Concurrent Treatments of Substance Use Disorders with Anxiety or Trauma: A Comprehensive Meta-Analysis

Abstract

Among those seeking treatment for a substance use disorder (SUD), the prevalence of a concurrent anxiety disorder or posttraumatic stress disorder (PTSD) is surprisingly high, with some estimates placing the comorbidity rate at 33% to 43%. There is evidence that this comorbidity is associated with greater symptom severity, impairment, and substance use relapse than when the disorders present independently. One of the greatest challenges that clinicians face when presented with a patient with an anxiety disorder/PTSD and SUD is deciding how to approach treatment. Though the prevailing approach has been to treat the disorders sequentially, with the SUD receiving initial attention, there is a movement towards developing integrated or concurrent treatment models. The current meta-analytic study examined integrated or concurrent psychotherapies or pharmacotherapies for SUDs and anxiety disorders or PTSD. A meta-analysis on this topic is particularly important given the generally mixed findings of existing randomized controlled trials in this area of research. Our main question of interest was how integrated/concurrent treatments compared to single-target treatments. In addition, we explored whether there were outcome differences between psychotherapy and pharmacotherapy, between anxiety disorders and PTSD, and differences based on treatment setting (e.g., substance use treatment center versus other settings). Our findings suggested that integrated or concurrent treatments were superior in reducing anxiety or PTSD symptoms, compared to treatments that only targeted substance use or anxiety/PTSD. The effect, however, was small. There was no evidence that integrated or concurrent treatments improved substance use outcomes in comparison to stand alone substance use treatment. We also found evidence that treatment studies conducted at substance use inpatient or outpatient programs produced smaller anxiety/PTSD effects. A trend was found suggesting combined psychotherapy-pharmacotherapy interventions may be more effective than psychotherapy alone. No difference was found between treatments targeting PTSD versus anxiety disorders. Implications of our findings are discussed.