Some new directions for research on psychological interventions for comorbid anxiety and substance use disorders

Abstract

Issues. Comorbidity between anxiety and substance use disorders is common, yet it is poorly understood and poorly treated.Approach. Narrative literature review. PsycINFO Research on psychological interventions for comorbid substance and mental disorders should address specific comorbid relationships, test specific models of comorbidity, examine processes that underlie or maintain comorbidity, and test interventions that target likely maintaining processes. Furthermore, as comorbidity is the norm rather than the exception in clinical samples, research on single disorders will lack generalisability unless it addresses comorbidity. Comorbidity between substance use and other mental disorders can include heterogeneous and complex combinations of problems that may need to be grouped into those with similar features for intervention to be successful.In many cases there is good evidence from preclinical [1] and epidemiological [2] research that substance use and anxiety disorders have a reciprocal relationship. The nature of the relationship between comorbid disorders provides a rationale for sequential, parallel or integrated treatment of the comorbidity [3]. Where comorbid disorders show a reciprocal relationship successful treatment should then target not just the specific disorders but the relationship between the disorders in an integrated fashion. However, clinical trial evidence suggests at best that treatment for specific disorders leads to outcomes for that disorder and not the other [4,5].

Clinical presentations and diagnostic issues in dual diagnosis disorders

“…There is also a great need to recognize the risk factors for dual disorders, as well as the heterogeneity in clinical presentation and symptom severity, particularly for conditions for which prognosis and outcome are worse in patients with two or more disorders. Further work on dual diagnosis should investigate, across a wide range of disorder combinations, whether comorbidity is associated with greater baseline severity, predicts the amount and rate of symptom improvement over time, or moderates or mediates the effects of specific interventions [22].…”

Impact of Addiction Severity and Psychiatric Comorbidity on the Quality of Life of Alcohol-, Drug- and Dual-Dependent Persons in Residential Treatment

“…Since, in the linear regression analyses of the present study, the presence of an anxiety disorder appeared to have the largest impact on patients’ overall QoL, it is crucial to set up more targeted psychological interventions and to engage in more research on underlying mechanisms [62]. Several studies report better treatment outcomes when patients with comorbid psychiatric problems are treated in programs with a stronger dual diagnosis focus [63].…”

Age-based differences in treatment outcome among alcohol-dependent women.

“…Furthermore, the younger group was more likely to be diagnosed with an anxiety disorder than the other groups. Although research on the impact of comorbid disorders on treatment is still evolving, there is some indication of an association between comorbidity and poor outcomes (Baillie, Stapinski, Crome, Morley, Sannibale, Haber, & Teesson, 2010). Since co-morbidity appears to be more prevalent among younger women in the current sample, treatment might be improved by assessing for and addressing co-morbid disorders, particularly within the anxiety spectrum, alongside issues of substance use.…”