My personal research interest is the treatment of anxiety in patients with comorbid alcohol use disorder (AUD). I would like to focus specifically on reducing relapse rates for adult, treatment-seeking AUD patients with comorbid anxiety disorders within the first year of treatment/abstinence.
The treatment of anxiety disorders in patients who are being treated for AUD is significant for psychiatric professionals if for no other reason than its prevalence. Generalized anxiety disorder occurs in 24%-46% of patients diagnosed with AUD or substance use disorder (Domenico et al, 2018). Another 15% of individuals with AUD or alcohol dependence have co-occurring social anxiety disorder (Schneier et al 2010). Management of these disorders is particularly challenging for clinicians because the symptomatology is interrelated: alcohol withdraw exacerbates anxiety, though primary anxiety disorders often precede alcohol dependence. A comprehensive approach requires concurrent treatment of both disorders.
Adults are a relevant target population for study because diagnosis of AUD is ten-fold more common among adults than in pediatric population (SAMHSA, 2019). In my professional experience, I have observed that complaints of anxiety are common during medically assisted alcohol detox, as well as in the post-acute withdrawal phase, which may last several months. Therefore, continued management of anxiety within the first year of treatment is a needed research focus. A study by Willinger et al (2002) demonstrated significantly increased risk of relapse among detoxified AUD patients with high anxiety.
I would like to focus on pharmacological intervention for this patient population. Benzodiazepine anxiolytics are generally contraindicated in AUD patients due to the increased risk of dependence, making the effective treatment of anxiety in this population particularly challenging. In my career, I have worked with patients in various levels of care being treated for alcohol use disorder, from patients hospitalized with delirium tremens, to patients in intensive outpatient therapy. Throughout the continuum of care for AUD, anxiety is a problem requiring management by nurses and prescribing providers. It is critical for nurses and prescribers to consider the way in which in which anxiety is managed in this population, because anxiety is a major cause of relapse for AUD (Willinger, et al, 2002). Research is needed to establish an evidence base for best practices concerning the treatment of anxiety disorders among patients being treated for alcohol use disorder.
Domenico, L. H., Lewis, B., Hazarika, M., & Nixon, S. J. (2018). Characterizing anxiety among individuals receiving treatment for alcohol and substance use disorders. Journal of the American Psychiatric Nurses Association, 24(4), 343–351. https://doi.org/10.1177/1078390317739106
SAMHSA. (2019). Table 5.4A— alcohol use disorder in past year among persons aged 12 and older, by age group and demographic characteristics: number in thousands, 2018 and 2019. 2019 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality. https://www.samhsa.gov/data/sites/default/files/reports/rpt29394/NSDUHDetailedTab s2019/NSDUHDetTabsSect5pe2019.htm?s=5.4&#tab5-4b
Schneier, F. R., Foose, T. E., Hasin, D. S., Heimberg, R. G., Liu, S. M., Grant, B. F., & Blanco, C. (2010). Social anxiety disorder and alcohol use disorder co-morbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological medicine, 40(6), 977–988. https://doi.org/10.1017/S0033291709991231
Willinger, U., Lenzinger, E., Hornik, K., Fischer, G., Schönbeck, G., Aschauer, H. N., Meszaros, K. (2002). Anxiety as a predictor of relapse in detoxified alcohol dependent patients. Alcohol and Alcoholism, 37(6), 609-612. https://doi.org/10.1093/alcalc/37.6.609