Current Major Depression and Anxiety Disorders in Former Substance Abusers

PURPOSE. This study investigates the complex relationship of alcohol and marijuana dependence to depression and anxiety disorders. The high rates of psychiatric comorbidity documented among substance abusers could, in part, be due to misdiagnosed intoxication and withdrawal effects. To investigate whether such expected effects could account for the entire relationship or if a history of alcohol or marijuana dependence increases the risk for depression and anxiety disorders even among those who abstain from drug use and whose current drinking is not high, we examined whether past dependence increased the risk for current DSM-IV major depression and panic disorder or generalized anxiety disorder (GAD) in individuals who no longer drink heavily or use drugs.

METHODS. Data were obtained from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). In this survey 43,093 individuals aged 18 or older were assessed for current and past DSM-IV substance disorders and other psychopathology. Two subsamples were identified: 1) alcohol subsample: individuals who had one or more drinks prior to the last 12 months, were abstainers or non-risk drinkers in the last 12 months, and did not use tobacco or drugs in the last 12 months (n=18,323, 41.7%). Non-risk drinking was defined as no more than 4 drinks (men) or 3 drinks (women) on a single occasion and no more than 14 drinks (men) or no more than 7 drinks (women) per week. 2) marijuana subsample: individuals who used marijuana one or more times prior to the last 12 months, were alcohol abstainers or non-risk drinkers in the last 12 months, and did not use tobacco or drugs in the last 12 months (n=2,434, 5.65%). Each subsample was divided into those with and without past dependence on the substance of interest. Logistic regression was used to test the association between past dependence and current major depression, panic disorder or GAD, controlling for demographic characteristics.

RESULTS. A history of alcohol dependence increased the risk for current major depression 2.2-fold (95%CI 1.10-4.38) among abstainers and non-risk drinkers with no history of depression. A history of alcohol dependence increased the risk for current panic disorder or GAD 2.5-fold (95%CI 1.24-5.18) among abstainers and non-risk drinkers with no history of such disorders. A history of marijuana dependence was not associated with current major depression. The association of past marijuana dependence and current panic or GAD did not reach statistical significance (OR 2.24, 95%CI 0.61-8.17).

CONCLUSION. The findings regarding alcohol dependence provide important information for alcohol relapse prevention. The association of major depression, panic disorder and GAD with alcohol dependence is not an artifact of misdiagnosed alcohol-producing symptoms. Improvements in drinking behavior in individuals with a history of dependence do not necessarily protect against episodes of these disorders. Clinicians should be sensitive to potential depression and anxiety problems even in individuals where no such history exists as this could result in alcohol relapse. Recently released NESARC longitudinal data collected in 2004-2005 provides an optimal opportunity to test if depression and anxiety predict relapse in a large general population sample.