Treatment for Comorbid Social Anxiety and Alcohol Use Disorders.
Condition: Alcohol Use Disorder; Social Anxiety Disorder
MeSH terms: Alcoholism; Anxiety Disorders; Alcohol Drinking; Phobia, Social
Study type: Interventional

Summary: 
      Alcohol use disorders (AUD) and social anxiety disorder (SAD) are highly comorbid and
      associated with significant impairment. Social anxiety comorbidity is associated with poorer
      addiction treatment engagement and outcomes. Thus, addressing underlying SAD symptoms that
      may lead to and maintain alcohol problems, as well as undermine successful treatment for AUD,
      is warranted. This proposal aims to develop and evaluate a fully integrated outpatient
      program for comorbid SAD and AUD that weaves evidence-based treatment for SAD (i.e.,
      exposure-based cognitive behavioral therapy) into a traditional, evidence-based treatment for
      AUD.

      First, the investigators will develop the protocol for the fully integrated treatment (FIT).
      The overarching goal of FIT will be to simultaneously deliver AUD and SAD treatment.
      Development will be an iterative process guided by previous research (including our own), and
      by input from clinicians, administrators, and patients in an outpatient substance use
      disorder treatment clinic. After the protocol is developed, the investigators will use their
      established clinician training procedures to train clinicians at their community partnered
      clinic to competently deliver the intervention. After protocol development and clinician
      training, the investigators will conduct a pilot randomized clinical trial (RCT) comparing
      the efficacy of our fully integrated treatment (FIT) for comorbid alcohol use and social
      anxiety disorders to usual care (UC) in the community substance use disorder specialty
      clinic. The goals of the RCT will be to gather data regarding acceptability, feasibility, and
      preliminary efficacy of the FIT protocol. The investigators will randomize treatment-seeking
      participants (N = 60) who have comorbid SAD and AUD. The investigators will assess treatment
      engagement, social anxiety outcomes, and alcohol use outcomes at baseline, 3-months, and
      6-months from baseline. The investigators will also gather qualitative and quantitative
      acceptability data from patients after completing FIT, which may guide final refinements of
      FIT prior to testing in a larger-scale grant.

      The knowledge gained from this investigation has the potential to significantly improve the
      treatment of alcohol use disorders and make a significant public health impact. The focus on
      direct translation to community practice paradigms and the emphasis on full mental health and
      addiction treatment integration significantly advance the field.
    

Detailed description: 
      In this study, potential participants will be screened either by University of California,
      Los Angeles (UCLA) staff or at the Matrix Institute on Addiction to determine whether they
      may have social anxiety and alcohol use disorder symptoms. If they screen positive for these
      symptoms, they will be invited to come in for a comprehensive baseline assessment consisting
      of interviews, questionnaires, and a behavioral assessment. Eligible participants will be
      randomly assigned to either receive standard Matrix treatment consisting of a 9-hour per week
      Intensive Outpatient Program (IOP) lasting approximate 2-3 months; or FIT, an Intensive
      Outpatient Program (also 9 hours per week for approximately 2-3 months) consisting of
      cognitive behavioral therapy (CBT) for social anxiety disorder that is woven into the alcohol
      recovery program. After treatment, participants will complete another assessment, and then
      will complete one several months later.
    

Intervention name(s): Fully integrated treatment; Stand-alone Intensive Outpatient Program
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Clinicians will be delivering CBT for Social Anxiety Disorder directly into the context of the Matrix's evidence-based treatment for substance use disorders (i.e., The Matrix Model).; Evidence-based treatment for substance use disorders (i.e., The Matrix Model).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Eligible participants will be randomized to the Fully Integrated Treatment (FIT; N =30) or usual care in the Matrix Institute IOP (UC; N = 30).
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Integrated Treatment; Alcohol Use Disorder; Social Anxiety Disorder; Comorbidity; Cognitive Behavioral Therapy