Abstract：
Alcohol use disorder (AUD) and anxiety disorders (AnxD) are prevalent health concerns in clinical practice which frequently co-occur (AUD-AnxD) and compound one another. Concurrent AUD-AnxD poses a challenge for clinical management as approaches to treatment of one disorder may be ineffective or potentially counterproductive for the other disorder.
We present the case of a middle-aged man with anxiety disorder, AUD, chronic pain, and gamma-hydroxybutyrate use in context of tapering prescribed benzodiazepines who experienced severe alcohol withdrawal episodes during a complicated course of repeated inpatient withdrawal management. After medical stabilization, the patient found significant improvement in symptoms and no return to alcohol use with a regimen of naltrexone targeting his AUD, gabapentin targeting both his AUD and AnxD, and engagement with integrated psychotherapy, Alcoholics Anonymous, and addictions medicine follow-up.
Proper recognition and interventions for AUD and AnxD, ideally with overlapping efficacy, can benefit individuals with comorbid AUD-AnxD. Gabapentin, tobacco cessation, and integrated psychotherapy have preliminary evidence of synergistic effects in AUD-AnxD. Meta-analysis evidence does not support serotoninergic medications (e.g. selective serotonin reuptake inhibitors) which are commonly prescribed in AnxD and mood disorders as their use has not been associated with improved outcomes for AUD-AnxD. Additionally, several double-blind placebo-controlled randomized trials have suggested that serotonergic medications may worsen alcohol-related outcomes in some individuals with AUD. Areas for future investigation are highlighted.
We present the case of a middle-aged man with anxiety disorder, AUD, chronic pain, and gamma-hydroxybutyrate use in context of tapering prescribed benzodiazepines who experienced severe alcohol withdrawal episodes during a complicated course of repeated inpatient withdrawal management. After medical stabilization, the patient found significant improvement in symptoms and no return to alcohol use with a regimen of naltrexone targeting his AUD, gabapentin targeting both his AUD and AnxD, and engagement with integrated psychotherapy, Alcoholics Anonymous, and addictions medicine follow-up.
Proper recognition and interventions for AUD and AnxD, ideally with overlapping efficacy, can benefit individuals with comorbid AUD-AnxD. Gabapentin, tobacco cessation, and integrated psychotherapy have preliminary evidence of synergistic effects in AUD-AnxD. Meta-analysis evidence does not support serotoninergic medications (e.g. selective serotonin reuptake inhibitors) which are commonly prescribed in AnxD and mood disorders as their use has not been associated with improved outcomes for AUD-AnxD. Additionally, several double-blind placebo-controlled randomized trials have suggested that serotonergic medications may worsen alcohol-related outcomes in some individuals with AUD. Areas for future investigation are highlighted.
摘要：
酒精使用障碍(AUD)和焦虑症(AnxD)是临床实践中常见的健康问题,其经常共同出现(AUD-AnxD)并彼此复合。并发AUD-AnxD对临床管理提出了挑战，因为治疗一种疾病的方法可能对另一种疾病无效或可能适得其反。
我们介绍了一个患有焦虑症的中年男子的案例，AUD,慢性疼痛,以及在反复住院戒断管理的复杂过程中出现严重酒精戒断发作的减量处方苯二氮卓类药物的情况下使用γ-羟基丁酸酯。医疗稳定后，患者发现症状有显著改善，并没有恢复酒精使用纳曲酮方案以他的AUD为目标，加巴喷丁瞄准他的AUD和AnxD,并参与综合心理治疗，匿名酗酒者,和成瘾药物随访。
正确识别和干预AUD和AnxD，理想情况下具有重叠的功效，可以使合并症AUD-AnxD的个人受益。加巴喷丁,戒烟,和综合心理治疗在AUD-AnxD中具有协同作用的初步证据。荟萃分析证据不支持在AnxD和情绪障碍中常用的5-羟色胺能药物（例如选择性5-羟色胺再摄取抑制剂），因为它们的使用与AUD-AnxD的改善结果无关。此外,多项双盲安慰剂对照随机试验表明,在某些AUD患者中,5-羟色胺能药物可能使酒精相关结局恶化.强调了未来调查的领域。
我们介绍了一个患有焦虑症的中年男子的案例，AUD,慢性疼痛,以及在反复住院戒断管理的复杂过程中出现严重酒精戒断发作的减量处方苯二氮卓类药物的情况下使用γ-羟基丁酸酯。医疗稳定后，患者发现症状有显著改善，并没有恢复酒精使用纳曲酮方案以他的AUD为目标，加巴喷丁瞄准他的AUD和AnxD,并参与综合心理治疗，匿名酗酒者,和成瘾药物随访。
正确识别和干预AUD和AnxD，理想情况下具有重叠的功效，可以使合并症AUD-AnxD的个人受益。加巴喷丁,戒烟,和综合心理治疗在AUD-AnxD中具有协同作用的初步证据。荟萃分析证据不支持在AnxD和情绪障碍中常用的5-羟色胺能药物（例如选择性5-羟色胺再摄取抑制剂），因为它们的使用与AUD-AnxD的改善结果无关。此外,多项双盲安慰剂对照随机试验表明,在某些AUD患者中,5-羟色胺能药物可能使酒精相关结局恶化.强调了未来调查的领域。
