title: Reports of drinking to self-medicate anxiety symptoms: longitudinal assessment for subgroups of individuals with alcohol dependence.
abstract: BACKGROUND
  Self-medication with alcohol is frequently hypothesized to explain anxiety and alcohol dependence comorbidity. Yet, there is relatively little assessment of drinking to self-medicate anxiety and its association with the occurrence or persistence of alcohol dependence in population-based longitudinal samples, or associations within demographic and clinical subgroups.
  
  
  METHODS
  Hypothesizing that self-medication of anxiety with alcohol is associated with the subsequent occurrence and persistence of alcohol dependence, we assessed these associations using data from the National Epidemiologic Survey on Alcohol and Related Conditions, and examined these associations within population subgroups. This nationally representative survey of the US population included 43,093 adults surveyed in 2001-2002, and 34,653 reinterviewed in 2004-2005. Logistic regression incorporating propensity score methods was used.
  
  
  RESULTS
  Reports of drinking to self-medicate anxiety was associated with the subsequent occurrence (adjusted odds ratio (AOR) = 5.71, 95% confidence interval (CI) = 3.56-9.18, P < .001) and persistence (AOR = 6.25, CI = 3.24-12.05, P < .001) of alcohol dependence. The estimated proportions of the dependence cases attributable to self-medication drinking were 12.7 and 33.4% for incident and persistent dependence, respectively. Stratified analyses by age, sex, race-ethnicity, anxiety disorders and subthreshold anxiety symptoms, quantity of alcohol consumption, history of treatment, and family history of alcoholism showed few subgroup differences.
  
  
  CONCLUSIONS
  Individuals who report drinking to self-medicate anxiety are more likely to develop alcohol dependence, and the dependence is more likely to persist. There is little evidence for interaction by the population subgroups assessed. Self-medication drinking may be a useful target for prevention and intervention efforts aimed at reducing the occurrence of alcohol dependence.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. rcrum@jhsph.edu
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Crum
authors.forename: Lareina
authors.initials: L
authors.lastname: La Flair
authors.forename: Carla L
authors.initials: CL
authors.lastname: Storr
authors.forename: Kerry M
authors.initials: KM
authors.lastname: Green
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stuart
authors.forename: Anika A H
authors.initials: AA
authors.lastname: Alvanzo
authors.forename: Samuel
authors.initials: S
authors.lastname: Lazareck
authors.forename: James M
authors.initials: JM
authors.lastname: Bolton
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robinson
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.forename: Ramin
authors.initials: R
authors.lastname: Mojtabai
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology / Q000523:psychology; D000437:Alcoholism / Q000453:epidemiology / Q000209:etiology*; D001007:Anxiety / Q000628:therapy*; D001008:Anxiety Disorders / Q000628:therapy*; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D057216:Propensity Score; D044469:Racial Groups; D012651:Self Medication / Q000009:adverse effects* / Q000523:psychology; D012737:Sex Factors