Co-Occurring Alcohol Use Disorder and Anxiety Bridging Psychiatric, Psychological, and Neurobiological Perspectives

Open Access Abstract:

A substantial number of people who have problems with alcohol also experience strong anxiety and mood problems. This article provides an overview of the evolving perspectives of this association in the context of three related disciplines—psychiatry, psychology, and neuroscience. Psychiatric and epidemiological studies show that having either an anxiety- or alcohol-related diagnosis elevates the prospective risk for developing the other disorder. From the psychological perspective, behavioral research demonstrates that drinking to cope with negative affect is a potent marker for current and future problems with alcohol. Neuroscientific research implicates overlapping neurobiological systems and psychological processes in promoting the rise of negative affect and alcohol misuse. The psychiatric perspective that alcohol misuse and co-occurring anxiety represent neurobiologically distinct diagnostic conditions has dominated the field for many decades. However, recent research provides increasing support for the neuroscientific perspective that these conditions share underlying, mutually exacerbating, neurobiological processes.

Adolescents with Co-Occurring Disorders: Already in our Care

Event Date

Wednesday, November 18, 2020 @ 3-4:30pm ET (2CT/1MT/12PT)


Adolescence is a unique and active period of development. Differential diagnostic understanding and treatment is complicated, specialized, and vital. Often, protective change and treatment progress can be stalled by unrecognized areas of risk and need. As many as 40% of adolescents with identified mental health needs have co-occurring substance use issues. Identified substance use needs predict co-occurring mental health disorders over 70% of the time. Treatment retention and progress, safety factors, and beneficial change are all improved with integrated applications. This integrative approach can be initially daunting for clinicians. Adolescents with CODs are already in our care – and integrating care provides the better opportunity for healthy changes for youth and families.

Learning Objectives
  • Describe current research regarding youth with co-occurring disorders – including prevalence(s) - and list factors that differentiate youth from adults.
  • Describe how physical, social, and personality development factors during adolescents can be dramatically impacted by substance use/abuse, trauma/victimization and mental health disorders.
  • Describe screening and assessment from an integrated perspective.

Does an Adapted Dialectical Behaviour Therapy Skills Training Programme Result in Positive Outcomes for Participants with a Dual Diagnosis? A Mixed Methods Study



Treating severe emotional dysregulation and co-occurring substance misuse is challenging. Dialectical behaviour therapy (DBT) is a comprehensive and evidence-based treatment for borderline personality disorder (BPD). It has been hypothesised that the skills training, which is a facet of the full DBT programme, might be effective for people with severe emotional dysregulation and other co-occurring conditions, but who do not meet the criteria for BPD. However, there is limited research on standalone DBT skills training for people with substance misuse and emotional dysregulation.


A mixed methods study employing an explanatory sequential design was conducted where participants with a dual diagnosis (n = 64) were recruited from a community-based public addiction treatment service in Ireland between March 2015 and January 2018. DBT therapists screened potential participants against the study eligibility criteria. Quantitative self-report measures examining emotion regulation, mindfulness, adaptive and maladaptive coping responses including substance misuse, and qualitative feedback from participants were collected. Quantitative data were summarised by their mean and standard deviation and multilevel linear mixed effects models were used to estimate the mean change from baseline to post-intervention and the 6-month follow-up period. Thematic analysis was used to analyse the qualitative data.


Quantitative results indicated reductions in binge drinking and use of Class A, B and C drug use from pre-intervention (T1) to the 6-month follow-up (T3). Additionally, significant improvements were noted for mindfulness practice and DBT skills use from T1 to T3 (p < 0.001). There were also significant reductions in dysfunctional coping and emotional dysregulation from T1 to T3 (p < 0.001). Significant differences were identified from pre to post intervention in reported substance use, p = 0.002. However, there were no significant differences between pre-intervention and 6-month follow up reports of substance use or at post-intervention to 6 month follow up. Qualitative findings indicated three superordinate themes in relation to participants’ experiences of a DBT skills training programme, adapted from standard DBT: (1) new lease of life; (2) need for continued formal aftercare and (3) programme improvements. Participants described reductions in substance misuse, while having increased confidence to use the DBT skills they had learned in the programme to deal with difficult emotions and life stressors.


This DBT skills training programme, adapted from standard DBT, showed positive results for participants and appears effective in treating people with co-occurring disorders. Qualitative results of this mixed methods study corroborate the quantitative results indicating that the experiences of participants have been positive. The study indicates that a DBT skills programme may provide a useful therapeutic approach to managing co-occurring symptoms.

The Link between Childhood Trauma and Dissociation in Frequent Users of Psychedelics and Dissociatives

Research suggests clear associations between the severity of childhood trauma, levels of substance use and dissociation - the detachment or disruption to normal consciousness. Despite the apparent link, it remains unclear whether the level of substance use can, in some part, explain the relationship between trauma severity and the extent of dissociation.

A recent study, published in the Journal of Substance Use, has investigated whether substance use significantly influences the link between childhood trauma and the severity of depersonalization - a common symptom of dissociation involving changes in perception and emotion processing.

