Follow-up Study of Anxiety Disorder and Alcohol Dependence in Comorbid Alcoholism Treatment Patients

Department of Psychology, University of Richmond, Ричмонд, Virginia, United States
Alcoholism Clinical and Experimental Research (Impact Factor: 3.21). 09/2005; 29(8):1432-43. DOI: 10.1097/01.alc.0000175072.17623.f8
Source: PubMed


Anxiety disorders are present in a high percentage of alcoholism treatment patients. We tested the prediction that having a comorbid anxiety disorder increases the prospective risk for relapse to drinking after alcoholism treatment. We also explored the prospective associations of specific anxiety syndromes (and depression) with drinking and anxiety outcomes.
We assessed the diagnostic status and daily drinking patterns of 82 individuals approximately one week after they entered alcoholism treatment (baseline) and again approximately 120 days later (follow-up) (n=53).
Consistent with study predictions, those with a baseline anxiety disorder (approximately 55%) were significantly more likely than others to meet various definitions of drinking relapse over the course of the follow-up. Regression models showed that baseline social phobia was the single best predictor of a return to any drinking after treatment, whereas panic disorder was the single best predictor of a relapse to alcohol dependence after treatment. Having multiple anxiety disorders (versus any specific anxiety disorder) at the baseline was the strongest predictor of having at least one active ("persistent") anxiety disorder at the follow-up. Cross-sectional analysis at the follow-up showed that anxiety disorder persisted in the absence of a relapse to alcohol dependence far more often than relapse to alcohol dependence occurred in the absence of a persistent anxiety disorder.
Screening for comorbid anxiety disorder in alcoholism treatment patients is warranted and, where found, should be considered a marker of high relapse risk relative to that of noncomorbid patients. The capacity of specific anxiety treatment to mitigate relapse risk among comorbid patients remains an open question.

Download full-text


Available from: Kenneth B Abrams
  • Source
    • "Individuals undergoing treatment for alcohol use disorder (AUD) who have a co-occurring anxiety disorder (AnxD) relapse to drinking at a substantially higher rate than do those with no cooccurring AnxD (Driessen et al., 2001; Falk et al., 2008; Kushner et al., 2005). Much of the clinical research aimed at remediating this problem has pursued the agenda of augmenting standard AUD treatment with an established AnxD treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Epidemiological studies and theory implicate drinking to cope (DTC) with anxiety as a potent moderator of the association between anxiety disorder (AnxD) and problematic alcohol use. However, the relevance of DTC to the treatment of alcohol use disorder (AUD) in those with a co-occurring AnxD has not been well studied. To address this, we examined whether DTC moderates the impact of two therapies: (1) a cognitive behavioral therapy (CBT) designed to reduce DTC and anxiety symptoms; (2) a progressive muscle relaxation training (PMRT) program designed to reduce anxiety symptoms only. Methods: Patients undergoing a standard AUD residential treatment with a co-occurring AnxD (N=218) were randomly assigned to also receive either the CBT or PMRT. DTC in the 30 days prior to treatment was measured using the Unpleasant Emotions subscale of the Inventory of Drinking Situations. Results: Confirming the predicted moderator model, the results indicated a significant interaction between treatment group and level of pre-treatment DTC behavior. Probing this interaction revealed that for those reporting more pre-treatment DTC behavior, 4-month alcohol outcomes were superior in the CBT group relative to the PMRT group. For those reporting less pre-treatment DTC behavior, however, 4-month alcohol outcomes were similar and relatively good in both treatment groups. Conclusions: These findings establish a meaningful clinical distinction among those with co-occurring AUD-AnxD based on the degree to which the symptoms of the two disorders are functionally linked through DTC. Those whose co-occurring AUD-AnxD is more versus less strongly linked via DTC are especially likely to benefit from standard AUD treatment that is augmented by a brief CBT designed to disrupt this functional link.
    Full-text · Article · Dec 2015 · Drug and alcohol dependence
  • Source
    • "Additionally, the risk of relapse after treatment for AUD increases if people have concurrent conditions, such as anxiety or stress sensitivity (Kushner et al. 2005; Sinha et al. 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic alcohol-related neuroadaptations in key neural circuits of emotional and cognitive control play a critical role in the development of, and recovery from, alcoholism. Converging evidence in the neurobiological literature indicates that neuroplastic changes in the prefrontal-striatal-limbic circuit, which governs emotion regulation and decisionmaking and controls physiological responses in the autonomic nervous system and hypothalamic-pituitary-adrenal axis system, contribute to chronic alcoholism and also are significant predictors of relapse and recovery. This paper reviews recent evidence on the neuroplasticity associated with alcoholism in humans, including acute and chronic effects, and how these neurobiological adaptations contribute to alcohol recovery, along with the discussion of relevant clinical implications and future research directions.
    Preview · Article · Sep 2015 · Alcohol research : current reviews
  • Source
    • "Elyakoubi, Millet, Drapier, Robin, D. y Moirand, 2013; Kushner, Abrams, Thuras, Hanson, Brekke y Sletten, 2005). Diversos estudios concluyen que los pacientes con trastorno de ansiedad presentan 2,5 a 4,3 veces más riesgo para presentar un abuso de alcohol que la población general (Chignon y Papeta, 1999). "
    [Show description] [Hide description]
    DESCRIPTION: The influence of high levels of anxiety prior to surgery has been sufficiently researched as a symptom to be considered in all surgical processes. It is necessary to observe its possible influence in patients as well as in the different surgery protocols. Alcoholics frequently suffer psychiatric syndromes, particularly anxiety and depression. The objective of this work is to examine the possible relationship between anxiety and alcohol abuse in patients that are about to undergo a surgical procedure. The study was based on the voluntary participation of 42 hospital patients awaiting surgery at the Infanta Cristina Hospital in Badajoz, Spain. They completed the State-Trait-Anxiety-Inventory (STAI) and the MCMII-II questionnaire before the surgical intervention took place. Results indicated that scores on the alcohol abuse scale are higher in patients with a greater degree of anxiety.
    Full-text · Research · Apr 2015
Show more