Years of research have demonstrated that anxiety issues, depression, and alcoholism are frequently co-occurring. Determining which mental health condition comes first is a sort of chicken-and-egg problem and probably depends largely on individual variation. A European population study conducted in 2007 revealed that anxiety disorders often precede alcoholism, but alcohol dependence does not typically precede anxiety disorders. The same study illustrated what had long been suspected—comorbid mental health conditions represent a unique diagnosis, not simply a combination of symptoms and potential treatments. Failure to identify comorbidity can result in inadeqate treatment, often resulting in relapse.
A study sponsored by the University of New Mexico and the National Institute on Alcohol Abuse and Alcoholism is investigating a combination approach to comorbid alcohol dependence and anxiety. Forty participants will receive a 16-week treatment with Antabuse (disulfiram) and Ativan (lorazepam). Antabuse is a unique chemical compound that interferes with the digestion of alcohol. The result is a severe and unpleasant reaction when alcohol is consumed. The knowledge of this negative reinforcement is seen as a deterrent to continued drinking. Ativan, on the other hand, is a commonly prescribed anti-anxiety medication. After week 8, Ativan is gradually tapered. Both medications are stopped by week 16, the end of the study. Participants who still score highly on an anxiety rating scale will be administered an appropriate medication that is not in the same category as Ativan.
Primary outcomes for this study include abstinence from alcohol and retention in the study, since alcohol dependence is known to exercise such a strong grip on people. In addition, scores on an anxiety rating scale are one of several secondary outcome measures. The drugs used in the study are generally regarded as safe. Headache, drowsiness, and rash are among the more common side effects of Antabuse. Ativan is known to cause fuzzy thinking, fatigue, drowsiness, and dizziness. For the most part, these side effects fade with time as the body adjusts to the medication.
Despite years of research into alcohol dependence, treatment of comorbid disorders is still an inexact science. Studies like the one underway at the University of New Mexico will provide data that addiction counselors and health care providers can put to good use in treatment regimens.
References
- Disulfiram – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved June 15, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000726/
- Disulfiram Combined With Lorazepam for Alcohol Dependence and Anxiety Disorder. (n.d.). ClinicalTrials.gov. Retrieved June 15, 2012, from http://clinicaltrials.gov/ct2/show/NCT00721526?intr=%22Lorazepam%22&rank=17
- Marquenie, L., Schade, A., Balkom, A. v., Comijs, H., Graaf, R. d., Vollebergh, W., et al. (2007). Origin of the Comorbidity of Anxiety Disorders and Alcohol Dependence: Findings of a General Population Study. European Addiction Research, 13, 39-49. Retrieved June 15, 2012, from the EBSCOhost database.
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