Pilar A Sáiz, Gerardo Flórez, Manuel Arrojo, Miquel Bernardo, Ana González-Pinto, José Manuel Goikolea, Iñaki Zorrilla, Ruth Cunill, Xavier Castells, Elisardo Becoña, Ana López, Marta Torrens, Francina Fonseca, Judit Tirado-Muñoz, Belén Arranz, Marina Garriga, Luis San
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Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram). Our results suggest that 1) we can (weakly) recommend the use of desipramine over paroxetine to alleviate symptoms of anxiety in patients with a PTSD and alcohol use; 2) In these patients, the use of naltrexone to reduce symptoms of anxiety is also recommended (weak strength); and 3) SSRI antidepressants vs placebo can be recommended to reduce alcohol use (weak recommendation). Our review highlights the need for more research in this area and for larger, multisite studies with generalizable samples to provide more definite guidance for clinical practice.</p>","PeriodicalId":55560,"journal":{"name":"Adicciones","volume":"34 2","pages":"157-167"},"PeriodicalIF":2.2000,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical practice guideline on pharmacological and psychological management of adult patients with an anxiety disorder and comorbid substance use.\",\"authors\":\"Pilar A Sáiz, Gerardo Flórez, Manuel Arrojo, Miquel Bernardo, Ana González-Pinto, José Manuel Goikolea, Iñaki Zorrilla, Ruth Cunill, Xavier Castells, Elisardo Becoña, Ana López, Marta Torrens, Francina Fonseca, Judit Tirado-Muñoz, Belén Arranz, Marina Garriga, Luis San\",\"doi\":\"10.20882/adicciones.1548\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid anxiety disorders and SUDs while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus anxiety symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Clinical trials are only available for posttraumatic stress disorder (PTSD) and for social anxiety. Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram). Our results suggest that 1) we can (weakly) recommend the use of desipramine over paroxetine to alleviate symptoms of anxiety in patients with a PTSD and alcohol use; 2) In these patients, the use of naltrexone to reduce symptoms of anxiety is also recommended (weak strength); and 3) SSRI antidepressants vs placebo can be recommended to reduce alcohol use (weak recommendation). 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Clinical practice guideline on pharmacological and psychological management of adult patients with an anxiety disorder and comorbid substance use.
This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid anxiety disorders and SUDs while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus anxiety symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Clinical trials are only available for posttraumatic stress disorder (PTSD) and for social anxiety. Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram). Our results suggest that 1) we can (weakly) recommend the use of desipramine over paroxetine to alleviate symptoms of anxiety in patients with a PTSD and alcohol use; 2) In these patients, the use of naltrexone to reduce symptoms of anxiety is also recommended (weak strength); and 3) SSRI antidepressants vs placebo can be recommended to reduce alcohol use (weak recommendation). Our review highlights the need for more research in this area and for larger, multisite studies with generalizable samples to provide more definite guidance for clinical practice.
期刊介绍:
Adicciones publica artículos originales sobre el tratamiento, la prevención, estudios básicos y descriptivos en el campo de las adicciones, como son las drogas ilegales, el alcohol, el tabaco o cualquier otra adicción, procedentes de distintas disciplinas (medicina, psicología, investigación básica, investigación social, etc.). Todos los artículos son seleccionados después de pasar un proceso de revisión anónimo hecho por expertos en ese tema.