Comorbid Alcohol Use Disorder (AUD) + Anxiety Disorder (AnxD) is a significant barrier to successful AUD treatment. Converging evidence implicates overlap in dysregulation of systems governing stress response (HPA,ANS, CNS) for symptom development in AUD and AnxD. However, this must be systematically demonstrated in comorbid AUD+AnxD. The overall objective of this project is identification and prospective assessment of stress system function of AUD inpatients with and without comorbid AnxD.
AnxD additively increases severity and persistence of stress system dysregulation thus precipitating AUD relapse, while reregulation occurs with standard AUD treatment and is further enhanced by a combined AUD+AnxD intervention (AnxD-CBT). The researchers will evaluate the effect(s) of:
- Co-occurring AnxD on severity of biological stress system parameters in AUD inpatients at pre-treatment
- Co-occurring AnxD on persistence of stress system dysregulations in AUD inpatients immediately after treatment (post-treatment) and 1 month later (early abstinence)
- AnxD-CBT treatment on biological stress system reregulation among AUD patients with co-occurring AnxD
- Reregulation change in biological stress system responding on 4-month AUD clinical outcomes
- Comparing AUD inpatients with and without co-occurring AnxD to healthy controls to identify the impact of AnxD comorbidity on HPA-ANS-CNS stress system dysregulation
- Identifying severity and persistence of stress system dysregulation as a biomarker of AUD recovery in comorbid AUD+AnxD
- Employing multiple assessment time points
- Determining if AnxD-CBT treatment normalizes perturbed stress systems while reregulation during post-treatment abstinence predicts treatment outcomes four months later
This research is significant because identification of additive stress system dysregulation in AUD+AnxD vs. AUD alone will provide an integrated, biological-systems approach to supplement descriptive symptom-based diagnoses of comorbid AUD+AnxD, and validating that stress system reregulation in comorbid AUD+AnxD is modulated by AUD treatment and predicts AUD recovery will facilitate intervention development.