Anxiolytics and the alcoholic patient

There is a growing appreciation of the heterogeneity of alcoholic patients with implications for treatment intervention. Several recent studies suggest that a minority of alcoholic patients suffer from diagnosable anxiety disorders, although symptoms of anxiety may be present in alcoholics while drinking and in the acute, subacute and protracted periods of abstinence from alcohol. In addition, recent research on biological mechanisms of anxiety may suggest a testable model for examining the existence of an altered biological state associated with symptoms of protracted abstinence in alcoholics, and may suggest an additional rationale for studying newer anxiolytic drugs in the postwithdrawal management of alcoholic patients. In the mid-1970s, Benjamin Kissin made three points regarding the optimal qualities for a tranquilizing drug in the treatment of alcoholism: it should be effective in maintaining individuals in treatment, it should have a low potential for abuse and it should not potentiate the effects of alcohol. Buspirone, a new anxiolytic drug, fulfills the second two criteria. The case for examining anxiolytics with low abuse potential in alcoholic patients is reviewed.