title: The impact of alcohol use severity on anxiety treatment outcomes in a large effectiveness trial in primary care.
abstract: OBJECTIVE
  The presence of anxiety disorders is associated with poorer alcohol use disorder treatment outcomes, but little is known about the impact of alcohol use problems on anxiety disorder treatment outcomes despite their high comorbidity. The current study examined the impact of alcohol use symptom severity on anxiety disorder treatment outcomes in a multi-site primary care effectiveness study of anxiety disorder treatment.
  
  
  METHODS
  Data came from the Coordinated Anxiety Learning and Management (CALM) effectiveness trial. Participants (N=1004) were randomized to an evidence-based anxiety intervention (including cognitive behavioral therapy and medications) or usual care in primary care. Participants completed measures of alcohol use, anxiety, and depression at baseline, 6-, 12-, and 18-month follow-up periods. Patients with alcohol dependence were excluded.
  
  
  RESULTS
  There were no significant moderating (Treatment Group × Alcohol Use Severity) interactions. The majority of analyses revealed no predictive effects of alcohol use severity on outcome; however, alcohol problems at baseline were associated with somewhat higher anxiety and depression symptoms at the 18-month follow-up.
  
  
  CONCLUSIONS
  These data indicate that patients with alcohol problems in primary care can be effectively treated for anxiety disorders. Baseline alcohol problems were associated with some poorer long-term outcomes, but this was evident across CALM and usual care. These findings provide preliminary evidence that there may be no need to postpone treatment of anxiety disorders until alcohol problems are addressed, at least among those who have mild to moderate alcohol problems. Replication with more severe alcohol use disorders is needed.
authors.affiliation: Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, United States.
authors.forename: Kate
authors.initials: K
authors.lastname: Wolitzky-Taylor
authors.affiliation: Department of Psychology, University of California, Los Angeles, United States.
authors.forename: Lily A
authors.initials: LA
authors.lastname: Brown
authors.affiliation: Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.affiliation: RAND Corporation, Santa Monica, CA, United States.
authors.forename: Cathy
authors.initials: C
authors.lastname: Sherbourne
authors.affiliation: Department of Psychiatry and Department of Family & Preventive Medicine, University of California, San Diego, United States.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.affiliation: South Central VA Mental Illness Research Education and Clinical Center, North Little Rock, AK, United States; University of Arkansas for Medical Sciences, United States.
authors.forename: Greer
authors.initials: G
authors.lastname: Sullivan
authors.affiliation: Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, United States.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bystritsky
authors.affiliation: Department of Psychology, University of California, Los Angeles, United States. Electronic address: craske@psych.ucla.edu.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology; D019973:Alcohol-Related Disorders / Q000523:psychology*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents
keywords: Alcohol use; Anxiety disorders; Predictors of treatment outcome