Medication for treating anxiety disorders in people with alcohol use problems

Who may be interested in this review?

People with anxiety disorders and alcohol use problems, as well as their healthcare providers.

Why is this review important?

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.