title: Drinking to cope with negative emotions moderates alcohol use disorder treatment response in patients with co-occurring anxiety disorder.
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.
authors.affiliation: University of Minnesota - Minneapolis, Department of Psychiatry, United States.
authors.forename: J J
authors.initials: JJ
authors.lastname: Anker
authors.affiliation: University of Minnesota - Minneapolis, Department of Psychiatry, United States. Electronic address: kushn001@umn.edu.
authors.forename: M G
authors.initials: MG
authors.lastname: Kushner
authors.affiliation: University of Minnesota - Minneapolis, Department of Psychiatry, United States.
authors.forename: P
authors.initials: P
authors.lastname: Thuras
authors.affiliation: University of Minnesota - Minneapolis, Department of Psychiatry, United States.
authors.forename: J
authors.initials: J
authors.lastname: Menk
authors.affiliation: University of Minnesota - Minneapolis, Department of Psychiatry, United States.
authors.forename: A S
authors.initials: AS
authors.lastname: Unruh
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology*; D019973:Alcohol-Related Disorders / Q000150:complications* / Q000628:therapy*; D001008:Anxiety Disorders / Q000150:complications*; D001326:Autogenic Training; D015928:Cognitive Behavioral Therapy; D004644:Emotions / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D010555:Personality Inventory; D016896:Treatment Outcome
keywords: Alcohol; Anxiety disorder; CBT treatment; Comorbidity; Drinking motives