Alcohol Use and Anxiety: Diagnostic and Management Issues

"Ms. M" is a 40-year-old Caucasian female who presents with complaints of anxiety and sleep disturbance. She recently went through a difficult divorce after 14 years of marriage, and she has two children, ages 8 and 10. She was trained as a nurse and had stopped working when her first child was born, but she is now working as a school nurse. She reports feeling anxious about everything, including financial issues, the well-being of her children, and her competence at work. She has a great deal of difficulty falling asleep. Approximately 3 months ago, she began to drink wine at night to help her sleep. She has gradually increased her drinking and is currently drinking 2-3 glasses of wine (4 ounces each) per night on average, but on several nights within the past month she drank a 32-ounce bottle of wine by herself. Her father was an alcoholic, and she worries about her drinking. She reports binge drinking during adolescence and in college and recalls having one "blackout." After she met her husband 18 years ago, her drinking decreased considerably because he drank alcohol only occasionally and disapproved of her drinking. They kept little alcohol in the house and she drank only socially. She says that since childhood she has felt extremely anxious in social settings and that drinking alcohol always helped to "take the edge off." She has several close friends and is involved in her church community. [PUBLICATION ABSTRACT]