Abstract
PurposePatients’ problematic substance use prevalence and effects were explored in relation to internet-based cognitive behavioral therapy (ICBT) outcomes for depression, panic disorder and social anxiety disorder.MethodsAt baseline and treatment conclusion, 1601 ICBT patients were assessed with self-rated measures for alcohol and drug use (AUDIT/DUDIT), depressive symptoms (MADRS-S), panic disorder symptoms (PDSS-SR) and social anxiety symptoms (LSAS-SR).ResultsProblematic substance use (AUDIT ≥8 for men, ≥6 for women; DUDIT ≥1) occurred among 32.4% of the patients; 24.1% only alcohol, 4.6% only drugs, and 3.7% combined alcohol and drug use. Hazardous alcohol use and probable alcohol dependence negatively affected panic disorder outcomes, and hazardous drug use led to worse social anxiety outcomes. Depression outcomes were not affected by substance use. Treatment adherence was negatively affected by problematic drug use among men and 25–34 year olds; combined substance use negatively affected adherence for women and 35–64 year olds.ConclusionProblematic substance use does not preclude ICBT treatment but can worsen outcomes, particularly problematic alcohol use for panic disorder patients and hazardous drug use for social anxiety patients. ICBT clinicians should exercise particular caution when treating men and younger patients with problematic drug use, and women or older patients with combined substance use.
Highlights
Considerable evidence indicates an association between psychiatric disorders and problematic substance use
Substance use prevalence Among the population of 1581 patients, problematic substance use was reported by 32.4%, with 24.1% indicating problematic alcohol use only, 4.6% reporting problematic drug use only and 3.7% indicating combined problematic alcohol and drug use, with a total of 8.3% indicating problematic drug use with or without alcohol
Patients treated for depression were slightly older than the population mean, whereas panic disorder and social anxiety disorder patients were younger
Summary
Considerable evidence indicates an association between psychiatric disorders and problematic substance use. In a US national survey, the 12month prevalence level of a diagnosed alcohol use disorder among individuals with a mood disorder was 17.3% and 6.9% for a drug use disorder. Among individuals with an anxiety disorder, 12month prevalences were 13.0% and 4.6% respectively. Prevalences in the general population were lower – 8.5% for diagnosed alcohol and 2% for drug use disorders. Among those seeking treatment for major depressive disorder, panic disorder with agoraphobia, panic disorder without agoraphobia and social anxiety disorder the 12-month prevalences for an alcohol use disorder were 16.8%, 15.4%, 13.7% and 16.0% respectively. The corresponding numbers for a drug use disorder were 7.5%, 9.7%, 5.1% and 8.2% [2]
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