Phased Treatment for Social Anxiety Disorder and Coping Behaviors in a Medical Setting
Condition: Social Anxiety Disorder; Alcohol Use Disorders
MeSH terms: Alcoholism; Anxiety Disorders; Phobia, Social
Study type: Interventional

Summary: 
      The purpose of this study is to treat individuals with social anxiety disorder with a Food
      and Drug Administration-approved medication for the treatment of social anxiety disorder, the
      antidepressant paroxetine, and to evaluate the impact of an intervention designed to help
      those individuals cope with anxiety without the use of common coping behaviors.
    

Detailed description: 
      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.
    

Intervention name(s): Brief Alcohol Intervention
Intervention type(s): Behavioral
Intervention description(s): At the Week 6 visit, all subjects who are randomized to the Experimental Group will receive the experimental brief alcohol intervention. The intervention will be in addition to a standard 20-minute physician visit, for a maximum of 30 minutes. The physician will use the Updated NIAAA Clinician's Guide to ask about drinking and will draw the connection between social anxiety and drinking and how they relate to each other. Subjects will be asked to consider making changes in their drinking and if they agree, a goal will be set and progress toward that goal will be monitored at subsequent visits.
Other intervention name(s): Helping Patients That Drink Too Much, NIAAA Guide
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: anxiety; social anxiety; social anxiety disorder; coping behaviors; alcohol abuse