwell, Hodgson & Rankin, 1982). Heavy alcohol consumption has been implicated in the development of anxiety and depression (Schuckit, 1983). Many cross-sectional studies have identified considerable comorbidity between anxiety and depression, and alcohol abuse. For example, data from four large community based epidemiological studies (n>422 000) in Europe and the USA consistently demonstrated a two- to threefold increase in the lifetime prevalence of anxiety and depression in those with DSM–III or DSM–III–R alcohol abuse or dependence (Swendsen et al, 1998).
If anxiety disorders and alcoholism are casually related, there should be a high rate of alcoholism among patients being treated for anxiety disorders. Two studies (Torgersen, 1986; Cloninger et al, 1981) of the prevalence of alcoholism in patients being treated for anxiety neurosis were identified. These investigations suggest a lifetime population prevalence of alcohol abuse/dependence of approximately 14%.
The survey of the relevant literature made it quite obvious that much of the studies show a prevalence of depression and anxiety among alcoholics. However, previous studies have also pointed out the possibility of alcoholism as risk factors for depression and anxiety. At the same time, literature does not provide any clear cut direction towards the casual relationship between alcoholism and depression and anxiety. Thus, despite the strong association of alcoholism with anxiety and depressive disorders, no universal consensus has been reached regarding the specific mechanisms underlying these associations. The present study aims to identify depression and anxiety among alcoholic and non-alcoholic peoples. Method:
Sample: sample of the present study consisted of 100 subjects (50 alcoholics and 50 non alcoholics). The alcoholics were identified through survey from different living areas (including rural, urban and semi-urban) of Delhi and 50 alcoholics were randomly selected for the study. In the same way the non-alcoholic subjects were also selected randomly from different parts of Delhi. The age range of the subjects was between 25 to 50 years.
“Beck Depression Inventory” BDI -2nd was designed by Beck, Steer & Brown (1996). This self report scale has shown to document levels of depression. BDI -2nd edition contains 21 items, each answer being scored on a scale value of 0 to 3. The cut offs used are 0-13 Minimal depression; 14-19 Mild depression; 20-28 Moderate depression; and 29-63 Severe Depression. Higher total scorer indicates more severe depression symptoms.
“Beck Anxiety Inventory” was designed Beck, Epstein, Brown, Steer (1988). This self report scale has shown to document levels of Anxiety symptoms in a valid and consistent manner. BAI contains 21 items each answer being scored on a scale value of 0 to 3. Each symptom item has four possible answer choices: not at all (assigned value =o); Mildly (it did not bother me much) (assigned value=1); Moderately (it was unpleasant but I could stand it) (assigned value =2); and Severely (I could barely stand it) (assigned value =3). The values for each item are summed together to yield an overall or score for all 21 symptoms that can range between 0 and 63 points. A total score of 0-7 is interpreted as a minimal level of Anxiety, 8-15 as ‘mild’, 16-25 as ‘moderate’ and 26-63 as ‘severe’. The BAI is psychometrically sound. Interval consistency α =.92 to.94, for adults and test-retest (one week interval) reliability is .75.
Procedure: The test for depression and anxiety were administered on the subjects individually after establishing the rapport with them. Each and every item was explained to the subject, and then he was asked to respond truly for the item. Thus data was collected for depression and anxiety from alcoholic and non-alcoholic people. t-test was applied to find out the significance of difference between the Mean scores of different groups.
Showing comparison of Mean for depression and anxiety scores between the alcoholics and non-alcoholics Variables| Groups| N| Mean| Std.deviation| t | df| P| depression| Alcoholic Nonalcoholic| 50 50| 35.7600 17.1000| 10.17913 6.15530| 11.092| 98| .01*| Anxiety| Alcoholicnonalcoholic| 50 50| 38.0800 18.3200| 11.55261 6.18570| 10.662| 98| .01*|
*Significant at .01 level of confidence
TABLE-1 further shows the results obtained by the comparison of alcoholics and non alcoholic group for depression and anxiety. The obtained results show that the mean depression score (M=35.7600) for alcoholic people is higher than the mean depression score (M=17.1000) for non alcoholic people, and the difference between the two means (t=11.092) is statistically significant at .01 level of confidence. Consequently it reveals the findings that alcoholic people have higher depression than the non-alcoholics.
