Drinking to cope with negative emotions moderates alcohol use disorder treatment response in patients with co-occurring anxiety disorder

Abstract

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.

A network approach to modeling comorbid internalizing and alcohol use disorders.

“…This suggests that while DTC may be more prevalent among women than men, its bivariate and multivariate relationships with comorbid anxiety/depression and AUD is similar for both men and women. This conclusion is consistent with our earlier findings showing both men and women benefited from a treatment specifically targeting DTC tendencies (Kushner et al, 2013) and that gender does not affect the importance of DTC in moderating this treatment effect (Anker et al, 2016). …”

“…This supports the notion that DTC can maintain comorbidity, even when internalizing conditions are treated. Additional support for DTC’s central role in comorbidity comes from previous findings demonstrating that level of DTC is a key predictor of AUD development (Crum, Mojtabai et al, 2013; Menary, Kushner, Maurer, & Thuras, 2011) and a robust moderator of AUD relapse risk among individuals with internalizing disorders (Anker, Kushner, Thuras, Menk, & Unruh, 2016). Taken together, these findings are consistent with a conceptualization of comorbidity, not as two distinct conditions, but as a single dynamic system maintained through processes such as DTC.…”

Current major depression is associated with greater sensitivity to the motivational effect of both negative mood induction and abstinence on tobacco-seeking behavior

“…An important adjunct may come from a novel cognitive behavioral approach which first ascertains individuals’ range of adverse triggers for drug use, and then challenges their beliefs that drug use helps cope with these adverse states, thus treating multiple triggers simultaneously. This technique produces superior treatment outcomes compared to standard treatment in drinkers or smokers with either anxiety disorder or who report high coping motives (Anker et al, 2016; Bradizza et al, 2017; Kushner et al, 2013; Stasiewicz et al, 2013) suggesting that concurrent treatment of the trigger cluster may represent a progressive approach for depressed smokers.…”

The Addictions Neuroclinical Assessment Negative Emotionality Domain Among Treatment‐Seekers with Alcohol Use Disorder: Construct Validity and Measurement Invariance

“…Those with greater substance use and negative affect severity are more likely to benefit from mindfulness-based relapse prevention (Roos et al, 2017a). Furthermore, reasons for alcohol use (e.g., reward vs. relief motives, drinking to cope) differentially predict response to naltrexone and acamprosate (Mann et al, 2018;Roos et al, 2017b;Witkiewitz et al, 2019b) and cognitive-behavioral therapy (Anker et al, 2016).…”