Alcoholism, Anxiety and Depression

Summary This paper discusses diagnostic and treatment approaches for dealing with patients who present with two or more psychiatric disorders. We emphasize the relationship between depressive and anxiety syndromes on one hand, and alcohol abuse on the other. Some reasons for diagnostic confusion are noted, such as the need to distinguish between drinking and alcoholism, sadness and depression, and anxiety feelings and major anxiety disorders. Because symptoms of sadness or anxiety and excessive drinking frequently overlap, a working hierarchy must be established–the approach suggested here is the determination of the primary disorder based on the chronology of development of symptoms. The authors point out some clinical guidelines for use in evaluating patients with primary alcohol abuse and secondary anxiety or depression. Using the data from the literature as well as clinical experience, it is concluded that alcoholism, major affective disorder and major anxiety disorder are distinct illnesses with different prognoses and treatments. Some implications for clinical practice are discussed.