One class of medications that has received support for its role in treating comorbid anxiety and alcohol abuse is selective serotonin reuptake inhibitors (SSRIs).
More specifically, both paroxetine (brand name: Paxil) and sertraline (brand name: Zoloft) have been explored among samples of individuals who have been diagnosed with alcohol abuse and anxiety. 
Findings from these studies, however, remain mixed with some finding support for reduced symptoms of both anxiety and alcohol dependence, while others do not. As such, more work is needed to explore the role of selective serotonin reuptake inhibitors on symptoms of comorbid substance abuse and anxiety.
One anti-anxiety medication, buspirone (brand name: BuSpar) has received support for its role in treating both alcohol abuse and symptoms of anxiety. Further, the anticonvulsant medication topiramate (brand name: Topamax) has demonstrated potentially positive results in treating individuals with cocaine dependence and symptoms of anxiety.
The use of behavioral therapy, either alone or in conjunction with medication, is a critical component of the treatment for dually diagnosed substance abuse and anxiety problems.
In fact, behavioral therapy is often the preferred method of treatment, given that prescribing medication—particularly the benzodiazepine anti-anxiety medications, with their high propensity for dependency and abuse—is a major concern for many substance abuse professionals.
Cognitive Behavioral Therapy
The most commonly referred behavioral approach for individuals suffering from comorbid substance abuse problems and anxiety is cognitive behavioral therapy (CBT). The goal of this approach is to change an individual’s maladaptive beliefs and unhelpful behaviors.
Individuals who undergo cognitive behavioral therapy are taught:
- To recognize their thoughts, feelings and physiological responses to certain situations.
- Skills in relaxation practice that they then use during graded exposure exercises.
- Are clinician-guided.
- Encourage individuals to face feared situations in a stepwise fashion.
- Allow the individual to experience success and mastery, in order to face increasingly challenging situations.
CBT, in particular, has received empirical support for its role in treating substance abuse, both among adult and pediatric populations, as well as anxiety problems.
CBT has received much support for its role in treating substance abuse and anxiety problems.
While most studies have supported the use of CBT for individuals with substance abuse and anxiety, other studies have actually shown that exposure—a specific intervention component of cognitive behavioral therapy—can have detrimental impacts on the individual’s progress with regard to their substance abuse problems.
Targeting Treatment for Co-occurring Conditions
The treatment of individuals with dually diagnosed, or co-occurring, substance abuse problems and anxiety brings about important considerations.
In most cases, professionals will attempt to treat both co-occurring conditions simultaneously; however, this may not actually be the most beneficial for individuals with substance abuse problems and anxiety. For instance, some individuals may be more ready to make changes with regard to one disorder over the other.
As such, it may actually be beneficial for these individuals to target treatment accordingly, rather than attempting to focus treatment on both.
Further, individuals undergoing behavioral treatment for anxiety may impede their progress by using alcohol to cope with feelings of distress that may come up as the result of undergoing treatment.
Thus, it is important for professionals treating these conditions to be mindful of the course of symptoms of the comorbid condition and to engage in continual monitoring of the individual’s progress in treatment.
Indeed, there is very little information regarding outcomes from treatment approached in this way. Thus, more work is necessary in order to clearly identify the ideal approach to targeting symptoms of co-occurring substance abuse problems and anxiety.