This study investigates the impact of social phobia on adherence to and outcomes 6 months following standard alcohol treatment and Alcoholics Anonymous (AA) group meetings among alcohol-dependent patients with and without social phobia.
In a cohort study, 300 detoxified alcohol-dependent individuals in Porto Alegre, Brazil, were interviewed during, as well as 3 and 6 months after hospital detoxification. At both follow-up points, treatment adherence was low and relapse rates were high among patients with and without social phobia, and no significant differences were seen between the two groups of patients in relapse, adherence to AA, or adherence to psychotherapy.
Findings from this sample suggest that although alcohol-dependent patients with social phobia showed a tendency for less adherence at AA and felt less integrated with their AA group, social phobia comorbidity was not a significant risk factor for alcohol use relapse or for nonadherence to AA or psychotherapy.
The diagnosis of alcoholism occurs in approximately 26% of patients with social phobia, and, reciprocally, social phobia is detected in approximately 21% of alcohol-dependent patients (Lépine & Pélissolo, 1998). Alcohol-dependent patients often report onset of social phobia prior to their alcohol dependence (Terra, Figueira, & Barros, 2004). Studies show two- to threefold higher risk for the development of abuse or dependence on alcohol among patients with social phobia as compared with those without social phobia (Kessler et al., 1997). Thus, social phobia and alcohol dependence are two of the most prevalent comorbid conditions found in clinical practice; the combination has been shown to significantly increase the use of health services among these patients (Helzer & Pryzbeck, 1998).
Despite the prevalence and health care utilization consequences of alcoholism and social phobia, few studies have compared outcomes of alcohol-dependent patients with and without social phobia (Thomas, Thevos, & Randall, 1999). It has been proposed that social phobia should be taken into account when defining treatment strategies for patients who abuse alcohol as a self-medication strategy for anxiety symptoms (LaBounty et al., 1992 and Lépine & Pélissolo, 1998). In this regard, it has been reported that comorbid anxiety disorders lead to worse outcomes in the treatment of alcohol dependence (as reviewed by Da Silveira & Jorge, 1999 and Schadé et al., 2003).
Also, it has been suggested, but not tested, that alcohol-dependent patients with social phobia may have more difficulty attending or benefiting from a group-based treatment such as Alcoholics Anonymous (AA; Myrick & Brady, 1997). AA is an effective intervention for alcohol dependence (Kownacki & Shadish, 1999, Morgenstern et al., 1997 and Timko et al., 1994). However, about 50% of AA participants drop out in the first 3 months of treatment (Chappel, 1993, Fiorentine, 1999, Gossop et al., 2003 and Humphreys et al., 1997). Because patients with social phobia may have difficulties with AA group activities and speaking in front of an audience, attending the meetings and adherence to the AA philosophy may be particularly difficult for the alcohol-dependent patient with social phobia. Thus, it is important to compare the effectiveness of the 12-step, AA-oriented treatment approaches for patients with and without social phobia.
This study is a longitudinal investigation of patients within alcoholism treatment programs in Brazil, reporting alcohol use relapse and adherence to psychotherapy or AA group meetings during the first 6 months following detoxification. We were particularly interested in the relationship between attendance at AA meetings and presence of a comorbid diagnosis of social phobia.
