Three RCTs have examined the effectiveness of CBT-based therapies for SAD among people with alcohol use disorders with mixed findings. The first, conducted by Randall et al. [1184], compared the efficacy of CBT for alcohol use alone with CBT for both alcohol use and social anxiety. The latter was delivered in the same session but not in an integrated fashion (i.e., the first half of the session was dedicated to alcohol, the second half to social anxiety). Contrary to expectations, this study found that although both groups demonstrated improvements in relation to alcohol use and social anxiety, the combined condition did not demonstrate greater improvements in social anxiety, and in fact demonstrated poorer alcohol-related outcomes.
The second study by Schadé et al. [1185] examined the efficacy of providing CBT for social anxiety as an adjunct to relapse prevention. Alcohol-related outcomes were comparable to those found among people who only received relapse prevention for alcohol use, but those who received the adjunctive CBT for social anxiety were found to have greater improvements in relation to anxiety. More recently, an Australian study examined the efficacy of an integrated program comprised of CBT and motivational enhancement for alcohol and social anxiety relative to CBT for alcohol use alone [669]. This study similarly found that while both groups demonstrated improvements in relation to both drinking and social anxiety, the integrated treatment was found to produce greater improvements in social anxiety and quality of life.
A third study by Kushner and colleagues [1169] examined an integrated group CBT program for co-occurring anxiety (GAD, panic disorder, or SAD) and alcohol use disorders among people in a residential treatment program (45% of whom had a principal diagnosis of SAD) . Those randomised to receive the integrated program experienced considerably better alcohol outcomes relative to the control group who received progressive muscle relaxation training, and both groups demonstrated a reduction in anxiety symptoms.
In a further RCT, Buckner and colleagues [1171] examined an outpatient treatment involving an individual integrated CBT program for people with co-occurring anxiety and cannabis use disorders (67% of whom had a principal diagnosis of SAD) . People who received the integrated intervention were more likely to be abstinent and experienced greater reductions in the severity of anxiety symptoms following treatment compared to the control group (who received motivation enhancement therapy), and both groups used less cannabis, and reported fewer cannabis-related problems.
Collectively, this research suggests that either integrated or adjunctive treatment of social anxiety and alcohol use disorder may be of greater benefit than treatment for alcohol use alone, but further research is needed. Further research is also needed regarding the efficacy of other types of psychotherapy which to date, has concentrated on CBT. This focus is not surprising however, as there is a strong evidence-base for the use of CBT for social anxiety as a single disorder, but little evidence to support the use of other psychotherapies [1158].