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Lortye SA, Will JP, Marquenie LA, Goudriaan AE, Arntz A, de Waal MM. Correction: Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment. BMC Psychiatry 2022; 22:482. [PMID: 35854251 PMCID: PMC9295271 DOI: 10.1186/s12888-022-04092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sera A. Lortye
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Joanne P. Will
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Loes A. Marquenie
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anna E. Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands ,grid.7177.60000000084992262Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen M. de Waal
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
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Lortye SA, Will JP, Marquenie LA, Goudriaan AE, Arntz A, de Waal MM. Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment. BMC Psychiatry 2021; 21:442. [PMID: 34493253 PMCID: PMC8423329 DOI: 10.1186/s12888-021-03366-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment. METHODS In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger. DISCUSSION This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide. TRIAL REGISTRATION Netherlands Trial Register (NTR), Identifier: NL7885 . Registered 22 July 2019.
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Affiliation(s)
- Sera A. Lortye
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Joanne P. Will
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Loes A. Marquenie
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anna E. Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands ,grid.7177.60000000084992262Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen M. de Waal
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
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Schadé A, Marquenie LA, van Balkom AJLM, Koeter MMJ, van den Brink W, van Dyck R. [The effectiveness of anxiety treatment on alcohol-dependent patients with a comorbid phobic disorder: a randomised controlled trial]. Tijdschr Psychiatr 2008; 50:137-148. [PMID: 18324601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is evidence that the post-treatment relapse rate for alcohol-dependent patients with a comorbid anxiety disorder is higher than for alcohol-dependent patients without this disorder. aim To discover whether the post-treatment relapse rate in alcohol-dependent patients who suffer from both alcohol-dependence and a comorbid anxiety disorder can be lowered by giving them additional treatment specifically for the comorbid anxiety disorder. METHOD A 32-week randomised controlled trial among 96 abstinent patients with a primary diagnosis of alcohol dependence and a comorbid anxiety disorder involving agoraphobia or social phobia. The patients were randomly assigned either to an intensive psychosocial relapse-prevention programme only (n = 49) or to a combined programme in which the aforementioned programme was supplemented by an anxiety treatment programme comprising cognitive behavioural therapy and optional pharmacotherapy in the form of an SSRI (n = 47). The primary outcome measure was the percentage of patients who suffered an alcohol relapse during a 32-week period. The secondary outcome measures were: total abstinence, a reduction in the number of days of heavy drinking and a reduction in anxiety symptoms. results Although the anxiety symptoms in the group receiving cognitive behavioural therapy diminished more than in the group not receiving this therapy, the alcohol relapse rates in the former group were not significantly lower than in the latter group. CONCLUSION Anxiety treatment for alcohol-dependent patients with a comorbid anxiety disorder can alleviate anxiety symptoms but has no significant effect on the outcome of alcohol treatment programmes.
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Affiliation(s)
- A Schadé
- GGZ Buitenamstel, A.J.Ernststraat 887, 1081 HL Amsterdam.
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Schadé A, Marquenie LA, van Balkom AJLM, Koeter MWJ, de Beurs E, van Dyck R, van den Brink W. Anxiety disorders: treatable regardless of the severity of comorbid alcohol dependence. Eur Addict Res 2007; 13:109-15. [PMID: 17356283 DOI: 10.1159/000097941] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS Clinical and epidemiological research has shown that comorbidity is the rule rather than exception in the case of psychiatric disorders. Cognitive behavioral therapy (CBT) has been clearly demonstrated to be effective in treating anxiety and avoidance symptoms in patient samples of social phobia and agoraphobia without comorbid alcohol use disorders. It has recently been shown that treatment of comorbid anxiety disorders in alcohol-dependent patients can also be very successful. The purpose of the present study was to find predictors of treatment success for comorbid anxiety disorders in alcohol-dependent patients. METHODS The study was conducted in a sample of 34 completers with a double diagnosis of alcohol dependence and agoraphobia or social phobia who received CBT for their comorbid anxiety disorder in a 32-week randomized controlled trial comparing alcohol and CBT anxiety disorder treatment with alcohol treatment alone. In the current report, treatment success was defined as a clinically significant change (recovery) on the anxiety discomfort scale. RESULTS The severity of comorbid alcohol dependence did not influence the beneficial effect of CBT on the anxiety disorder. Psychological distress (SCL-90), neuroticism (NEO N), conscientiousness (NEO C), gender, employment and age of onset of alcohol dependence showed some predictive value. CONCLUSIONS Alcohol-dependent males with a comorbid anxiety disorder seem to benefit most from CBT if their alcohol dependence started after age 25, if they are employed and if their general psychopathology is less severe. The most important conclusion, however, is that even severely alcohol-dependent patients with an anxiety disorder can benefit from psychotherapy for their anxiety disorder.
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Affiliation(s)
- Annemiek Schadé
- Department of Psychiatry and Institute for Extramural Medicine, VU University Medical Centre, GGZ-Buitenamstel, Amsterdam, The Netherlands.
