The potential utility of drinking motive questions to screen at-risk drinking in socially anxious patients.

Background: Drinking motives are thought to be important mediators of the relationship between social anxiety and alcohol use. This project evaluates whether specific drinking motives accurately reflect alcohol dependence. If so, brief questions about drinking motives could serve as valuable alcohol screening tools with socially anxious patients.

Treating individuals with social anxiety disorder and at-risk drinking: phasing in a brief alcohol intervention following paroxetine.

Paroxetine alone is not sufficient to decrease alcohol use in socially anxious alcoholics seeking anxiety treatment. We tested the hypothesis that adding a brief-alcohol-intervention (BI) to paroxetine would decrease alcohol use. All subjects (N=83) had a diagnosis of social anxiety disorder, endorsed drinking to cope with anxiety, were NIAAA-defined at-risk drinkers, and were randomized to either paroxetine alone, or paroxetine plus BI.

Anxiety and alcohol use disorders: comorbidity and treatment considerations.

The co-occurrence of anxiety disorders and alcohol use disorders (AUDs) is relatively common and is associated with a complex clinical presentation. Sound diagnosis and treatment planning requires that clinicians have an integrated understanding of the developmental pathways and course of this comorbidity. Moreover, standard interventions for anxiety disorders or AUDs may need to be modified and combined in targeted ways to accommodate the unique needs of people who have both disorders.

12-Step Therapy and Women with and without Social Phobia: A Study of the Effectiveness of 12-Step Therapy to Facilitate AA Engagement.

Alcoholism treatment often encourages involvement in Alcoholics Anonymous (AA). Little provision is made for women with social phobia (SP), who have been reported to have worse outcomes in twelve-step-facilitation (TSF) relative to cognitive behavioral therapy. This study examined whether SP moderated the effects of gender for these women in TSF.

Gender differences in alcohol treatment: an analysis of outcome from the COMBINE study.

Background: Relatively few studies have examined gender differences in the effectiveness of specific behavioral or pharmacologic treatment of alcohol dependence. The aim of this study is to assess whether there were gender differences in treatment outcomes for specific behavioral and medication treatments singly or in combination by conducting a secondary analysis of public access data from the national, multisite NIAAA-sponsored COMBINE study.

Methods: The COMBINE study investigated alcohol treatment among 8 groups of patients (378 women, 848 men) who received medical management (MM) with 16 weeks of placebo, naltrexone (100 mg/day), acamprosate (3 g/day), or their combination with or without a specialist-delivered combined behavioral intervention.

A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal.

Introduction: Some anticonvulsants ameliorate signs and symptoms of alcohol withdrawal, but have an unacceptable side effect burden. Among the advantages of using anticonvulsant agents in this capacity is their purported lack of interaction with alcohol that could increase psychomotor deficits, increase cognitive impairment, or increase intoxication. The aim of this study was to evaluate alcohol use and symptom reduction of gabapentin when compared with lorazepam in the treatment of alcohol withdrawal in a double-blinded randomized clinical trial.

Social anxiety impacts willingness to participate in addiction treatment.

Individuals with social anxiety have difficulty participating in group settings. Although it makes intuitive sense that social anxiety could present a challenge in addiction treatment settings, which often involve small groups and encouragement to participate in self-help groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), to our knowledge no study has yet assessed the impact of shyness on the treatment experience. Assessment surveys were given to 110 individuals seeking intensive outpatient substance abuse treatment at three community treatment programs.

Alcohol outcome expectancies and drinking to cope with social situations.

Repeated use of alcohol as a coping strategy to reduce anxiety or discomfort increases one's risk of developing alcohol dependence. Previous studies have found alcohol outcome expectancies (AOE) strongly predict drinking behavior, in general, and also are related to drinking to cope. The purpose of the current study was to examine AOE that may be related to drinking to cope with discomfort in social situations.

A complex relationship between co-occurring social anxiety and alcohol use disorders: what effect does treating social anxiety have on drinking?

Background: Individuals with social anxiety disorder and co-occurring alcohol problems report using alcohol to cope with anxiety symptoms. Interventions that reduce both social anxiety and drinking are needed. Paroxetine, an FDA-approved medication to treat social anxiety disorder, reduces anxiety in individuals with co-occurring alcohol problems.

Paroxetine reduces social anxiety in individuals with a co-occurring alcohol use disorder.

Patients with social anxiety disorder who are seen in clinical practice commonly have additional psychiatric comorbidity, including alcohol use disorders. The first line treatment for social anxiety disorder is selective-serotonin-reuptake-inhibitors (SSRIs), such as paroxetine. However, the efficacy of SSRIs has been determined with studies that excluded alcoholics.

Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial.

Context: Alcohol dependence treatment may include medications, behavioral therapies, or both. It is unknown how combining these treatments may impact their effectiveness, especially in the context of primary care and other nonspecialty settings.

Objectives: To evaluate the efficacy of medication, behavioral therapies, and their combinations for treatment of alcohol dependence and to evaluate placebo effect on overall outcome.

Measurement and choice of drinking outcome variables in the COMBINE Study.

Objective: The COMBINE Study, a federally funded multisite clinical trial, endeavored to choose drinking and related outcome variables that were scientifically sound and had both convergent validity with previously published studies and face validity for clinical meaning. This article describes these variables and the methods used to collect them.