The TABLE-1 also shows the results of the comparison of alcoholic and non-alcoholic people on anxiety. The mean anxiety scores (M=38.0800) of alcoholics is found very much higher than the mean anxiety scores (M=18.3200) of the non-alcoholics and the two means difference (t=10.662) is statistically significant at .01 level of confidence. It indicates that alcoholic people have higher anxiety than the non-alcoholic people.
The basis of the above results may safely be concluded that the alcoholics are highly depressed and extremely anxious than the non-alcoholic people. However, the high prevalence of these anxiety and depressives’ symptoms does not necessarily mean that these alcoholic individuals will demonstrate the long term course or require the long term treatments associated with DSM-III-R major depressive and anxiety disorders. The temporal nature of the association between Depression & Anxiety and alcohol is difficult to determine from studies, which uncertainty arising as to whether alcohol is a risk factor or a form of self –medication. The finding of the present study support the findings of Hartka et al, (1991) that reported a significant correlation between baseline consumption of alcohol and depression at follow-up based on data from eight longitudinal studies. However, in this analysis control of confounders was limited to age, gender and interval between measurements.
Overall, our findings are contradictory with those of Wang & Patten (2001) who observed no excess morbidity among those who drank daily, those who drank in binges (more than five drinks), those who had more than one drink daily, and among drinkers in general. Alcohol dependence was not considered. Similarly, in a randomly selected community cohort with follow-up at 3 and 7 years, Moscato et al (1997) found no excess incidence of depressive symptoms among those with ‘alcohol problems’ (defined as a DSM–IV diagnosis of alcohol dependence or abuse or drinking more than five drinks a day on one or more occasions per week).
It may safely be concluded on the bases of previous literature and result of the present study that there is no clear cut casual relationship between depressive and anxiety disorder and alcoholism. In the similar way our findings of the study show that the alcoholics are more depressive and anxious than the non alcoholics. Though it does not show any clear cut picture either alcohol is risk factor for depression and anxiety or depression and anxiety is a risk factor for alcoholism.
Babor, T., Wolfson, A., Boivin, D., Radouco-Thomas, S., Clark, W. (1992). Alcoholism, culture, and psychopathology: A comparative study of French, French Canadian, and American alcoholics. In: Helzer, J., Canino, G. (eds): Alcoholism in North America, Europe, and Asia. New York, NY: Oxford University Press; 182-195.
Beck, A.T., Epstein, N., Brown, G., Steer, R.A. (1988). “An inventory for measuring clinical anxiety: Psychometric Properties, Journal of Consulting and clinical Psychology; 56:893-897
Beck, A.T., Steer, R.A., & Brown, B.K. (1996). Beck Depression Inventory 2nd Ed.). San Antonio. Tx; Psychological Corporation.
Chambless, D., Cherney, J., Caputo, G., Rheinstein, B. (1987). Anxiety disorders and alcoholism: A study with inpatient alcoholics. J Anxiety Disord; 1:29-40.
Cloninger, C.R., Martin, R.L., Clayton, P., Guze, S.B. (1981). A blind follow-up and family study of anxiety neurosis: preliminary analysis of the St Louis 500, in Anxiety: New Research and changing Concepts, Edited by Klein, D.F., Rabkin, J. New York, Raven Press,
Hartka, E., Johnstone, B., Leino,V. (1991). A meta-analysis of depressive symptomatology and alcohol consumption over time. British Journal of Addiction; 86: 1283-1298.
Hasegawa, K., Mukasa, H., Nakazawa, Y., HK., Nakamura, K. (1991). Primary and secondary depression in alcoholism-clinical features and family history. Drug Alcohol Depend; 27:275-281.
Helzer, J., Pryzbeck, T. (1988). The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. J Stud Alcohol; 49:219-224.
Hesselbrock, M., Meyer, R., Keener, J. (1985). Psychopathology in hospitalized alcoholics. Arch Gen Psychiatry; 42:1050- 1055.
Keller, M. (1994). Dysthymia in clinical practice: Course, outcome and impact on the community. Acta Psychiatr Scand; 383(Suppl):24-34.
