Research concerning both psychological and pharmacological treatments for comorbid anxiety and AOD use disorders is sparse [708, 756] and the evidence for integrated treatments is mixed . In the absence of research examining treatments for comorbid anxiety and AOD use disorders, it may be useful to seek guidance from treatment approaches to single disorders. More rigorous research is required in order to determine whether the same approach for treating single disorders is equally efficacious in the treatment of comorbid disorders.
Box 17 illustrates the continuation of case study E, following Alina’s story after identification of her anxiety disorder was made. However, as illustrated, the presence of a comorbid AOD use disorder may complicate the management and treatment plan.
Box 17: Case study E: Treating comorbid anxiety and AOD use: Alina’s story continued
Alina’s psychologist diagnosed her with GAD, and suggested that they try CBT for the treatment of her anxiety and panic attacks. With the worsening of Alina’s symptoms, the psychologist took the view that she might need longer term treatment than provided under the Medicare Better Access Scheme.
The treatment plan developed in consultation with Alina emphasised the need to deal with both her anxiety and alcohol use. The psychologist liaised with Alina’s GP, who ordered some blood tests and recommended a short course of medication to help Alina withdraw from alcohol. Both the GP and the psychologist advised Alina that the first few days without alcohol would likely be the worst, but that symptoms typically abate within one week. In particular, they highlighted a possible increase in her anxiety during this period, but reassured Alina that this would likely subside and they would be there to help her through.
Over the next few weeks, Alina began to see a cycle between her anxiety and alcohol use, with alcohol providing temporary relief from her anxiety, which then worsened once the effects of alcohol wore off. Alina began to realise how the vicious cycle led to avoidance behaviours which made her feel depressed because she was no longer engaging in activities that she enjoyed. She also began to appreciate that her alcohol use had become an independent problem, and that although she was acquiring coping strategies to deal with anxiety, the potential for developing an even more serious alcohol problem was a real possibility.
Alina’s psychologist arranged for her to attend weekly sessions of a relapse prevention program run by local AOD services. Her psychologist also helped her to deal with avoidance behaviours with a program of gradual exposure to situations that had previously been anxiety provoking. Although Alina responded very well to these treatment initiatives within two to three months, they both agreed that she should remain in contact with her psychologist over a longer term period. The frequency of sessions gradually reduced over time.
- Treatments for anxiety and AOD use may require client contact over a period of months, rather than weeks.
- Without addressing AOD use, psychological treatments for anxiety may be rendered ineffective.