Cognitive-Behavioral Therapy & Venlafaxine Treatments For Anxiety In Alcoholism

描述（由申请人提供）：焦虑管理技能的缺陷是酒精使用复发的常见原因。经验数据支持焦虑在酒精复发中的作用。酒精问题的社会心理和药物治疗越来越多地涉及酒精使用障碍中负面影响的作用。由于缺乏大型、控制良好的治疗结果试验，最佳治疗（或治疗组合）仍然未知。在现实世界中，治疗酒精使用障碍的实践通常是从短暂的、密集的解毒和稳定开始的，然后通常是对那些抱怨情绪困难并试图早期戒酒的患者进行CBT和药物治疗的结合。根据项目公告PA-98-003，该项目是一项“典型临床实践”测试，是一项以焦虑为重点的CBT和药物治疗（文拉法辛；CBT- ven）相结合的完全对照试验，用于治疗合并酒精使用和焦虑障碍的患者。CBT-VEN包将根据主要表现焦虑症（即PD， GAD或SP）以三种形式进行管理，并将与两种单活性治疗条件（CBT-PLA和REL-VEN）和一种完全控制条件（放松训练和安慰剂药物；rel - placc）进行对比。128名参与者将被招募，随后将被随机分配到一个为期12周的酒精中毒强化门诊治疗平台。两种情况都将以1周的安慰剂磨合开始，并以3周的药物减量结束。随访评估将在治疗后、3、6、9和12个月进行。本研究的长期目标是为影响预后的共病酒精使用和焦虑障碍患者开发一种现实世界的社会心理和药物联合治疗方法，并评估针对这种共病患者焦虑的社会心理和药物联合治疗的有效性。

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.