Hybrid cognitive behavioral therapy versus relaxation training for co-occurring anxiety and alcohol disorder: A randomized clinical trial.

Abstract

Objective Treatment for alcohol use disorder (AUD) is far less effective for those with a co-occurring anxiety disorder. Surprisingly, adding an independent anxiety treatment to AUD treatment does not substantially improve the poor alcohol outcomes of these patients. This may reflect the lack of attention from independent treatments to the dynamic interaction of anxiety symptoms with alcohol use and drinking motivation. On the basis of this view, we assembled a cognitive behavioral therapy (CBT) program designed to both reduce anxiety symptoms and weaken the links between the experience of anxiety and the motivation to drink. Method 344 patients undergoing residential AUD treatment with current social phobia, generalized anxiety disorder, or panic disorder were randomly assigned to receive either the CBT or an active comparison treatment, Progressive Muscle Relaxation Training (PMRT). Assessments took place immediately following treatment and 4 months later (n = 247). Results As predicted, the CBT group demonstrated significantly better alcohol outcomes 4 months following treatment than did the PMRT group. Although both groups experienced a substantial degree of anxiety reduction following treatment, there were no significant group differences immediately after treatment and only a slight advantage for the CBT group 4 months after treatment. Conclusions These findings suggest that specific interventions aimed at weakening the association between the experience of anxiety and drinking motivation play an important role in improving the alcohol outcomes of these difficult-to-treat patients beyond that of anxiety reduction alone.

Drinking to cope with negative emotions moderates alcohol use disorder treatment response in patients with co-occurring anxiety disorder

“…These findings align with the theoretical (Kushner et al, 2000a) and clinical (Kushner et al, 2013) importance we assign to DTC in the development and maintenance of a functional linkage between AnxD and AUD. They are also generally consistent with the neurobiological model of allostatic adaptation in addiction (Koob, 2013; Koob and Le Moal, 2006) and various learning-based models linking negative affect to maintenance of AUD (c.f., Stasiewicz and Maisto, 1993).…”

“…Consistent with this model, Kushner et al (2013) found that augmenting AUD treatment with a CBT-based treatment designed to reduce both DTC behavior and anxiety symptoms produced better AUD outcomes than did a treatment designed to reduce anxiety symptoms alone (i.e., progressive muscle relaxation training; PMRT). The present study reanalyzed data from the Kushner et al (2013) study to evaluate whether level of pre-treatment DTC behavior moderates response to the two treatments studied.…”

“…A full description of the recruitment methods is reported in Kushner et al (2013) and is briefly summarized here. Participants were recruited during their first week of the CD treatment program in 3 screening steps.…”

“…The present study reanalyzed data from the Kushner et al (2013) study to evaluate whether level of pre-treatment DTC behavior moderates response to the two treatments studied. Specifically, we predicted a significant interaction between level of pre-treatment DTC behavior (i.e., the moderator) and treatment group (i.e., the independent variable) in predicting 4-month post-treatment alcohol outcomes (i.e., the dependent variables).…”

Interactive and Indirect Effects of Anxiety and Negative Urgency on Alcohol‐Related Problems

“…The notion that elevated anxiety puts an individual at risk for alcohol problems via increased coping motives is not new (Stewart et al, 2001), and this particular risk mechanism is already targeted in some interventions for populations at risk for coping-related drinking (e.g., Kushner et al, 2013). Similarly, negative urgency has previously been shown to increase risk for alcohol use and problems indirectly through coping motives (Adams et al, 2012), so identifying negative urgency as a risk factor is also not unique to the current study.…”