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Marquenie LA, Schadé A, van Balkom AJLM, Comijs HC, de Graaf R, Vollebergh W, van Dyck R, van den Brink W. Origin of the comorbidity of anxiety disorders and alcohol dependence: findings of a general population study. Eur Addict Res 2007; 13:39-49. [PMID: 17172778 DOI: 10.1159/000095814] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A representative general population sample (n = 7,076) was used to study retrospectively and prospectively the nature of the relationship between co-morbid alcohol dependence and anxiety disorders. Four different models were tested: (1) anxiety disorders increase the risk of alcohol dependence; (2) alcohol dependence increases the risk of anxiety disorders; (3) family history or childhood traumatisation increase the risk of both alcohol dependence and anxiety disorders, and (4) comorbid conditions are a separate psychopathological entity. The data show that alcohol dependence does not precede the onset of anxiety disorders, that anxiety disorders do precede the onset of alcohol dependence, that family history is not very likely to be the third factor explaining the elevated comorbidity, and that in women childhood trauma might be partially responsible for the association between both disorders. The data are inconsistent with regard to comorbidity as a distinct psychopathological entity. These findings are of great importance for treatment planning in patients with alcohol dependence and comorbid anxiety disorders.
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Affiliation(s)
- Loes A Marquenie
- Department of Psychiatry and Institute for Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Marquenie LA, Schadé A, Van Balkom AJLM, Koeter M, Frenken S, van den Brink W, van Dyck R. COMORBID PHOBIC DISORDERS DO NOT INFLUENCE OUTCOME OF ALCOHOL DEPENDENCE TREATMENT. RESULTS OF A NATURALISTIC FOLLOW-UP STUDY. Alcohol Alcohol 2005; 41:168-73. [PMID: 16352656 DOI: 10.1093/alcalc/agh252] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Despite claims that comorbid anxiety disorders tend to lead to a poor outcome in the treatment of alcohol dependence, the few studies on this topic show conflicting results. OBJECTIVE To test whether the outcome of treatment-seeking alcohol-dependent patients with a comorbid phobic disorder is worse than that of similar patients without a comorbid phobic disorder. METHODS The probabilities of starting to drink again and of relapsing into regular heavy drinking in (i) a group of 81 alcohol-dependent patients with comorbid social phobia or agoraphobia were compared with those in (ii) a group of 88 alcohol-dependent patients without anxiety disorders in a naturalistic follow-up using Cox regression analysis. RESULTS Adjusted for initial group differences, the hazard ratio for the association of phobic disorders with resumption of drinking was 1.05 (95% CI, 0.85-1.30, P = 0.66) and the adjusted hazard ratio for the association of phobic disorders with a relapse into regular heavy drinking was 1.02 (95% CI, 0.78-1.33, P = 0.89). CONCLUSION The findings of this study do not confirm the idea that alcohol-dependent patients who have undergone alcohol-dependence treatment are at greater risk of a relapse if they have a comorbid anxiety disorder. No differences were found in abstinence duration or time to relapse into regular heavy drinking between patients with and without comorbid phobic disorders.
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Affiliation(s)
- Loes A Marquenie
- Department of Psychiatry and Institute for Research in Extramural Medicine, VU-University MedicalCentre, GGZ Buitenamstel, The Netherlands.
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Schadé A, Marquenie LA, van Balkom AJLM, Koeter MWJ, de Beurs E, van den Brink W, van Dyck R. The Effectiveness of Anxiety Treatment on Alcohol-Dependent Patients with a Comorbid Phobic Disorder: A Randomized Controlled Trial. Alcohol Clin Exp Res 2005; 29:794-800. [PMID: 15897725 DOI: 10.1097/01.alc.0000163511.24583.33] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evidence has emerged which indicates that the post-treatment relapse rate for alcohol-dependent patients with a comorbid anxiety disorder is higher than for alcohol-dependent patients without a comorbid anxiety disorder. The question raised by this evidence is whether the relapse rate in these dually diagnosed patients could be reduced if they were given additional treatment for the comorbid anxiety disorder. We attempted to answer this question by conducting a trial among patients with a double diagnosis of alcohol dependence and agoraphobia or social phobia. METHOD We conducted a 32-week randomized controlled trial among 96 abstinent patients with a primary diagnosis of alcohol dependence and a comorbid anxiety disorder involving agoraphobia or social phobia. The patients were randomly assigned to an intensive psychosocial relapse-prevention program on its own (n = 49) or in combination with an anxiety treatment program comprising cognitive behavioral therapy (CBT) and optional pharmacotherapy consisting of an SSRI (n = 47). The primary outcome measure was the percentage of patients who suffered an alcohol relapse during a 32-week period. The secondary outcome measures were total abstinence, a reduction in the days of heavy drinking, and less severe anxiety symptoms. RESULTS Although the additional therapy clearly reduced the anxiety symptoms, it had no significant effect on the alcohol relapse rates. CONCLUSION Anxiety treatment for alcohol-dependent patients with a comorbid anxiety disorder can alleviate anxiety symptoms, but it has no significant effect on the outcome of alcohol treatment programs.
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Affiliation(s)
- Annemiek Schadé
- Department of Psychiatry and Institute for Extramural Medicine, Amsterdam, The Netherlands.
