A complex relationship between co-occurring social anxiety and alcohol use disorders: what effect does treating social anxiety have on drinking?
BACKGROUND
Individuals with social anxiety disorder and co-occurring alcohol problems report using alcohol to cope with anxiety symptoms. Interventions that reduce both social anxiety and drinking are needed. Paroxetine, an FDA-approved medication to treat social anxiety disorder, reduces anxiety in individuals with co-occurring alcohol problems.


OBJECTIVE
To examine whether effective treatment of social anxiety with paroxetine reduces drinking in dual-diagnosed individuals who endorse using alcohol to cope.


METHODS
A 16-week, double-blind, randomized controlled trial of paroxetine was conducted. Participants (placebo n = 22; paroxetine n = 20) met DSM-IV diagnostic criteria for social anxiety disorder and alcohol abuse or dependence. Participants were seeking treatment for social anxiety, not for the alcohol problem. Alcohol use outcomes were measured with conventional quantity/frequency measures and novel measures of drinking to cope.


RESULTS
Paroxetine improved social anxiety more than placebo. Paroxetine reduced self-reported reliance on alcohol for self-medication purposes, but was not different than placebo in changing quantity and frequency drinking or the proportion of drinking days that were identified as coping-related. Exploratory analyses revealed that for the placebo group, drinking during the trial was correlated with social anxiety severity, whereas for the paroxetine-treated group, drinking was uncoupled from social anxiety severity.


CONCLUSIONS
Successfully treating social anxiety symptoms with paroxetine does not reduce drinking in dual-diagnosed individuals who are not seeking treatment for alcohol problems. Paroxetine does, however, reduce reliance on alcohol to engage in social situations, and may change the reasons why one drinks (such that drinking occurs for other reasons besides coping with anxiety). These results have implications for staging of social anxiety and alcohol treatment in individuals with the co-occurring disorders presenting to a mental health or primary care provider.
Thomas
Suzanne E
SE
Department of Psychiatry and Behavioral Sciences, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, South Carolina 29425, USA. thomass@musc.edu
Randall
Patrick K
PK
Book
Sarah W
SW
Randall
Carrie L
CL
D000328:Adult; D000428:Alcohol Drinking / Q000188:drug therapy* / Q000523:psychology; D001008:Anxiety Disorders / Q000150:complications / Q000188:drug therapy*; D004311:Double-Blind Method; D006801:Humans; D017374:Paroxetine / Q000627:therapeutic use*; D010349:Patient Compliance; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012919:Social Behavior
D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors