The patient attributes his failure to follow though with self-help groups to feeling uncomfortable participating in group activities. The first step is to detoxify the patient from alcohol. The second step is to control the patient's anxiety disorder to the point that he can tolerate the group activities that are the mainstay of addiction treatment. The final step is to treated the patient's alcohol problem, since he is at high risk for relapse, even if the social anxiety has been controlled. Benzodiazepines are contraindicated in patients who have a history of alcohol or drug abuse or dependence.
Most antidepressants have anti- anxiety effects.
Patients in whom paroxetine will eventually prove effective generally show at least a partial response to 20 mg once daily but may require up to 40 mg. Higher dosages may result in increased anxiety. Our clinical experience is that, in recovering alcoholics, paroxetine may be less well tolerated than other SSRIs. Such complicating factors may affect the choice of anti-anxiety medication. Addiction Program Royal Ottawa Hospital Ottawa, Ont.