Moderators of drinking outcomes during specialised care for comorbid anxiety depression and alcohol use disorder: the influence of anti-depressants and anti-craving medication

Introduction and Aims: A major barrier to successful treatment of alcohol dependence is psychiatric comorbidity. We recently conducted a randomised controlled trial of a structured stepped-care intervention for alcohol dependence and comorbid anxiety and/or depression. In this secondary analysis we examined the moderating effect of pharmacotherapy (selective serotonin reuptake inhibitors and naltrexone and/or acamprosate) on drinking outcomes during the intervention. Design and Methods: Thirty-seven alcohol-dependent patients with a clinical diagnosis of anxiety and/or depression were included in the intention-to-treat analysis. Following a 21 day period of abstinence, participants were diagnosed and then randomised to one of two treatment arms: (i) a novel intervention comprising of specific cognitive behavioural therapy (CBT) (n = 21); or (ii) usual-care (UC) typically comprising brief individualised motivation enhancement therapy (n = 16).The main efficacy results have previously been presented (Leung et al., 2011, abstract; Baillie et al., in preparation). Mixed models were employed to determine differences between intervention (UC vs. CBT) on drinking-related outcomes over time with anti-depressant and anti-craving use placed as dichotomous covariates. Results: Rates of anti-depressants and anti-craving medication use were 57% and 73% respectively. There were no differences in rate of use between intervention groups (χ2 = 0.52, P > 0.05) although there was a trend for increased alcohol pharmacotherapy use in the usual care group (χ2 = 2.14, P = 0.15). Over the 12 week treatment period, while there were significant effects of the intervention (UC vs. CBT) on alcohol dependence severity scores and levels of alcohol consumption (P< 0.05), the variables anti-depressant use and anti-craving use were not significant. Discussion and Conclusions: The novel stepped-care intervention for comorbid anxiety, depression and alcohol use disorder reduced drinking outcomes and this effect was independent of pharmacotherapy.