Alcohol and anxiety: subtle and obvious attributes of abuse in adults with social anxiety disorder and panic disorder

Social anxiety and communal living: The influence of social anxiety on men and women in substance abuse recovery homes

Research has demonstrated high rates of co-occurrence among anxiety and substance use disorders. However, few studies have specifically examined the relationship between substance use and social anxiety among individuals who are in substance abuse recovery. The present study examined social anxiety as a predictor of substance use among a sample randomized to a sober-living home versus usual aftercare. Given the social nature of many substance abuse treatment and aftercare programs, it was also hypothesized that high levels of social anxiety would reduce the length of stay in the sober-living home and negatively influence participation in self-help groups. Results suggested that social anxiety was a significant predictor of relapse at one time point, and that social anxiety decreased the likelihood for remaining in a sober-living house for six months or more. No significant relationship between social anxiety and participation in self-help groups were found. Implications for further research and substance abuse treatment are discussed.

Neighborhood socioeconomic characteristics, the retail environment, and alcohol consumption: a multilevel analysis

BACKGROUND

The neighborhoods where people live can influence their drinking behavior. We hypothesized that living in a neighborhood with lower median income, higher alcohol outlet density, and only liquor stores and no grocery stores would be associated with higher alcohol consumption after adjusting for individual demographic and lifestyle factors.

METHODS

We used two self-report measures to assess alcohol consumption in a sample of 9959 adults living in a large Midwestern county: volume of alcohol consumed (count) and binge drinking (5 or more drinks vs.<5 drinks). We measured census tract median annual household income based on U.S. Census data. Alcohol outlet density was measured using the number of liquor stores divided by the census tract roadway miles. The mix of liquor and food stores in census tracts was assessed using a categorical variable based on the number of liquor and number of food stores using data from InfoUSA. Weighted hierarchical linear and Poisson regression were used to test our study hypothesis.

RESULTS

Retail mix was associated with binge drinking. Individuals living in census tracts with only liquor stores had a 46% higher risk of binge drinking than individuals living in census tracts with food stores only after controlling for demographic and lifestyle factors.

CONCLUSION

Census tract characteristics such as retail mix may partly explain variability in drinking behavior. Future research should explore the mix of stores, not just the over-concentration of liquor stores in census tracts.

A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students

OBJECTIVE

The current study is a multisite randomized alcohol prevention trial to evaluate the efficacy of both a parenting handbook intervention and the Brief Alcohol Screening and Intervention for College Students (BASICS) intervention, alone and in combination, in reducing alcohol use and consequences among a high-risk population of matriculating college students (i.e., former high school athletes).

METHOD

Students (n = 1,275) completed a series of Web-administered measures at baseline (in the summer before starting college) and follow-up (after 10 months). Students were randomized to one of four conditions: parent intervention only, BASICS only, combined (parent and BASICS), and assessment-only control. Intervention efficacy was tested on a number of outcome measures, including peak blood alcohol concentration, weekly and weekend drinking, and negative consequences. Hypothesized mediators and moderators of intervention effect were tested.

RESULTS

The overall results revealed that the combined-intervention group had significantly lower alcohol consumption, high-risk drinking, and consequences at 10-month follow-up, compared with the control group, with changes in descriptive and injunctive peer norms mediating intervention effects.

CONCLUSIONS

The findings of the present study suggest that the parent intervention delivered to students before they begin college serves to enhance the efficacy of the BASICS intervention, potentially priming students to respond to the subsequent BASICS session.

Social anxiety disorder comorbidity in patients with bipolar disorder: a clinical replication

BACKGROUND

The authors investigated frequency, clinical correlates and onset temporal relationship of social anxiety disorder (SAD) in adult patients with a diagnosis of bipolar I disorder.

METHODS

Subjects were 189 patients whose diagnoses were assessed by the Structured Clinical Interview for DSM-III-R-Patient Version.

RESULTS

Twenty-four patients (12.7%) met DSM-III-R criteria for lifetime SAD; of these, 19 (10.1% of entire sample) had SAD within the last month. Significantly more bipolar patients with comorbid SAD also had substance use disorders compared to those without. On the HSCL-90, levels of interpersonal sensitivity, obsessiveness, phobic anxiety and paranoid ideation were significantly higher in bipolar patients with SAD than in those without. Bipolar patients with comorbid SAD recalled separation anxiety problems (school refusal) more frequently during childhood than those without. Lifetime SAD comorbidity was associated with an earlier age at onset of syndromal bipolar disorder. Pre-existing OCD tended to delay the onset of bipolarity.

CONCLUSIONS

Social anxiety disorder comorbidity is not rare among patients with bipolar disorder and is likely to affect age of onset and phenomenology of bipolar disorder. These findings may influence treatment planning and the possibility of discovering a pathophysiological relationship between SAD and bipolarity.

Does subtle screening for substance abuse work? A review of the Substance Abuse Subtle Screening Inventory (SASSI)

AIM

Through a complex combination of direct (face-valid) and indirect (subtle) subscales, the Substance Abuse Subtle Screening Inventory (SASSI) is purported to detect substance use disorders with a high degree of validity regardless of respondent honesty or motivation. This review evaluates empirical evidence regarding the reliability and validity of this widely used screening instrument.

METHODS

Source documents were 36 peer-reviewed reports yielding data regarding the SASSI's internal consistency, test-retest reliability, psychometric structure, convergent and divergent validity and criterion (predictive) validity.

RESULTS

The total N of the studies reviewed equaled 22 110. Internal consistency is high for the overall SASSI and for its direct but not its indirect (subtle) subscales, suggesting that the instrument taps a single face-valid construct. SASSI classifications converged with those from other direct screening instruments, and were also correlated with ethnicity, general distress and social deviance. Studies found test-retest reliability lower than that reported in the test manuals. Sensitivity was found to be similar to that for public domain screening instruments, but on specificity the SASSI appears to yield a high rate of false positives.

CONCLUSION

No empirical evidence was found for the SASSI's claimed unique advantage in detecting substance use disorders through its indirect (subtle) scales to circumvent respondent denial or dishonesty. Recommendations for screening and for future research with the SASSI are offered.

Correlation of liver dysfunction biological markers to the mood status of alcohol-dependent individuals

OBJECTIVE

Alcohol intake is a major cause of liver cirrhosis as well as chronic liver disease, and commonly coexists with mood disorders such as depression and anxiety. The aim of the present study was to investigate the possible correlation between liver dysfunction related to alcohol intake with anxiety and depressive-like symptomatology prior to and after the detoxification period.

METHODS

One hundred alcohol abusing/dependent subjects (81 males and 19 females) were treated on an inpatient basis according to a standard detoxification protocol and measurements of serum levels of hepatic enzymes (ASAT, ALAT, γGT), and measures of anxiety (HARS), depression (HDRS) and global functioning (GAS) were also obtained at baseline and at weekly intervals over a period of 4 weeks.

RESULTS

Increased levels of hepatic enzymes were observed upon admission that were significantly reduced (P<0.001) following completion of the detoxification treatment. In addition, the psychopathological profile was improved at the end of the detoxification period and a significant correlation was obtained between the levels of hepatic enzymes and the global functioning of alcohol-dependent individuals.

CONCLUSION

This observation further supports a relationship between the depressogenic action of alcohol and the disordered liver function observed in alcohol-dependent individuals, with possible implications in the diagnosis and treatment of mood disorders associated to alcohol abuse.