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Is there a link between anxiety and alcoholism?

Data Management and Visualization

Bill Sutherland

The connection between anxiety disorders and alcoholism

STEP 1: Choose a data set that you would like to work with.

NESARC Wave 1

STEP 2. Identify a specific topic of interest I have an interest in researching which how anxiety disorders may correlate with alcohol abuse.

I’m interested because my kids’ mother is an alcoholic and I want to understand which factors may contribute to abusing alcohol. If I can discover the correlations, then I can be mindful about teaching skills to my kids that might help them avoid abusing alcohol

I think my first challenge is going to be creating a subset of respondents who meet the criteria of an alcoholic. The criteria are subjective and open to scrutiny, but I will use the variables available to me to build the subset.

STEP 3. Prepare a codebook of your own. Variables that will make up my subset.

I first want to identify the subset of alcoholics. I will use the variable ALCABDEP12DX (ALCOHOL ABUSE/DEPENDENCE IN LAST 12 MONTHS) and ALCABDEPP12DX (ALCOHOL ABUSE/DEPENDENCE PRIOR TO THE LAST 12 MONTHS).

Tape Location Question Variable = ALCABDEP12DX ALCOHOL ABUSE/DEPENDENCE IN LAST 12 MONTHS 1 ALCABDEPP12DX ALCOHOL ABUSE/DEPENDENCE PRIOR TO THE LAST 12 MONTHS 1

Now I want to identify those people who have experienced anxiety symptoms.

Next, I’d like to know which of those people in my anxiety subset sought treatment for their anxiety.

Next, I’d like to know which of those people in my anxiety subset did not seek treatment.

Next, I’d like to know the correlation between those people who sought treatment for anxiety and those who did not with whether they are in the alcoholic subset.

STEP 4. Identify a second topic that you would like to explore in terms of its association with your original topic.

I’m curious if there’s a link between alcoholism and the type of anxiety experienced. According to the National Institute of Mental Health (https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml), there are several types of anxiety. Generalized Anxiety Disorder People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work. Generalized anxiety disorder symptoms include: a. Feeling restless, wound-up, or on-edge b. Being easily fatigued c. Having difficulty concentrating; mind going blank d. Being irritable e. Having muscle tension f. Difficulty controlling feelings of worry g. Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Panic Disorder People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.

During a panic attack, people may experience:

Heart palpitations, a pounding heartbeat, or an accelerated heartrate

Sweating

Trembling or shaking

Sensations of shortness of breath, smothering, or choking

Feelings of impending doom

Feelings of being out of control

Phobia-related disorders A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object. People with a phobia: • May have an irrational or excessive worry about encountering the feared object or situation • Take active steps to avoid the feared object or situation • Experience immediate intense anxiety upon encountering the feared object or situation • Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders: Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of: • Flying • Heights • Specific animals, such as spiders, dogs, or snakes • Receiving injections • Blood

Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment. Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations: • Using public transportation • Being in open spaces • Being in enclosed spaces • Standing in line or being in a crowd • Being outside of the home alone People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated. Selective mutism: A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders. STEP 5. Add questions/items/variables documenting this second topic to your personal codebook.

My goal with this second question is to categorize the variables into anxiety disorders. Generalized Anxiety Disorder Tape Location Question Values S9Q1A EVER HAD 6+ MONTH PERIOD FELT TENSE/NERVOUS/WORRIED MOST OF TIME Yes = 1 S9Q1B EVER HAD 6+ MONTH PERIOD FELT VERY TENSE/NERVOUS/WORRIED MOST OF TIME ABOUT EVERYDAY PROBLEMS Yes = 1 S9Q31 IN WORST PERIOD, EVER WORRY A LOT ABOUT THINGS YOU USUALLY DIDN'T WORRY ABOUT Yes = 1

Panic Disorder Tape Location Question Values S6Q1 HAD PANIC ATTACK, SUDDENLY FELT FRIGHTENED/OVERWHELMED/NERVOUS AS IF IN GREAT DANGER BUT WERE NOT Yes = 1 S6Q3 THOUGHT WAS HAVING HEART ATTACK, BUT DOCTOR SAID JUST NERVES OR PANIC ATTACK Yes = 1 S6Q61 HAD TROUBLE CATCHING BREATH, FELT SHORT OF BREATH, FELT LIKE SMOTHERING Yes = 1

Phobia Disorder Tape Location Question Values S7Q1 EVER HAD STRONG FEAR OR AVOIDANCE OF SOCIAL SITUATION Yes = 1 S7Q2 HAD FEAR/AVOIDANCE OF SOCIAL SITUATION DUE TO FEAR OF EMBARRASSMENT AT WHAT YOU MIGHT SAY/DO AROUND OTHERS Yes = 1 S7Q3 HAD FEAR/AVOIDANCE OF SOCIAL SITUATION DUE TO FEAR OF BECOMING SPEECHLESS, HAVING NOTHING TO SAY OR SAYING SOMETHING FOOLISH Yes = 1

STEP 6. Perform a literature review to see what research has been previously done on this topic. Use sites such as Google Scholar (http://scholar.google.com) to search for published academic work in the area(s) of interest. Try to find multiple sources and take note of basic bibliographic information.

The relationship between anxiety disorders and alcohol use disorders: A review of major perspectives and findings paper discusses the comorbidity between anxiety and alcoholism. - Matt G Kushner, Kenneth Abrams, Carrie Borchardt https://doi.org/10.1016/s0272-7358(99)00027-6 Link

Abstract It is generally agreed that problems related to alcohol use and anxiety tend to occur within the same individual (“comorbidity”); however, the cause of this association remains controversial. Three prominent perspectives are that anxiety disorder promotes pathological alcohol use, that pathological alcohol use promotes anxiety disorder and that a third factor promotes both conditions. We review laboratory, clinical, family, and prospective studies bearing on the validity of these explanatory models. Findings converge on the conclusion that anxiety disorder and alcohol disorder can both serve to initiate the other, especially in cases of alcohol dependence versus alcohol abuse alone. Further, evidence from clinical studies suggests that anxiety disorder can contribute to the maintenance of and relapse to pathological alcohol use. Relying heavily on pharmacological and behavioral laboratory findings, we tentatively propose that short-term anxiety reduction from alcohol use, in concert with longer-term anxiety induction from chronic drinking and withdrawal, can initiate a vicious feed-forward cycle of increasing anxiety symptoms and alcohol use that results in comorbidity.

STEP 7. Based on your literature review, develop a hypothesis about what you believe the association might be between these topics. Be sure to integrate the specific variables you selected into the hypothesis.

I hypothesize that those people who did not seek treatment for their anxiety have a higher chance of becoming an alcoholic.

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