ANXIETY AND ALCOHOL WITHDRAWAL: DISTINCT DISORDERS OR A SHARED CIRCUIT DYSREGULATION

Abstract

Background: Anxiety disorders and alcohol use disorders often co-exist and are historically regarded as different diagnoses in the categorical systems (DSM-5-TR, ICD-11). Nevertheless, there is growing clinical and neurobiological data indicating a great deal of overlap in their pathogenesis.

Objective: The purpose of this review is to appreciate anxiety and alcohol withdrawal as the two divergent expressions of the same dysregulation within the same neurocircuit, and not as two diseases.

Methods: A narrative synthesis of existing research in clinical psychiatry, affective neuroscience, and addiction biology was employed, in which cortico-limbic circuitry and neurotransmitter dynamics were tracked.

Results: Distinctive features of anxiety as well as alcohol-related states are dysfunction of Cortico-limbic networks (such as hyperactivity of the amygdala, prefrontal control failure, and dysregulation in the hippocampus). One key process is the imbalance between the inhibitory GABAergic and the excitatory glutamatergic neurotransmission. There is a transient recovery in inhibitory tone after acute alcohol consumption, and chronic consumption brings about neuroadaptations that favour excitatory prevalence, which leads to withdrawal effects of hyperexcitability. These are a continuum from subclinical anxiety to extreme withdrawal syndromes.

Conclusion: A circuit-based continuum model offers a single framework that connects anxiety and alcohol use-withdrawal states. The practice promotes the transdiagnostic, mechanism-based diagnosis and treatment, with outstanding implications for early intervention, integrated care, as well as enhanced outcomes, especially in resource-limited environments.