Pharmacotherapy

There has been little research examining the efficacy of pharmacotherapy interventions among people with comorbid OCD and AOD use. A Cochrane review of pharmacotherapy for anxiety and comorbid alcohol use disorders found no rigorously conducted trials of medication treatment for comorbid alcohol misuse and OCD [708]. In view of the lack of evidence for pharmacological interventions for comorbid OCD and AOD use, workers may be guided by the body of research that has been conducted for single disorder OCD.

Systematic reviews and meta-analyses of RCTs examining pharmacotherapy treatments for single disorder OCD have found that the SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), and the TCA antidepressant clomipramine, to be associated with reductions in symptom severity and improvements in health-related quality of life [781, 782]. Evidence-based guidelines for the treatment of single disorder OCD recommend that SSRIs be used as the first line of pharmacotherapy, and further suggest that the combination of psychological and pharmacological treatments is likely to be superior to either approach in isolation, though this has yet to be confirmed [758]. The current evidence for a combined approach is conflicting, with some studies finding an enhanced effect from the combination of both psychotherapy and pharmacotherapy (e.g., fluvoxamine enhancing ERP [783], and CBT [784], ERP and SSRIs being superior to SSRIs alone [785], ERP/CBT plus SSRIs being superior to SSRI alone [786]), which is not supported in others (e.g., d-cycloserine hastens the response to CBT, but overall effectiveness of CBT is not enhanced [787-789]). Table 42 provides a list of SSRIs for the pharmacological treatment of single disorder OCD.

Adapted from Australian Government Department of Health [630]. For a full list of generic brands available, see the Therapeutic Goods Administration website (https://www.tga.gov.au/).