It is generally accepted that alcoholism is a multifaceted disorder with multiple etiologies. It is not surprising, therefore, that treating alcoholics as a homogenous population has not been very successful. Recent efforts have recommended """"""""matching"""""""" of patients to treatment type. While such matching may improve treatment efficacy, to date no coherent scheme for dividing alcoholics into subpopulations with specific targeted treatment has been identified. The advances in the last decade in diagnostic criteria (i.e., DSM-III, DSM-III-R) for psychiatric diagnoses may offer a promising approach to this problem. The present application focuses on a target subgroup of outpatient alcoholics who suffer both from alcoholism and from an anxiety disorder called social phobia, which is known to be amenable to behavioral treatment. The major hypothesis to be tested is that treatment of both social phobia and alcohol abuse disorders concurrently (i.e., treatment of the co-morbidity with cognitive/behavioral therapy (Experimental Group) will be associated with greater reduction in social anxiety and more positive alcohol outcomes than treatment of alcoholism alone with cognitive behavioral therapy (Comparison Group). The investigators will be use structured psychiatric interviews (i.e., SCID and C-DIS) to identify subgroups of alcoholics who meet DSM-IIIR criteria for current alcohol abuse/dependence and current social phobia. Trained therapists will deliver individual therapy over 12 weekly sessions using manual-guided cognitive behavioral therapy (CBT) for alcohol or for both alcohol and social phobia. The comparison group of socially phobic alcohol abusers will receive CBT for only the alcohol problem. Patients will be randomly assigned to one of the two treatment groups. The two groups will be compared on three primary indices of alcohol treatment outcome (i.e., number of drinks/day, number of drinks/drinking day, and percent days abstinent), as well as on severity of social evaluative anxiety (i.e., social phobia). Assessments will be conducted at baseline, at the end of treatment (i.e., 3 months), and at 6, 9 and 12 months follow-up. This project will determine if targeted treatment of co-morbidity results in improved treatment outcome. This study has the potential of making a significant contribution to the field.
| Carrigan, Maureen H; Drobes, David J; Randall, Carrie L (2004) Attentional bias and drinking to cope with social anxiety. Psychol Addict Behav 18:374-80 |
| Randall, C L; Thomas, S; Thevos, A K (2001) Concurrent alcoholism and social anxiety disorder: a first step toward developing effective treatments. Alcohol Clin Exp Res 25:210-20 |
