Elsevier

Addictive Behaviors

Volume 34, Issues 6–7, June–July 2009, Pages 554-560
Addictive Behaviors

Cognitive-behavioral therapy for panic disorder in patients being treated for alcohol dependence: Moderating effects of alcohol outcome expectancies

https://doi.org/10.1016/j.addbeh.2009.03.011Get rights and content

Abstract

Anxiety disorders commonly co-occur with alcohol use disorders and reliably mark a poor response to substance abuse treatment. However, treating a co-occurring anxiety disorder does not reliably improve substance abuse treatment outcomes. Failure to account for individual differences in the functional dynamic between anxiety symptoms and drinking behavior might impede the progress and clarity of this research program. For example, while both theory and research point to the moderating role of tension-reduction alcohol outcome expectancies (TR-AOEs) in the association between anxiety symptoms and alcohol use, relevant treatment studies have not typically modeled TR-AOE effects. We examined the impact of a hybrid cognitive-behavioral therapy (H-CBT) treatment for panic disorder (independent variable) on response to a community-based alcohol dependence treatment program (dependent variable) in patients with higher vs. lower TR-AOEs (moderator). The H-CBT treatment was generally effective in relieving participants' panic symptoms relative to controls. However, TR-AOEs interacted with study cohort (H-CBT vs. control) in predicting response to substance abuse treatment. As expected, the H-CBT was most effective in improving alcohol use outcomes among those with the highest TR-AOEs. The study's primary methodological limitations are related to the quasi-experimental design employed.

Section snippets

Participants

All participants were drawn from the incoming patients of a residential community-based 28-day chemical dependence treatment program based within the University-Fairview Medical Center located in Minneapolis (“treatment as usual;” TAU). As described in detail in the Procedure section below, the treatment and control cohorts were obtained at separate times (serially) from the same TAU program. For the treatment cohort, 31 of the 43 individuals (78%) provided follow-up data. For the control

Baseline characteristics

The cohorts were highly similar regarding both clinical and demographic characteristics at the baseline assessment. Regarding the latter, 88.0% in the control cohort and 91.4% in the treatment cohort were self-identified as Caucasian. Approximately half of each cohort was employed (60.0% for control and 51.4% for treatment). The median income and education level in both cohorts was < $30k annually with a high school/GED degree and “some” (i.e., attendance but no degree) college or vocational

Discussion

Anxiety disorders in general and panic disorder in particular are common among substance abuse treatment patients and mark those at a high risk for relapse to drinking following treatment for alcohol dependence. These well-replicated findings provide a background to the hypothesis that treating co-occurring panic disorder should improve substance abuse treatment outcomes. However, this hypothesis is not logically necessitated by the earlier findings and, more importantly, it has not been

Acknowledgement

We acknowledge and thank the director (Jeff Powers) and staff of the Fairview-University Medical Center's Chemical Dependency Treatment Program for their support in the conduct of this work.

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    This research was supported, in part, by a grant from the National Institute on Alcoholism and Alcohol Abuse (AA12426 and AA015069) awarded to the first author.

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