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Alcohol and Alcoholism Vol. 38, No. 3, pp. 255-262, 2003
© 2003 Medical Council on Alcohol

DO COMORBID ANXIETY DISORDERS IN ALCOHOL-DEPENDENT PATIENTS NEED SPECIFIC TREATMENT TO PREVENT RELAPSE?

Annemiek Schadé*, Loes A. Marquenie, Anton J. L. M. van Balkom, Edwin de Beurs1, Richard van Dyck and Wim van den Brink2

Vrije Universiteit, Department of Psychiatry and Institute for Extramural Medicine, Lassusstraat 2, 1075 GV Amsterdam,
1 Leiden University Medical Centre and
2 Amsterdam Medical Centre, University of Amsterdam, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands

Received 17 July 2002; first review notified 2 December 2002; accepted 19 December 2002

Aims: It has been repeatedly stated that comorbid anxiety disorders predict poor outcome of alcoholism treatment. This statement is based on the high comorbidity of alcohol use disorders and anxiety disorders, and the negative influence of other comorbid psychiatric disorders on the outcome of treatment of alcohol dependence. This review focuses on outcome results of alcohol-dependent patients with a comorbid anxiety disorder. We try to answer the question whether anxiety disorders should be treated in alcohol-dependent patients to improve outcome results in alcoholism treatment. Methods: In a search through Pubmed, Psychinfo and Cochrane, we found only 12 articles on this subject. We distinguished three perspectives: (1) studies on the predictive value of comorbid anxiety disorders on the outcome of alcoholism treatment; (2) studies on the improvement of abstinence rates and anxiety symptoms by offering pharmacological treatment for comorbid anxiety disorders; (3) studies on psychotherapeutic treatment. Results: Most studies showed methodological limitations. Only one high quality study showed that comorbid anxiety disorders predict poor outcome of the treatment of alcohol dependence. Conclusions: We cannot conclude that comorbid anxiety disorders in alcohol-dependent patients need a specific treatment to prevent relapse. However, medication and perhaps cognitive behavioural therapy can be useful in alcohol-dependent patients with a comorbid anxiety disorder to reduce anxiety symptoms. Methodological implications for further research are discussed.


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