Cochrane: People
with anxiety disorders often also abuse alcohol or have alcohol
dependence. All anxiety disorders involve long-lasting and excessive
fear, and can be classified according to the cause of the fear:
generalized anxiety disorder (everyday situations), obsessive-compulsive
disorder (repetitive thoughts and behaviours), panic disorder (panic
attacks), post-traumatic stress disorder (previous traumatic events),
social anxiety disorder (negative judgements by others) and specific
phobia (specific objects or situations).
When people with anxiety
disorders abuse or are dependent on alcohol, they may be more disabled
and difficult to treat than when they have either condition on its own.
Psychotherapy is most often used in treating anxiety disorders in people
with alcohol use problems. In psychotherapy
people are encouraged to explore their feelings, moods, behaviours,
thoughts and reactions to the cause of their anxiety. Psychotherapy does
not always work though, so it is important to test whether medications
are an effective treatment option.
What questions does this review aim to answer?
We wanted to find out whether medication is effective in treating
people with both anxiety disorders and alcohol use problems. For this
reason, we systematically searched for randomized controlled trials (RCTs) of medication in treating people with both disorders. RCTs provide a more accurate measure of the effectiveness of medication by making sure that people in the study have an equal chance of being treated with medication or placebo.
Which studies were included in the review?
This review found five RCTs
in 290 adults (average age 37.4 years) with anxiety and alcohol use
disorders. The evidence is current up to January 2014. Two trials looked
at social anxiety disorder, two looked at post-traumatic stress
disorder and one trial looked at generalized anxiety disorder. All of the included trials took place in the USA. Most of the study participants were male (70%), and were classified as having alcohol dependence (79%).
What does the evidence from the review tell us?
It was not possible to tell whether medication was effective in
treating people with anxiety and alcohol use disorders. Although more
than twice as many people (57.7%) with social anxiety disorder who were
treated with paroxetine in two trials showed signs of clinical
improvement compared with people receiving placebo (25.8%), the quality of the evidence was very low. One study
reported that buspirone reduced anxiety disorder symptoms after 12
weeks of treatment. None of the other studies found reductions in
symptoms. Treatment with medication appeared to be acceptable to
participants, but again the quality of the evidence showing this was
very low. Certain medication side effects, such as sexual problems, were
commonly reported after treatment with paroxetine and sertraline. There
was no evidence that treatment had an effect on alcohol use.
It was difficult to interpret the findings reported by the studies included in this review.
Many participants (43.1% altogether) dropped out of the studies before
treatment ended. In addition, outcomes that were reported were either
not precise, or appeared to be based on the selective reporting of
measures that showed an effect of medication. Funding of two of the
studies by drug companies may also have led to reporting of results that
favoured the medication.