Cognitive-Behavioral Therapy & Venlafaxine Treatments For Anxiety In Alcoholism

描述(由申请者提供)：焦虑管理技能的缺陷是反复饮酒的常见原因。经验数据支持焦虑在酒精复发中的作用。针对酒精问题的心理社会和药物治疗越来越多地处理负面情绪在酒精使用障碍中的作用。由于缺乏大型、良好控制的治疗结果试验，最佳治疗(或治疗组合)仍然未知。现实世界中治疗酒精使用障碍的实践通常始于短暂、密集的戒毒和稳定，随后往往是CBT和药物治疗的一些组合，用于在试图早期戒酒的同时抱怨情绪困难的患者。这项拟议的项目是根据计划公告PA-98-003编写的一项“典型临床实践”测试，是一项针对同时患有酒精使用和焦虑症患者的焦虑症CBT和药物疗法(文拉法辛；CBT-VEN)的完全对照试验。CBT-VEN包将根据主要表现的焦虑症(即PD、GAD或SP)以三种形式进行治疗，并将与两种单一的积极治疗条件(CBT-解放军和REL-VEN)和一种完全控制的条件(放松训练和安慰剂药物；REPLAC)进行对比。将招募128名参与者，在完成酒精中毒的强化门诊治疗平台后，将随机分配到为期12周的治疗条件下。这两种情况都将以1周的安慰剂磨合开始，以3周的用药减少结束。随访评估将在治疗后以及3、6、9和12个月进行。这项研究的长期目标是为合并饮酒和焦虑障碍的患者开发一种现实世界中心理社会和药物治疗的组合，这些患者危及预后，并评估针对这种共病患者的焦虑的联合心理社会和药物治疗的有效性。

DESCRIPTION (provided by applicant): Deficits in anxiety management skills are frequent causes of relapse to alcohol use. Empirical data support the role of anxiety in alcohol relapse. Psychosocial and pharmacological treatments for alcohol problems increasingly address the role of negative affect in alcohol use disorders. Due to the lack of large, well-controlled treatment outcome trials, the optimal treatment (or combination of treatments) remains unknown. Real world practice in the treatment of alcohol use disorders frequently begins brief, intensive detoxification and stabilization, and is often followed by some combination of CBT and pharmacotherapy for patients complaining of mood difficulties while attempting early abstinence from alcohol. The proposed project is written as a "typical clinical practice" test in response to the Program Announcement PA-98-003, and is a fully-controlled trial of a combined anxiety-focused CBT and pharmacotherapy (venlafaxine; CBT-VEN) delivered for patients with comorbid alcohol-use and anxiety disorders. The CBT-VEN package will be administered in three forms depending upon the primary presenting anxiety disorder (i.e., PD, GAD, or SP) and will be contrasted with two single-active treatment conditions (CBT-PLA and REL-VEN), and one fully-controlled condition (relaxation training and placebo medication; REL-PLAC). One hundred and twenty eight participants will be recruited and, subsequent to a platform of intensive outpatient treatment for alcoholism, will be randomly assigned to a 12-week treatment condition. Both conditions will begin with a 1-week placebo run-in, and conclude with a 3-week medication taper. Follow-up assessments will be conducted at post-treatment and at 3, 6, 9, and 12-months. The long-term objectives of this research are to develop a real-world combination of psychosocial and pharmacological treatments for patients with comorbid alcohol-use and anxiety disorders that compromise prognosis, and to evaluate the effectiveness of combined psychosocial and pharmacological treatments that target anxiety among patients with this comorbidity.