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Randomized Controlled Trial
. 2016 Feb 1:159:93-100.
doi: 10.1016/j.drugalcdep.2015.11.031. Epub 2015 Dec 11.

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

J J Anker  1 , M G Kushner  2 , P Thuras  1 , J Menk  1 , A S Unruh  1
Affiliations
Randomized Controlled Trial

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

J J Anker et al. Drug Alcohol Depend. .

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.

Keywords: Alcohol; Anxiety disorder; CBT treatment; Comorbidity; Drinking motives.

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Conflict of interest statement

Conflict of interest

The authors have no conflicts to declare.

Figures

Fig. 1
Fig. 1
Distribution of participant IDS-UE scores within the sample of treatment seeking AUD patients with comorbid AnxD. The solid vertical line represents the median used to split High and Low IDS-UE groups.
Fig. 2
Fig. 2
Estimated means (±SEM) for drinking days (A) binge days (B), and total drinks(C) at the 4-month follow-up as a function of treatment and IDS-UE.
See this image and copyright information in PMC

References

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