ORIGINAL RESEARCH

Comorbidity of Phobic Disorders With Alcoholism in a Canadian Community Sample
Jitender Sareen BSc, MD, FRCPC1, Mariette Chartier RN, MSc2,
Kevin D Kjernisted MD, FRCPC3, Murray B Stein MD, FRCPC4

Objectives:  To examine the relation between phobic disorders and alcoholism in a Canadian community sample.
Method:  Data came from the Mental Health Supplement of the Ontario Health Survey. The University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI) was used to diagnose DSM-III-R psychiatric disorders in 8116 Canadian respondents between ages 15 and 64 years. Since the cross-system agreement (ICD-10 and DSM-III-R or DSM-IV) on the diagnosis of alcohol abuse is much lower than that for alcohol dependence, we also examined a WHO category, “hazardous alcohol use.” Logistic regression controlling for age and sex was used to determine odds ratios (ORs) for phobic disorders and alcohol-use diagnoses.
Results:  Individuals with lifetime alcohol abuse or dependence had two- to threefold increased odds of having a phobic disorder. Simple phobia and social phobia with multiple fears were significantly associated (ORs 1.5 to 2) with hazardous alcohol use (which had a prevalence of approximately 10%).
Conclusions:  Given the early onset of most phobic disorders, the findings suggest that these are a risk factor for hazardous patterns of alcohol use.

(Can J Psychiatry 2001; 733–740)

Key Words:  comorbidity, phobia, anxiety, alcoholism, Ontario Health Survey, alcohol abuse, epidemiology


In the last 2 decades, there has been a burgeoning of literature on the comorbidity of anxiety and alcohol-use disorders (1–3). Understanding the nature of the relation between these disorders has substantial clinical relevance for recognition, prevention, and treatment of these disabling conditions.

Population-based community surveys across multiple countries, using structured or semistructured interviews, have provided estimates of the magnitude and extent of psychiatric disorders in community populations (4–6). Contemporary surveys in 4 countries have found high cross-sectional rates of comorbidity between anxiety and alcohol-use disorders (7,8). When controlled for age, sex, and education, having an anxiety disorder increased the risk of alcohol

Manuscript received February 2001, revised, and accepted July 2001.
1Assistant Professor of Psychiatry, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
2Graduate Student, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
3Associate Professor of Psychiatry, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
4Professor of Psychiatry-in-Residence, Department of Psychiatry, University of California, San Diego, California
Address for correspondence: Dr J Sareen, University of Manitoba, St Boniface General Hospital M5024 409 Taché Avenue, Winnipeg, MB R2H 2A6
sareen@cc.umanitoba.ca

abuse or dependence diagnosis by twofold in each of these community samples. When alcohol abuse and alcohol dependence diagnoses have been studied as mutually exclusive variables, however, community surveys have found inconsistent findings.

In the Epidemiologic Catchment Area (ECA) study, the National Comorbidity Survey (NCS), and the Ontario Health Survey (OHS), DSM-III-R anxiety disorders were found to be significant risk factors for DSM-III-R alcohol dependence, but not for DSM-III-R alcohol abuse (4,7,9–11). This latter finding is not consistent with studies in clinical populations that have found significant comorbidity of anxiety disorders with alcohol abuse (12,13). One possibility for this inconsistent finding may be the poor reliability of the DSM-III-R diagnosis of alcohol abuse.

Through several investigations, it has become evident that the alcohol-dependence diagnosis is highly reliable across different classification systems, while alcohol-abuse diagnosis is not (14–16). Although the diagnosis of alcohol abuse does not show good cross-system agreement, there is evidence that heavy drinking in an individual not dependent on alcohol leads to significant physical,

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