Method: In choosing the primary outcome drinking variables, the mechanisms of action of naltrexone and acamprosate were considered along with previously published results for them and the psychosocial therapies utilized (Project MATCH).

Sertraline in the treatment of co-occurring alcohol dependence and posttraumatic stress disorder.

Background: Posttraumatic stress disorder (PTSD) frequently co-occurs with alcohol use disorders. This study investigated the use of sertraline, a serotonin reuptake inhibitor, in treating co-occurring symptoms of alcohol dependence and PTSD.

Methods: A total of 94 individuals with current alcohol dependence and PTSD were randomly assigned to receive sertraline (150 mg/day) or placebo for 12 weeks.

Attentional bias and drinking to cope with social anxiety.

This study investigated the sensitivity of the emotional Stroop test for identifying individuals who reported drinking to cope with social fears. Community volunteers completed a modified Stroop task during which social threat, alcohol-related, and control words were presented. High scores on drinking-to-cope measures were hypothesized to be associated with longer response latencies to both social threat and alcohol-related words.

Pharmacological treatment of alcohol abuse/dependence with psychiatric comorbidity.

This article represents the proceedings of a symposium at the 2003 annual meeting RSA in Fort Lauderdale, FL. It was organized and cochaired by Charlene E. Le Fauve and Carrie L.

Drinking to cope in socially anxious individuals: a controlled study.

Background: Several hypotheses exist to account for the higher than normal rate of alcoholism in individuals with high trait anxiety (or anxiety disorders). Most of these suggest that the practice of drinking alcohol to reduce anxiety leads to an increased risk of alcoholism in vulnerable individuals. The first assumption of the hypothesis is that anxious individuals use alcohol to cope with their anxiety.

Gender differences in individuals with comorbid alcohol dependence and post-traumatic stress disorder.

This study investigated gender differences in a sample of outpatient, treatment-seeking individuals (N=84) with comorbid alcohol dependence and post-traumatic stress disorder (PTSD). Assessments included substance use severity, trauma history, PTSD symptomatology, and comorbid psychiatric disorders. Men reported an earlier age of onset of alcohol dependence, greater alcohol use intensity and craving, and more severe legal problems due to alcohol use.

Self-medication in social phobia: a review of the alcohol literature.

It is well documented that many individuals endorse the belief that alcohol reduces social anxiety. Individuals with social phobia, therefore, might be expected to use alcohol as a coping strategy in an attempt at self-medication. The purpose of the present paper was to review the published literature on the relationship between alcohol use and social phobia to test the self-medication hypothesis (SMH).

Baseline Differences in Social Support Among Treatment-Seeking Alcoholics With and Without Social Phobia.

Differences on demographics and seven measures of social support between matched, treatment-seeking alcoholics with and without social phobia (SP and NSP groups, respectively) were examined. The groups did not differ on most demographic variables, although the SP group (n = 397) had a lower occupational status and had fewer years of education (both p's <.01) than the NSP group (n = 397).

Confirmatory analysis of the adolescent obsessive compulsive drinking scale (A-OCDS): a measure of 'craving' and problem drinking in adolescents/young adults.

The A-OCDS was modeled after the Obsessive Compulsive Drinking Scale (OCDS) to establish an instrument appropriate for use in adolescent/young adult populations. Initial exploratory analysis of the A-OCDS revealed two factors, namely "irresistibility" and "interference," which were specific and sensitive to identifying problematic drinking. The study objective was to administer the A-OCDS to obtain data for confirmatory analyses regarding the dimensionality of the scale, its reliability and its sensitivity and specificity in identifying problem drinkers.

A double-blind, placebo-controlled trial of sertraline in depressed adolescent alcoholics: a pilot study.

In order to preliminarily evaluate the efficacy, safety and tolerability of the serotonin reuptake inhibitor, sertraline, in the treatment of adolescents with a primary depressive disorder and a comorbid alcohol use disorder, a 12-week double-blind, placebo-controlled trial of sertraline plus cognitive behavior group therapy was conducted. Subjects were 10 outpatient treatment-seeking adolescents. Baseline assessment included the K-SADS, HAM-D, SCID, and the Time-Line Follow-Back.

Carbamazepine in the treatment of cocaine dependence: subtyping by affective disorder.

Studies investigating carbamazepine (CBZ) in the treatment of cocaine dependence have been inconsistent. In this study, cocaine-dependent individuals with (n = 57) and without (n = 82) affective disorder were compared in a 12-week, double-blind, placebo-controlled trial. Urine drug screens (UDS) and self-report of drug use were collected weekly.

Alcohol tolerance and nicotine cross-tolerance in adolescent mice.

The present experiment was designed to evaluate the development of tolerance to alcohol and cross-tolerance to nicotine in adolescent mice. C57BL/6J mice (30-40 days old) were injected IP with alcohol (2.5 g/kg) for 4 consecutive days.

Animal Research: Charting the Course for FAS.

Animal models of FAS have allowed researchers to study the mechanisms behind alcohol's deleterious effects on fetal development. Such models have helped verify hypotheses based on studies of children with FAS and uncover new features of FAS not evident in humans.