[Alcohol dependence and anxious disorders: dangerous liaisons].

Anxiety disorders and alcohol dependence have a higher co-occurence than expected by chance only. This association has a double origin, as the presence of alcohol dependence increases by 6 the risk of any anxious disorder, and the presence of an anxious disorder multiply by 3 the risk of alcohol-dependence. Interestingly, a large population-based epidemiological study performed 10 years apart clearly showed that anxiety disorders moderatly increase the risk of regular consumption in non-consumers or irregular drinkers (by 70%), does not increase ther risk of abuse in regular drinkers, but has a strong impact on the risk of alcohol dependence while already an abuser (OR = 2.7). Assessing the kinetic of symptoms of anxiety and focusing on some symptoms that are more specific than others (for example nausea, vomiting and/or shaking hands in the morning, all being relieved by the first drink) is helpful. Treating anxiety symptoms in alcohol dependence means, whatever the type of relationship they have, to begin with a detoxification program. Indeed, antidepresants have a larger liver-toxicity in alcohol dependence, and benzodiazepine loose most of their benefits with high level of alcohol consumption. Furthermore, when benzodiazepines are taken with large doses of alcohol, the risk of severe withdrawal symptoms is increased (such as seizures). The same trend could be proposed for psychotherapy, as cognitive behavioural therapy sollicitates a lot executive functions. The neurotoxicity of alcohol explains the damages on executive functions, CBT therefore should have larger efficacy after the detoxification program, helping to reduce the risk of relapse.