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.
Bibliographical noteFunding Information:
Participants were selected from a 61-bed, 21-day, community-based residential chemical dependency (CD) treatment program. Inclusion criteria were current DSM-IV diagnosis of alcohol dependence and at least one of the following anxiety disorders: panic, social anxiety, and/or generalized anxiety. Exclusion criteria were a history of bipolar disorder, psychosis or schizophrenia, ongoing acute suicidality, inability to read or speak English, or the presence of cognitive impairments that would impede study participation. Patients with a diagnosis of drug dependence were not excluded; however, alcohol had to be the primary reason for their treatment. Major depression and posttraumatic stress disorder were also assessed and recorded. Eligible participants provided written informed consent. The study was approved by the University of Minnesota's Institutional Review Board and was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) awarded to the second author.
This research was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant R01-AA015069 awarded to Matt G. Kushner as well as a National Institute of Drug Abuse (NIDA) training grant supporting the work of Justin Anker ( T320A037183 ). NIAAA and NIDA had no further role in the study design; in the collection, analysis, and interpretation of data; in writing; nor in the decision to submit the manuscript for publication.
The authors wish to acknowledge and thank Christopher Hick- man and his staff at the Fairview-Riverside Lodging Plus Chemical Dependency program for their continued support of this and other work. The authors would also like to thank Joani Van Demark, Marc Mooney, Sheila Specker, Mallory Mahaffey, Kari Knefelkamp, and Hoa Le for their technical assistance.
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- Anxiety disorder
- CBT treatment
- Drinking motives