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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Meta-analysis of supplemental treatment for depressive and anxiety disorders in patients being treated for alcohol dependence

Review published: 2011.

Bibliographic details: Hobbs JD, Kushner MG, Lee SS, Reardon SM, Maurer EW.  Meta-analysis of supplemental treatment for depressive and anxiety disorders in patients being treated for alcohol dependence. American Journal on Addictions 2011; 20(4): 319-329. [PMC free article: PMC3124006] [PubMed: 21679263]

Quality assessment

The authors concluded that clinical psychiatric and alcohol-related outcomes could be improved by supplementing treatment of alcohol dependence with psychiatric treatment for patients with co-occurring internalising disorders. The authors' conclusions reflect the evidence presented, but potential for language bias, no validity assessment and poor reporting of review methods mean that the reliability of the conclusions is unclear. Full critical summary


Approximately half of those receiving treatment for an alcohol use disorder (AUD) also suffer with an anxiety or depressive (internalizing) disorder. Because all internalizing disorders mark a poor alcohol treatment outcome, it seems reasonable to supplement AUD treatment with a psychiatric intervention when these disorders co-occur with AUD. However, this conclusion may be faulty given that the various possible interrelationships between AUD and internalizing disorders do not uniformly imply a high therapeutic yield from this approach. Unfortunately, the studies conducted to date have been too few and too small to resolve this important clinical issue with confidence. Therefore, we used a meta-analytic method to synthesize the effects from published randomized controlled trials examining the impact of supplementing AUD treatment with a psychiatric treatment for co-occurring internalizing disorder (N = 15). We found a pooled effect size (d) of .32 for internalizing outcomes and .22 for a composite of alcohol outcomes; however, the alcohol outcomes effect sizes were greater than this for some specific outcome domains. Subgroups that differed in terms of internalizing outcomes included treatment type (medication vs. cognitive behavioral therapy) and treatment focus (anxiety vs. depression). There was also a trend for the studies with better internalizing disorder outcomes to have better alcohol outcomes. These results indicate that clinical outcomes (both psychiatric and alcohol-related) could be somewhat improved by supplementing AUD treatment with psychiatric treatment for co-occurring internalizing disorder.

© American Academy of Addiction Psychiatry.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2012 University of York.

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