Alcohol treatment for individuals with comorbid phobic disorders

Alcohol treatment clinics commonly treat individuals with comorbid disorders. In fact, an individual with “pure” alcoholism is rare in alcohol treatment clinics. Comorbid anxiety disorders, including generalized anxiety as well as phobic disorders, are extremely common in alcohol treatment clinics. For instance, the 1994 National Comorbidity Study found social phobia in 19.3 percent of alcohol dependent participants. According to the self-medication hypothesis, individuals with anxiety use alcohol to decrease anxiety symptoms, and this promotes excessive use. Researchers in Amsterdam and the Netherlands set out to answers three questions regarding comorbid phonic disorders: (1) What are the clinical characteristics of treatment-seeking alcohol-dependent patients with a comorbid phobic disorder? (2) Are alcohol dependence and other clinical characteristics of comorbid patients different from those of ‘pure’ alcohol-dependent patients? (3) Are anxiety symptoms and other clinical characteristics of comorbid patients different from those of ‘pure’ phobic patients? (Schade et. al., 2004).

The researchers recruited and compared three groups of treatment-seeking patients: 110 alcohol dependent patients with a comorbid phobic disorder, 148 alcohol dependent patients, and 106 patients with social phobia or agoraphobia. All assessments of comorbidity took place at least 6 weeks after detoxification for the alcohol dependent individuals. Diagnoses were assessed using the structured clinical interview for DSM-IV. Various alcohol use measures and other self-report measures were also recorded.

Results showed that the comorbid individuals had high scores on depressive symptoms and general psychopathology. Of the comorbid individuals, 25 percent had a current depressive disorder and 52 percent had a lifetime depressive disorder. Further, the majority of the comorbid individuals were unemployed, had no partner, and had a high incidence of substance use, and a substantial portion had been abused sexually, physically, and emotionally. However, compared to “pure” alcohol dependent individuals and phobic patients, the comorbid individuals did not have different types or severities of alcohol dependence or anxiety disorders. The researchers concluded that comorbid individuals make up a complex part of the population in alcohol treatment clinics as well as psychiatric hospitals.

“The strength of the present study lies in the fact that, for the first time, these three groups of patients have been compared on a wide variety of clinical characteristics,” report the authors. “Each group has a large enough sample size and the groups are assessed and analyzed using the same method. The study also has some limitations. First, all the participants in the study were treatment-seeking patients. It could be that patients with a double diagnosis of alcohol dependency and severe anxiety disorders do not seek alcohol treatment, or discharge themselves from the clinic owing to their anxiety symptoms. On the other hand, patients suffering from a combination of mood, anxiety and substance disorders are more likely to perceive the need for professional help and seek it. Second, we only included alcohol-dependent patients with a comorbid phobic disorder from an alcohol treatment clinic, which might have introduced some selection bias. At the Anxiety Clinic, however, only two patients with alcohol dependence and a comorbid phobic disorder were found and subsequently excluded. This seems to indicate that comorbid patients are much more likely to seek help for their alcohol dependence than for their anxiety disorder. Based on this observation, we conclude that the decision to recruit comorbid patients only from the alcohol treatment clinic has not introduced serious selection bias.”

Schade A, Marquenie LA, Van Balkom AJLM, Koeter MWJ, De Beurs E, Ven Den Brink W, Van Dyck R. Alcohol-dependent patients with comorbid phobic disorders: a comparison between comorbid patients, pure alcohol-dependent and pure phobic patients. Alcohol and Alcoholism. 2004; 39(3): 241-246.

http://alcalc.oxfordjournals.org/cgi/content/full/39/3/241