Phased Treatment for Social Anxiety Disorder and Coping Behaviors in a Medical Setting

Psychiatric and alcohol use problems co-occur in a significant number of individuals seeking
treatment in mental health treatment settings. However, there is a paucity of research to
guide clinical practice. This is especially true for psychiatrists treating patients with
anxiety disorders who also present with co-occurring hazardous drinking. If alcohol is being
used as a coping strategy, as it is frequently in individuals with social anxiety, it
follows that successful treatment of the social anxiety should resolve dysfunctional
drinking. However, results from our study completed during the current funding period did
not support this hypothesis and suggested, instead, that additional intervention for
hazardous drinking is necessary. The proposed project is a natural "next step" in this line
of research, and the design and methods are guided and informed by the results our previous
work as well as by recently-collected preliminary data. The proposed study will evaluate the
phased approach to the treatment of these co-occurring disorders. Social anxiety will be
treated first, then, in the Experimental group, the physician will introduce a brief alcohol
intervention at a standard time in the course of social anxiety treatment. The hypothesis
being tested is that drinking will decrease more in the Experimental group than in the
Control group, where only the social anxiety is treated and discussed. The design of the
study follows from the results of the project completed in the previous funding period. The
intent of the design was to balance scientific rigor with real-world practicality.
Individuals who are specifically seeking treatment for social anxiety and who also drink at
hazardous drinking levels will be recruited from the community from two treatment sites, one
in South Carolina and one in Minnesota. All subjects in the trial will receive 22 weeks of
flexible dosing with paroxetine, an FDA-approved medication for the treatment of social
anxiety shown to be effective in our previous trial. Half of the subjects will be randomized
to receive at Week 6, in addition to routine social anxiety treatment, a brief
physician-delivered alcohol intervention following the Updated NIAAA Clinical Guide for
Helping Patients Who Drink Too Much. Research assessments will coincide with physician
visits and will also include 34 and 46-week post-treatment follow-up visits. The study is a
novel test of the phased treatment model, is one of the first studies to address the
treatment of co-occurring anxiety and hazardous drinking in a mental health treatment
setting, and uses both social anxiety and alcohol interventions that are easily adoptable in
real-world mental health clinical practice. If the hypothesis is supported, the study has
broad implications for treatment of other co-occurring anxiety and mood disorders and
hazardous drinking.