Anxiety disorders and the use and abuse of drugs

Substance abuse continues to be a growing problem--both in the United States and worldwide. Moderate alcohol consumption reduces anxiety, but alcohol abuse actually increases anxiety and impairs judgment and performance. Research data indicate that phobic anxiety is more common than general anxiety as a prelude to alcohol dependence. Benzodiazepines are widely used throughout the world in the treatment of anxiety disorders. Patients who take benzodiazepines for clinical anxiety rarely exceed the prescribed dosage: benzodiazepine abuse is more likely to occur in those who abuse other drugs. For most people suffering from anxiety disorders, low doses of benzodiazepines for short periods are usually sufficient. When discontinuing patients from benzodiazepines, it is essential for physicians to monitor patients closely and to provide emotional support and counselling about the withdrawal process and potential clinical syndromes associated with it. The need for retaining the option of giving benzodiazepines in the management of anxiety disorders arises from the chronic nature of a high proportion of the anxiety disorders. More research is needed to examine the effects of pharmacologic, behavioral, psychotherapeutic, and combinations of these treatments in patients with chronic anxiety and phobic disorders.