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Schadé A, Marquenie LA, Van Balkom AJLM, Koeter MWJ, De Beurs E, Van Den Brink W, Van Dyck R. ALCOHOL-DEPENDENT PATIENTS WITH COMORBID PHOBIC DISORDERS: A COMPARISON BETWEEN COMORBID PATIENTS, PURE ALCOHOL-DEPENDENT AND PURE PHOBIC PATIENTS. Alcohol Alcohol 2004; 39:241-6. [PMID: 15082462 DOI: 10.1093/alcalc/agh039] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with a double diagnosis of alcohol dependence and phobic disorders are a common phenomenon in both alcohol and anxiety disorder clinics. If we are to provide optimum treatment we need to know more about the clinical characteristics of this group of comorbid patients. OBJECTIVE To answer the following questions. (1). What are the clinical characteristics of treatment-seeking alcohol-dependent patients with a comorbid phobic disorder? (2). Are alcohol dependence and other clinical characteristics of comorbid patients different from those of 'pure' alcohol-dependent patients? (3). Are the anxiety symptoms and other clinical characteristics of comorbid patients different from those of 'pure' phobic patients? METHOD Three groups of treatment-seeking patients were compared on demographic and clinical characteristics: alcohol dependent patients with a comorbid phobic disorder (n = 110), alcohol-dependent patients (n = 148) and patients with social phobia or agoraphobia (n = 106). In order to diagnose the comorbid disorders validly, the assessment took place at least 6 weeks after detoxification. RESULTS Comorbid patients have high scores on depressive symptoms and general psychopathology: 25% of patients have a current and 52% a lifetime depressive disorder. The majority have no partner and are unemployed, they have a high incidence of other substance use (benzodiazepine, cocaine, cannabis) and a substantial proportion of comorbid patients have been emotionally, physically and sexually abused. They do not have a more severe, or different type of alcohol dependence or anxiety disorder than 'pure' alcohol-dependent patients and phobic patients respectively. CONCLUSION Comorbid patients constitute a complex part of the treatment-seeking population in alcohol clinics and psychiatric hospitals. These findings should be taken into account when diagnosing and treating alcohol-dependent patients with a comorbid phobic disorder.
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Affiliation(s)
- Annemiek Schadé
- Department of Psychiatry and Institute for Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
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Schadé A, Marquenie LA, Van Balkom AJLM, De Beurs E, Van Dyck R, Van Den Brink W. Do comorbid anxiety disorders in alcohol-dependent patients need specific treatment to prevent relapse? Alcohol Alcohol 2003; 38:255-62. [PMID: 12711661 DOI: 10.1093/alcalc/agg062] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS It has been repeatedly stated that comorbid anxiety disorders predict poor outcome of alcoholism treatment. This statement is based on the high comorbidity of alcohol use disorders and anxiety disorders, and the negative influence of other comorbid psychiatric disorders on the outcome of treatment of alcohol dependence. This review focuses on outcome results of alcohol-dependent patients with a comorbid anxiety disorder. We try to answer the question whether anxiety disorders should be treated in alcohol-dependent patients to improve outcome results in alcoholism treatment. METHODS In a search through Pubmed, Psychinfo and Cochrane, we found only 12 articles on this subject. We distinguished three perspectives: (1) studies on the predictive value of comorbid anxiety disorders on the outcome of alcoholism treatment; (2) studies on the improvement of abstinence rates and anxiety symptoms by offering pharmacological treatment for comorbid anxiety disorders; (3) studies on psychotherapeutic treatment. RESULTS Most studies showed methodological limitations. Only one high quality study showed that comorbid anxiety disorders predict poor outcome of the treatment of alcohol dependence. CONCLUSIONS We cannot conclude that comorbid anxiety disorders in alcohol-dependent patients need a specific treatment to prevent relapse. However, medication and perhaps cognitive behavioural therapy can be useful in alcohol-dependent patients with a comorbid anxiety disorder to reduce anxiety symptoms. Methodological implications for further research are discussed.
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Affiliation(s)
- Annemiek Schadé
- Vrije Universiteit, Department of Psychiatry and Institute for Extramural Medicine, Lassusstraat 2, 1075 GV Amsterdam, The Netherlands
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Schadé A, Marquenie LA, van den Brink W, van Dyck R. [Combination of anxiety disorder and alcohol dependence]. Ned Tijdschr Geneeskd 1998; 142:57-60. [PMID: 9556993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Three patients, two men aged 47 and 37 and a woman aged 32, are described. All three suffered from a combination of alcohol addiction and anxiety disorder. None of them had previously received adequate treatment because on the one hand they had been refused by psychiatric institutes because of their alcohol addiction, and on the other the institutes for the care of addicted had not diagnosed the anxiety disorder. About 150,000 people are estimated to have both an alcohol addiction and an anxiety disorder in the Netherlands. The importance of making a correct diagnosis and providing proper treatment for both disorders is emphasized.
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Affiliation(s)
- A Schadé
- Vrije Universiteit/Psychiatrisch Centrum Amsterdam, Johan Weyer Instituut, Amsterdam
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