Psychological interventions for alcohol misuse among people with co-occurring depression or anxiety disorders: a systematic review

Authors:
BAKER Amanda L., et al
Journal article citation:
Journal of Affective Disorders, 139(3), August 2012, pp.217-229.
Publisher:
Elsevier

Psychological interventions, including motivational interviewing (MI) and cognitive behaviour therapy (CBT), seem to be effective in the treatment of co-occurring mood or anxiety disorders and alcohol misuse, although the evidence was based on only eight randomised controlled trials (RCTs). Even brief interventions were associated with beneficial mental health and alcohol use outcomes.

Extended abstract:
Author

BAKER Amanda L.; et al.;

Title

Psychological interventions for alcohol misuse among people with co-occurring depression or anxiety disorders: a systematic review.

Journal citation/publication details

Journal of Affective Disorders, 139(3), August 2012, pp.217-229.

Summary

Psychological interventions, including motivational interviewing (MI) and cognitive behaviour therapy (CBT), seem to be effective in the treatment of co-occurring mood or anxiety disorders and alcohol misuse, although the evidence was based on only eight randomised controlled trials (RCTs). Even brief interventions were associated with beneficial mental health and alcohol use outcomes. 

Context

Depression, anxiety and alcohol use disorders commonly co-occur; especially high rates of co-occurrence are seen in treatment settings. Psychological interventions have been found to be effective for each of the three disorders, but few have focused on the treatment of individuals with depressive or anxiety disorders and comorbid alcohol misuse. The aim of this study was to ‘systematically review the evidence from RCTs of psychological intervention for co-occurring alcohol misuse among people with unipolar depression, dysthymia or anxiety disorders and provide recommendations for clinical management and future research.’

Methods

What sources were searched?
The PubMed and PsycINFO databases were searched during March 2010 and the reference lists of relevant studies were screened for potentially relevant articles.

What search terms/strategies were used?
Searches were conducted using a combination of the following terms: depression, major depression, depressive disorder, anxiety, anxiety disorders, dysthymia, affective disorders, mood disorders, treatment and therapy. There are no details of specific search strategies. Searches were limited to RCTs or trials using sequential allocation published in English. No date limits were applied.    

What criteria were used to decide on which studies to include?
Studies had to use diagnostic criteria for mood or anxiety disorders and use a treatment manual or report data on alcohol use outcomes. Psychological interventions were defined as non-pharmacological treatments for either alcohol misuse alone or alcohol misuse and mood or anxiety disorders.

Who decided on their relevance and quality?
Potentially relevant studies were identified from the titles and abstract by one named author. Two other authors then independently reviewed the selected studies in full. Study quality was assessed using the nine-point PEDro (Physiotherapy Evidence Database) scale by the same two others working independently. Ratings were assigned after reaching a consensus.

How many studies were included and where were they from?
Thirty-four potentially relevant studies were selected from an initial total of 1,540 articles and four studies were identified on reviewing reference lists. The final number included in the systematic review was eight. The study selection process is outlined in Figure 1 and includes details of reasons for exclusion at each stage. There were three studies each from Australia and the USA, and one each from Canada and The Netherlands.

How were the study findings combined?
This is a narrative systematic review; effect sizes were compared between studies and between treatment conditions for alcohol use, and depression and anxiety outcomes. Data extraction was carried out by one named author and checked by a second. Cohen’s d paired standardised mean differences were calculated to compare alcohol, depression and anxiety variables at baseline and immediately after treatment using Comprehensive Meta-analysis software. It was not possible to conduct a meta-analysis due to heterogeneity in the study populations and the types of intervention and measures used.

Findings of the review

Alcohol use outcomes were reported prior to and after manual-led psychological interventions aimed at participants with depression in two studies, dysthymia in one study and with mixed diagnoses in two studies of inpatients. The remaining three studies used samples with social phobia, social phobia or agoraphobia, or agoraphobia or panic disorder, respectively. Study quality ratings ranged from a low of five in one study to a single study that was rated nine.

Psychological interventions including brief integrated MI and CBT of up to 10 sessions were effective in reducing depression and alcohol outcomes in two studies. Integrated CBT interventions of longer duration were also reported to be effective. In one study beneficial outcomes were reported for both men and women, and in another trial positive effects were reported for both computer- and therapist-delivered interventions. The two studies of psychiatric inpatients reported reduced alcohol consumption following MI in an intervention delivered to individuals in one, and after delivery to groups of patients in another.

Participants with co-occurring anxiety disorders and alcohol misuse were also responsive to psychological treatment, including brief interventions focussing on alcohol. Two of the three studies recommended a stepped approach to treatment.

Overall, treatment completion was uncommon and attendance at follow-up dropped off considerably over time.

Authors' conclusions

‘There is evidence that psychological interventions (MI/CBT) are effective for treating co-occurring mood and anxiety disorders and alcohol misuse. Even brief interventions appear to be effective, although longer interventions are associated with greater improvements in mood and alcohol use outcomes.’

Implications for policy or practice

None are discussed.

Subject terms:
intervention, mental health problems, motivational interviewing, alcohol misuse, behaviour therapy, cognitive behavioural therapy, counselling, dual diagnosis;
Content type:
systematic review
Link:
Journal home page
ISSN print:
0165-0327

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