Anxiety disorders: treatable regardless of the severity of comorbid alcohol dependence.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Schadé
Annemiek
A
Department of Psychiatry and Institute for Extramural Medicine, VU University Medical Centre, GGZ-Buitenamstel, Amsterdam, The Netherlands. a.schade@ggzba.nl
Marquenie
Loes A
LA
van Balkom
Anton J L M
AJ
Koeter
Maarten W J
MW
de Beurs
Edwin
E
van Dyck
Richard
R
van den Brink
Wim
W
D000328:Adult; D000437:Alcoholism / Q000150:complications*; D001008:Anxiety Disorders / Q000150:complications* / Q000534:rehabilitation*; D001362:Avoidance Learning; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010551:Personality; D011237:Predictive Value of Tests; D012720:Severity of Illness Index