Evaluation and treatment of anxiety symptoms and disorders in alcoholics

Anxiety symptoms are common among alcoholics. Despite evidence suggesting that anxiety symptoms eventually resolve in most alcoholics during persistent abstinence, clinical care often requires rapid evaluation and intervention. This article provides guidelines to differentiate transient from persistent anxiety states, a distinction that has important treatment implications. Psychosocial support and coping skills training to maintain abstinence are recommended for treatment of transient anxiety states. The use of medication should be reserved for persistent anxiety states. Recent placebo-controlled trials of buspirone, a non-benzodiazepine anxiolytic, suggest that this medication may help to retain anxious alcoholics in treatment and to reduce anxiety symptoms and heavy drinking. Guidelines are provided for the appropriate use of buspirone in alcoholics with persistent anxiety symptoms.