TOPLINE

Cannabis use disorder (CUD), alcohol use disorder (AUD), and nicotine use disorder (NUD) were each associated with a higher risk for subsequent generalized anxiety disorder (GAD) than no lifetime substance use disorder (SUD), a study showed. CUD was associated with a higher 10-year cumulative incidence of GAD onset than AUD or NUD. Remission from SUD was linked to a reduced risk for GAD.

METHODOLOGY

• Researchers conducted a survival analysis of cross-sectional survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a nationally representative US survey conducted during 2012-2013.
• 6685 adults with AUD, 1500 adults with CUD, 5673 adults with NUD, and 16,117 control individuals without an SUD (age ≥ 29 years) were included. The cohorts overlapped, and a pooled cohort of individuals with any SUD (n = 9812) was studied: 64.8%, 28.4%, and 6.9% of the individuals had one, two, and three SUDs, respectively, before GAD onset.
• Participants with SUD onset preceding GAD onset were followed up from the age at SUD onset to the first GAD episode or the age at the time of the interview; control individuals were followed from the age of 29 years.
• Researchers assessed the cumulative incidence of the first GAD episode at 10 years and the risk for GAD onset.
• The age at SUD onset, remission status, sex, race, marital status, employment status, the education level, a family history of GAD or SUD, the childhood adversity score, and the presence of comorbid mood disorders, non-GAD anxiety disorders, personality disorders, and posttraumatic stress disorder were examined as potential predictors of the association between SUD onset and GAD onset.

TAKEAWAY

• Within 10 years of SUD onset, the cumulative incidence of the first GAD episode was 7.06% in the CUD cohort, 5.45% in the NUD cohort, 5.22% in the AUD cohort, and 4.78% in the pooled cohort of individuals with any SUD vs 1.34% in the control cohort. The risk for GAD onset peaked near 5 years in the CUD cohort and was higher than the risks observed in the AUD cohort, NUD cohort, and pooled cohort of individuals with any SUD.
• Achieving remission from SUD was associated with a significantly reduced risk for GAD onset across the groups: AUD (hazard ratio [HR], 0.44), CUD (HR, 0.33), and NUD (HR, 0.45; all P < .0001).
• Participants with comorbid non-GAD anxiety disorders, mood disorders, or personality disorders had a significantly increased risk for GAD onset in all SUD cohorts (HR range, 1.91-2.70; all P < .0001).
• The risk for GAD onset increased stepwise with the number of co-occurring SUDs over the full follow-up period: 8%, 10.2%, and 11.5% among individuals with one, two, and three disorders, respectively, compared with 3.5% among control individuals.

IN PRACTICE

"These results may inform targeted screening, monitoring, and prevention strategies to interrupt development of GAD," the authors wrote.

SOURCE

The study was led by Xiaoxiao Zhang, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health in Toronto, Canada. It was published online on October 8 in Psychiatry Research.

LIMITATIONS

The study relied on retrospective self-reported ages at SUD and GAD onset recorded in whole years, which may have led to recall bias and potentially reduced precision. High censoring rates and analytic exclusions reduced the number of incident GAD events, limiting statistical precision for some predictors and potentially reducing generalizability. Additionally, multiple covariates were tested without adjustment for multiple comparisons.

DISCLOSURES

The study was funded in part by an Academic Scholars Award from the Department of Psychiatry, University of Toronto. NESARC-III was funded by the National Institute on Alcohol Abuse and Alcoholism as well as the National Institute on Drug Abuse and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.