MANAGING ANXIETY AND DEPRESSION IN ALCOHOL AND DRUG-DEPENDENCE

Previous research has highlighted the high prevalence (30-60%) of como rbid anxiety and mood disorders in clients with substance misuse disor ders and, equivalently. a third of those with affective disorder repor t a history of substance use disorder (Kessler et al., 1994; Regier et al., 1990; Robins & Regier, 1991). This article reviews the managemen t of such cases and identifies key issues in the assessment process, a s well as potential avenues for treatment. Other articles have highlig hted the increased service utilisation and the cost of care and treatm ent of comorbidity. This article will primarily focus on the managemen t of individual cases and will briefly refer to issues of service orga nisation. Although antidepressant or anxiolytic pharmacotherapy may ha ve a role in the treatment of severe disorders, the benefits of using these medications must be balanced against the increased risk of side- effects or adverse reactions in individuals who continue to engage in substance misuse or who have medical complications associated with dru g or alcohol dependency. Effective psychosocial approaches largely foc us on brief, empirically tested manualised therapies such as cognitive therapy (Carroll, 1998a). However, modifications are required to such approaches to ensure that the interventions are tailored to the needs of clients exhibiting comorbidity. The data available demonstrate som e evidence for the benefits of structured psychological approaches, bu t more sophisticated randomized controlled trials are required to eval uate the efficacy of both psychological and pharmacological approaches . (C) 1998 Elsevier Science Ltd.