Alcoholism is among the most serious health care problems of our time, affecting approximately 32.5 million Americans at an estimated cost of 136.3 billion dollars annually (NIAAA,1990). Recent epidemiological studies have been consistent in finding a high rate of alcohol problems among those suffering with panic disorder (an anxiety syndrome that involves repeated unexpected panic attacks often complicated by anxiety surrounding the anticipation of panic and agoraphobic avoidance). """"""""Self- medication,"""""""" a commonly held, but as yet invalidated explanatory model for these findings, suggest that those with panic disorder are prone toward pathological drinking because alcohol is used as a means of coping with unpleasant panic and anxiety symptoms. If validated, this model would have direct implications for the prevention, treatment, and relapse prevention of alcoholism. Unfortunately, little systematic research into the mechanisms underlying co-occurring panic disorder and alcoholism is currently ongoing. In part, this paucity of research reflects the methodological difficulty of directly observing and recording the interaction of alcohol consumption and panic symptoms. We will study the interaction of alcohol consumption and panic anxiety in subjects diagnosed with panic disorder using two novel methods: 1) Using an experimental design, we will provoke panic and administer alcohol in our laboratory, allowing us to directly observe the interaction of these phenomena: 2) we will use a prospective diary methodology to have subjects monitor and record all panic, anticipatory anxiety, and alcohol consumption events, allowing us to directly evaluate naturalistic patterns among these phenomena over time. Experiment 1 tests the hypothesis that alcohol consumption lowers panic challenge responding. Laboratory panic-challenge responding will be compared between panic disordered subjects who consumed either alcohol (medium or high dose) or a placebo. Experiment 2 tests the hypothesis that panic challenge increases the motivation to consume alcohol. Panic disordered subjects will be given an opportunity to consume an alcoholic and/or non-alcoholic beverage, ad lib. in between two challenges of either C02 (panic condition) or room air (no panic control condition). The Diary Study tests the hypothesis that panic attacks and anticipatory anxiety are positively associated with alcohol consumption both between and within subjects over time. For each of 42 consecutive days, panic disordered subjects will record and mail to us a diary detailing their drinking behavior, panic attacks, and anticipatory anxiety. These studies will be the first to directly evaluate the interaction of panic anxiety and alcohol consumption in diagnosed panic disorder subjects. Results will provide new knowledge concerning the nature of, and mechanisms underlying this interaction, as well as provide insight into the patho-development of co-occurring panic disorder and alcoholism.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
First Independent Research Support & Transition (FIRST) Awards (R29)
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Clinical and Treatment Subcommittee (ALCP)
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University of Minnesota Twin Cities
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Abrams, Kenneth; Rassovsky, Yuri; Kushner, Matt G (2006) Evidence for respiratory and nonrespiratory subtypes in panic disorder. Depress Anxiety 23:474-81
Rassovsky, Yuri; Abrams, Kenneth; Kushner, Matt G (2006) Suffocation and respiratory responses to carbon dioxide and breath holding challenges in individuals with panic disorder. J Psychosom Res 60:291-8
Rassovsky, Yuri; Hurliman, Elisabeth; Abrams, Kenneth et al. (2004) CO(2) hypersensitivity in recently abstinent alcohol dependent individuals:; A possible mechanism underlying the high risk for anxiety disorder among alcoholics. J Anxiety Disord 18:159-76
Abrams, Kenneth; Kushner, Matt G (2004) The moderating effects of tension-reduction alcohol outcome expectancies on placebo responding in individuals with social phobia. Addict Behav 29:1221-4
Rassovsky, Yuri; Kushner, Matt G (2003) Carbon dioxide in the study of panic disorder: issues of definition, methodology, and outcome. J Anxiety Disord 17:1-32
Abrams, Kenneth; Kushner, Matt G; Medina, Krista Lisdahl et al. (2002) Self-administration of alcohol before and after a public speaking challenge by individuals with social phobia. Psychol Addict Behav 16:121-8
Stewart, S H; Kushner, M G (2001) Introduction to the Special Issue on ""Anxiety Sensitivity and Addictive Behaviors"". Addict Behav 26:775-85
Kushner, M G; Thuras, P; Abrams, K et al. (2001) Anxiety mediates the association between anxiety sensitivity and coping-related drinking motives in alcoholism treatment patients. Addict Behav 26:869-85
Abrams, K; Kushner, M; Medina, K L et al. (2001) The pharmacologic and expectancy effects of alcohol on social anxiety in individuals with social phobia. Drug Alcohol Depend 64:219-31
Kushner, M G; Thuras, P; Kaminski, J et al. (2000) Expectancies for alcohol to affect tension and anxiety as a function of time. Addict Behav 25:93-8

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