Article

Anxiety Disorders: Treatable regardless of the Severity of Comorbid Alcohol Dependence

Department of Psychiatry and Institute for Extramural Medicine, VU University Medical Centre, GGZ-Buitenamstel, Amsterdam, The Netherlands.
European Addiction Research (Impact Factor: 2.1). 02/2007; 13(2):109-15. DOI: 10.1159/000097941
Source: PubMed

ABSTRACT

Clinical and epidemiological research has shown that comorbidity is the rule rather than exception in the case of psychiatric disorders. Cognitive behavioral therapy (CBT) has been clearly demonstrated to be effective in treating anxiety and avoidance symptoms in patient samples of social phobia and agoraphobia without comorbid alcohol use disorders. It has recently been shown that treatment of comorbid anxiety disorders in alcohol-dependent patients can also be very successful. The purpose of the present study was to find predictors of treatment success for comorbid anxiety disorders in alcohol-dependent patients.
The study was conducted in a sample of 34 completers with a double diagnosis of alcohol dependence and agoraphobia or social phobia who received CBT for their comorbid anxiety disorder in a 32-week randomized controlled trial comparing alcohol and CBT anxiety disorder treatment with alcohol treatment alone. In the current report, treatment success was defined as a clinically significant change (recovery) on the anxiety discomfort scale.
The severity of comorbid alcohol dependence did not influence the beneficial effect of CBT on the anxiety disorder. Psychological distress (SCL-90), neuroticism (NEO N), conscientiousness (NEO C), gender, employment and age of onset of alcohol dependence showed some predictive value.
Alcohol-dependent males with a comorbid anxiety disorder seem to benefit most from CBT if their alcohol dependence started after age 25, if they are employed and if their general psychopathology is less severe. The most important conclusion, however, is that even severely alcohol-dependent patients with an anxiety disorder can benefit from psychotherapy for their anxiety disorder.

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    • "Anxiety may play a role in relapse to alcohol in dually diagnosed alcoholics with depression (Dreissen et al., 2001), particularly in subjects with trait anxiety that persists into early abstinence. Anxiety has also been characterized as a negative prognostic factor for patients with alcoholism alone, and this anxiety may be responsive to treatment intervention such as cognitive behavioural therapy (Schade et al., 2007). "
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    Full-text · Article · Sep 2010 · Drug and Alcohol Review
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    • "McEvoy and Shand [24] found that baseline substance use disorders did not mediate anxiety outcomes from cognitive behaviour therapy (CBT) for anxiety disorders in one sample and that pre-treatment alcohol use predicted changes in social interaction anxiety but no other measure of outcome in another. Similarly Schade and colleagues [25] have reported that standard treatment for anxiety disorders can lead to improvements in anxiety in comorbid cases without the need for a focus on substance use. In our own research [26] baseline alcohol consumption before entering social situations but not total baseline consumption was a significant predictor of social phobia severity. "
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    ABSTRACT: Issues. Comorbidity between anxiety and substance use disorders is common, yet it is poorly understood and poorly treated. Approach. Narrative literature review. PsycINFO and Medline databases were searched for clinical trials of anxiety and substance use disorders using clinical queries for 2005–2009. Key Findings. There are few well-conducted treatment outcome trials for comorbid anxiety and substance use disorders. Some recent (2005–2009) outcome literature has focused on specific mechanisms (anxiety sensitivity and tension reduction alcohol expectancies) that may underlie comorbidity between anxiety and substance use disorders and may lead to more targeted intervention. Implications and Conclusion: The research base for understanding and treating comorbid anxiety and substance use disorders needs to be broadened. In particular research is needed with a focus on: (i) specifying particular comorbid relationships between anxiety and substance use disorders; (ii) the mechanisms that may underlie and maintain those relationships; and (iii) well-conducted evaluations of treatments that target those mechanisms. new directions for research on psychological interventions for comorbid anxiety and substance use disorders.
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