Alcohol and drug use among clients receiving internet-delivered cognitive behavior therapy for anxiety and depression in a routine care clinic – Demographics, use patterns, and prediction of treatment completion and outcomes

Abstract

Background Research shows that alcohol and drug use among mental health clients is common and has the potential to negatively impact treatment outcomes. Internet-delivered cognitive behavior therapy (ICBT) as a treatment for anxiety and depression is on the rise, but little is known about the prevalence of alcohol and drug use among clients and how this use affects treatment completion and outcomes. Objective The objective of the current study was to explore the prevalence of alcohol and drug use among clients in ICBT for depression and anxiety, and to investigate the impact of alcohol and drug use on treatment completion and symptom outcomes. Material and methods Data was collected from 1155 clients who participated in two randomized ICBT trials for depression and anxiety, conducted in a routine care clinic. Thirty-five individuals reporting severe substance use when applying to the trials were excluded. Demographic variables, and alcohol and drug use were measured at screening, and measures of depression and anxiety were administered at pre- and post-treatment. Results Four out of five clients reported having used alcohol in the past year, while one in five reported having used drugs in the past year. Around a third of clients had reported either problematic alcohol use, drug problems, or both. The analyses showed that drug problems, and combined alcohol and drug problems were negatively associated with treatment completion, but neither alcohol nor drug use had an impact on depression and anxiety outcomes. Conclusions Alcohol and drug problems are likely to be present among a large proportion of patients using ICBT for anxiety and depression. This may not be a barrier to treatment benefit, at least when those with severe alcohol and drug problems have been excluded.

Paternal alcohol exposure has task‐ and sex‐dependent behavioral effect in offspring

“…However, these authors find that male offspring with paternal alcohol exposure do not show an anxiolytic response to alcohol administration in the open field while control male offspring do. Alcohol is thought to have anxiolytic effects, particularly at low to moderate doses, in rodents and anxiety problems are linked to alcohol ingestion in humans (Garey et al, 2020; Kushner et al, 2000; Sundström et al, 2022). Further, alcohol use in fathers associates with an enhanced risk of anxiety behaviors in young boys (ages 4 and 6) but not young girls (Luan et al, 2022).…”

The Impacts of a Psychoeducational Alcohol Resource During Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety: Observational Study

“…Interestingly, the prevalence of hazardous or harmful drinking based on AUDIT was slightly higher in this trial (242/1333, 18.15%) than in previous ICBT samples (160/1155, 13.85%) [ 5 ]. The elevated levels of hazardous drinking may be explained by the trial occurring during the COVID-19 pandemic, as 20% of Canadians who stayed home during the pandemic reported increased alcohol consumption [ 29 ].…”

“…To our knowledge, no previous studies on transdiagnostic ICBT for depression and anxiety have specifically examined the inclusion of a resource addressing alcohol use. As drinking difficulties are a prevalent concern among ICBT clients with depression and anxiety [ 5 , 6 ], this study makes an important contribution to the literature by examining the uptake and utility of a resource that can address this area of concern. The mixed methods (ie, both quantitative and qualitative data collections) approach is also a strength of this study.…”

“…In transdiagnostic ICBT for depression or anxiety, it is relatively uncommon to address comorbid alcohol use difficulties. This represents a missed opportunity, as previous research suggests that heavy drinking days are common among ICBT clients, with 56.8% (514/905) of clients endorsing drinking ≥6 drinks on 1 occasion during the past year [ 5 ]. Moreover, in another study on ICBT for depression, panic disorder, and social anxiety, 24.1% (381/1581) of clients reported drinking difficulties [ 6 ].…”

“…Moreover, in another study on ICBT for depression, panic disorder, and social anxiety, 24.1% (381/1581) of clients reported drinking difficulties [ 6 ]. Interestingly, alcohol use difficulties have not been found to predict ICBT completion or outcomes in terms of improved depression or anxiety, which supports the use of ICBT for depression and anxiety among individuals with comorbid alcohol use difficulties [ 5 ]. The extent to which transdiagnostic ICBT is associated with reduced alcohol use or problems over time remains unknown.…”