Kendler, K., Waiters, E., Neale, M., Kessler, R., Heath, A., Eaves, L. The structure of the genetic and environmental risk factors for six major psychiatric disorders in women. Arch Gen Psychiatry 1995; 52:374-383.
Lader, M. (1972). The nature of anxiety. Br J Psychiatry; 121: 481-491.
Mendelson, J., Mello, N. (1979). Medical progress: Biologic concomitants of alcoholism. N Engl J Med; 301:912-921.
Mendelssohn, V.P. (1963). Depression in incyclopedia of mental health. Vol.II, Franklin Walts, Inc.
Merikangas, K., Leckman, J., Prusoff, B., Pauls, D., Weissman, M. (1985). Familial transmission of depression and alcoholism. Arch Gen Psychiatry ; 42:367-372.
Meyer, R., Kranzler, H. (1990). Alcohol abuse/dependence and co-morbid anxiety and depression. In: Maser J, Cloninger C (eds): Comorbidity of Mood and Anxiety Disorders. Washington, DC: American Psychiatric Press: 283-292.
Moscato, B., Russell, M., Zielezny, M. (1997). Gender differences in the relation between depressive symptoms and alcohol problems: a longitudinal perspective. American Journal of Epidemiology; 146: 966-974.
Nathan, P., O’Brien, J., Lowenstein, L. (1971). Operant studies of chronic alcoholism: Interaction of alcohol and alcoholics. In: Roach, P., Mclssac, W., Creaven, P. (eds): Biological Aspects of Alcohol. Austin, TX: University of Texas Press;.
Nijhawan, H. K. (1972). Anxiety in school children. New Delhi : Wiley Eastern Private Limited.
Nunes, E., Quitkin, F., Berman, C. (1988). Panic disorder and depression in female alcoholics. Journal of Clinical Psychiatry; 49:441- 443.
Penick, E., Powell, B., Nickel, E., Bingham, S., Riesenmy, K., Read, M. (1994). Comorbidity of lifetime psychiatric disorder among male alcoholic patients. Alcohol Clin Exp Res; 18:1289-1293.
Regier, D., Farmer, M., Rae, D., Locke, B., Keith, S., Judd, L. (1990).
Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. JAMA; 264:2511-2518.
Schuckit, M. (1983). Alcoholic patients with secondary depression. American Journal of Psychiatry, 140: 711-714.
Schuckit, M., Hesselbrock, V. (1994). Alcohol dependence and anxiety disorders: What is the relationship? Am J Psychiatry, 151:1723-1734.
Schuckit, M., Irwin, M., Brown, S. (1990) .The history of anxiety symptoms among 171 primary alcoholics. J Stud Alcohol; 51:34-41.
Schuckit, M., Irwin, M., Smith, T. (1994). One-year incidence rate of major depression and other psychiatric disorders in 239 alcoholic men. Addiction ; 89:441-445.
Schuckit, M., Tipp, J., Bergman, M., Reich, W., Hesselbrock, V., Smith, T. (1997). Comparison of induced and independent major depressive disorder in 2,945 alcoholics. Am J Psychiatry; 154:948-957.
Singleton, N. Lewis, G. (2003). Better or Worse: A Longitudinal Study of the Mental Health of Adults Living in Private Households in Great Britain. London: Stationery Office. .
Stockwell, T., Hodgson, R., Rankin, H. (1982). Tension reduction and the effects of prolonged alcohol consumption. Br J Addict; 77:65-73.
Stockwell, T., Smail, P., Hodgson, R., Canter, S. (1984). Alcohol dependence and phobic anxiety states. II. A retrospective study. Br J Psychiatry; 144:58-63.
Swendsen, J., Merikangas, K., Canino,G. (1998). The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities. Comprehensive Psychiatry; 39:176-184.
Torgersen, S. (1986). Childhood and family characteristics in panic and
generalized anxiety disorders. Am J Psychiatry; 143:630-632
Wang, J. & Patten, S. B. (2001). Alcohol consumption and major depression: findings from a follow-up study. Canadian Journal of Psychiatry; 46: 632-638.