RCT of combined CBT for alcohol use and social anxiety disorders

Social Anxiety and Alcohol Use disorders are commonly comorbid and appear to interact to produce greater severity, disability and difficulties in treatment. Previous clinical trials showed no clear superiority for treatment focused on the comorbidity over treatment for alcohol alone. This study aimed to determine the relative efficacy of an integrated CBT for alcohol use problems and social phobia compared with CBT targeting alcohol use problems alone for people with comorbid social phobia and alcohol problems. 120 participants with comorbid social phobia and alcohol use disorders were randomly allocated to integrated (60) or alcohol targeted (60) CBT based on existing best practices. Exclusion criteria were presence of active psychosis or current acute suicide risk, and dependence
on other substances other than tobacco. Those at risk for severe withdrawal reactions were referred for detox and offered treatment after completion. Initial diagnoses were confirmed after four weeks of abstinence or a significant reduction in consumption. Follow up assessors were blind to treatment allocation. Primary outcomes were social anxiety symptoms assessed by the Social Phobia Scale and Social Interaction Anxiety scale, drinks consumed and number of drinking days from the timeline follow back, and quality of life assessed by the SF-12 at 3 and 6 months post treatment. Preliminary results indicate superior effects for integrated treatment. The particular integrated treatment tested in this study appears to be effective. It seems clear that people with comorbid disorders are best provided with integrated services – the costs and benefits of integrating the content of intervention need further research.