Psychiatric and alcohol use problems co-occur in a significant number of individuals seeking treatment in mental health treatment settings. However, there is a paucity of research to guide clinical practice. This is especially true for psychiatrists treating patients with anxiety disorders who also present with co-occurring hazardous drinking. If alcohol is being used as a coping strategy, as it is frequently in individuals with social anxiety, it follows that successful treatment of the social anxiety should resolve dysfunctional drinking. However, results from our study completed during the current funding period did not support this hypothesis and suggested, instead, that additional intervention for hazardous drinking is necessary. The proposed project is a natural """"""""next step"""""""" in this line of research, and the design and methods are guided and informed by the results our previous work as well as by recently-collected preliminary data. The proposed study will evaluate the phased approach to the treatment of these co-occurring disorders. Social anxiety will be treated first, then, in the Experimental group, the physician will introduce a brief alcohol intervention at a standard time in the course of social anxiety treatment. The hypothesis being tested is that drinking will decrease more in the Experimental group than in the Control group, where only the social anxiety is treated and discussed. The design of the study follows from the results of the project completed in the previous funding period. The intent of the design was to balance scientific rigor with real-world practicality. Individuals who are specifically seeking treatment for social anxiety and who also drink at hazardous drinking levels will be recruited from the community from two treatment sites, one in South Carolina and one in Minnesota. All subjects in the trial will receive 22 weeks of flexible dosing with paroxetine, an FDA-approved medication for the treatment of social anxiety shown to be effective in our previous trial. Half of the subjects will be randomized to receive at Week 6, in addition to routine social anxiety treatment, a brief physician-delivered alcohol intervention following the Updated NIAAA Clinical Guide for Helping Patients Who Drink Too Much. Research assessments will coincide with physician visits and will also include 34 and 46-week post-treatment follow-up visits. The study is a novel test of the phased treatment model, is one of the first studies to address the treatment of co-occurring anxiety and hazardous drinking in a mental health treatment setting, and uses both social anxiety and alcohol interventions that are easily adoptable in real-world mental health clinical practice. If the hypothesis is supported, the study has broad implications for treatment of other co-occurring anxiety and mood disorders and hazardous drinking.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Study Section
Health Services Research Review Subcommittee (AA)
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Roach, Deidra
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Medical University of South Carolina
Schools of Medicine
United States
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Miller, Peter M; Book, Sarah W; Thomas, Suzanne et al. (2014) The potential utility of drinking motive questions to screen at-risk drinking in socially anxious patients. J Subst Use 19:225-228
Book, Sarah W; Thomas, Suzanne E; Smith, Joshua P et al. (2013) Treating individuals with social anxiety disorder and at-risk drinking: phasing in a brief alcohol intervention following paroxetine. J Anxiety Disord 27:252-8
Book, Sarah W; Thomas, Suzanne E; Smith, Joshua P et al. (2012) Severity of anxiety in mental health versus addiction treatment settings when social anxiety and substance abuse are comorbid. Addict Behav 37:1158-61
Book, Sarah W; Thomas, Suzanne E; Randall, Patrick K et al. (2008) Paroxetine reduces social anxiety in individuals with a co-occurring alcohol use disorder. J Anxiety Disord 22:310-8
Thomas, Suzanne E; Randall, Patrick K; Book, Sarah W et al. (2008) A complex relationship between co-occurring social anxiety and alcohol use disorders: what effect does treating social anxiety have on drinking? Alcohol Clin Exp Res 32:77-84