Wolitzky-Taylor Kate, Brown Lily A, Roy-Byrne Peter, Sherbourne Cathy, Stein Murray B, Sullivan Greer, Bystritsky Alexander, Craske Michelle G
Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, United States.
Department of Psychology, University of California, Los Angeles, United States.
J Anxiety Disord. 2015 Mar;30:88-93. doi: 10.1016/j.janxdis.2014.12.011. Epub 2015 Jan 8.
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.
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.
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.
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.
焦虑症的存在与酒精使用障碍的治疗效果较差有关，但尽管酒精使用问题与焦虑症高度共病，关于其对焦虑症治疗效果的影响却知之甚少。本研究在一项多地点的焦虑症治疗初级保健有效性研究中，考察了酒精使用症状严重程度对焦虑症治疗效果的影响。
数据来自协调焦虑学习与管理（CALM）有效性试验。参与者（N = 1004）被随机分配到基于证据的焦虑干预组（包括认知行为疗法和药物治疗）或初级保健中的常规护理组。参与者在基线、6个月、12个月和18个月随访期完成了酒精使用、焦虑和抑郁的测量。排除了酒精依赖患者。
不存在显著的调节作用（治疗组×酒精使用严重程度）交互作用。大多数分析表明，酒精使用严重程度对结果没有预测作用；然而，基线时的酒精问题与18个月随访时略高的焦虑和抑郁症状有关。
这些数据表明，初级保健中存在酒精问题的患者可以有效地接受焦虑症治疗。基线时的酒精问题与一些较差的长期结果有关，但这在CALM组和常规护理组中都很明显。这些发现提供了初步证据，表明至少在那些有轻度至中度酒精问题的患者中，可能无需在解决酒精问题之前推迟焦虑症的治疗。需要对更严重的酒精使用障碍进行重复研究。
