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Of all the anxiety disorders, only generalized anxiety disorder has appreciable data supporting the efficacy of an agent that is able to positively affect both anxiety symptoms and substance use. In generalized anxiety comorbid with an AUD, buspirone has been shown to reduce both anxiety symptoms and alcohol consumption (Nitenson and Gastfriend 2003). As a general rule for all of the other anxiety spectrum disorders, serotonin reuptake inhibitors should be considered first-line agents, and benzodiazepines should be avoided as much as possible unless absolutely necessary (e.g., in the case of severe panic disorder). If a benzodiazepine has to be used, slower-onset and longer-acting agents should be used (e.g., clonazepam).

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