Participants completed online questionnaires that collected information about childhood abuse, depersonalization severity and substance use.

Results found that

  • Dissociation severity, in the form of depersonalization, is predicted by both the severity of childhood trauma and the use of illicit substances.
  • The link between traumatic childhood experiences and dissociation was not, however, moderated by the quantity of classic psychedelics or dissociatives used by participants.
  • Differences in dissociation severity were explained more by childhood trauma than substance use.

Overall the study adds further evidence to support the link between childhood trauma and dissociation. The researchers suggest that it may be the context of substance use rather than the quantity of substance use that influence severity dissociation.

Implementing Effective Systems of Care for Children, Youth, and Transition-Aged Youth with or At-Risk of SED in Rural Communities

Event Date
United States

Tuesday, August 6, 2019 3:00:00 PM EDT - 4:30:00 PM EDT (Washington DC time)


To register, please visit:

In 2017, 4.5% (11.2 million) of Americans 18 years or older had a serious mental illness (SMI), and it is estimated that 6.8 to 11.5 percent of children and youth have a serious emotional disturbance (SED). To address this challenge, SAMHSA has included in the FY2019 – FY2023 Strategic Plan a goal to “Reduce the impact of SMI and SED and improve treatment and recovery support services through the implementation of the comprehensive set of recommendations put forward by the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC).”

On Tuesday, August 6, 2019, from 3:00 pm to 4:30 pm Eastern Time, a SAMHSA-sponsored webinar developed under a contract by the National Association of State Mental Health Program Directors (NAMHPD) and National Federation of Families for Children’s Mental Health, will take place. During the webinar, the panelists will discuss the challenges, successes, and lessons learned from their experiences in the implementation of effective rural Systems of Care. The discussion will include research findings related to engaging students and families in rural educational settings, cultural considerations, and strategies for engaging youth in remote communities. Presenters will offer insights and recommendations of interest to those who are currently involved in this work and for those who are contemplating the implementation of a rural System of Care. This webinar will be of interest to all audiences.

SAMHSA has a rich history of funding Systems of Care across the country. Implementation of these systems in rural communities is often challenging, in part due to factors such as culture and geography. These challenges require that implementers be well-grounded in community dynamics and demographics and that creative solutions be brought to the design of the framework for successful, rural systems.


  • Kurt Michaels, Ph.D., Professor of Psychology, Appalachian State University
  • Hannah Soundrarajan, B.S., Youth Engagement Coordinator, Minnesota System of Care
  • Brenda Donaldson, M.S., Family and Youth Engagement Program Manager, Tennessee System of Care, TN Department of Mental Health and Substance Abuse Services
  • Julie Smith, M.S., Child and Youth Care Coordinator, System of Care Across Tennessee (SOCAT)


  • Lynda Gargan, Ph.D., Executive Director, National Federation of Families for Children’s Mental Health

To register, please CLICK HERE

When in the seminar room, the Adobe Connect Log-in screen appears:

  1. Select "Enter as a Guest"
  2. Enter your name and state in the “Name” field (Ex. Jane Doe-AK)
  3. Click on "Enter Room"

For attendees, this is a “listen only” webinar. Should you need to dial in, the instructions are on the note pad in the seminar room.

If you dial in, please ensure that your computer speakers are turned off so that there is no audio feedback. Note: If you are only able to join the audio portion, then you will not be able to see the webinar presentation. We highly recommend that you test your connection to Adobe Connect in advance of the webinar to ensure access. You may need to work with your state’s IT Department to resolve any firewall issues. To test your connection, please go to: You may be prompted to install ActiveX control, Adobe Flash Player, and Adobe Connect add-ins. If you encounter any difficulty testing your connection or logging into the webinar, please contact Technical Support by calling 1-800-459-5680.

If you have any questions please contact Kelle Masten via email at kelle [dot] masten [at] nasmhpd [dot] org or at 703-682-5187.

Please note that c losed-captioning is available for this webinar.

CEU credits will not be offered. However, letters of attendance are offered upon request.

Event Language


Youth Substance Abuse and Co-Occurring Disorders

70%–80% of adolescents with a substance use disorder also manifest comorbid psychopathology, known also as co-occurring disorders or dual diagnosis. Co-occurring disorders are the presence of one or more comorbid psychiatric disorders in addition to a substance use disorder.

These comorbidities can greatly complicate assessment and treatment, and this book provides clinicians with not only the theory behind the various approaches to substance use disorder but also the practical knowledge that is essential to understand and treat psychiatric comorbidity in these adolescents.

Some of the most prominent investigators in the field have contributed scholarly chapters to the volume, which offers a multitude of useful features:

  • An extensive examination of the cause of a substance use disorder, focusing on whether psychopathology may precede a substance use disorder, as in the majority of cases, develop as a consequence of preexisting a substance use disorder, or originate from a common vulnerability;
  • Consistent emphasis on future directions in clinical research and treatment advancement, which helps the reader identify critical gaps in understanding the relationship between a substance use disorder and psychiatric comorbidity among youth
  • Thorough, state-of-the-art chapters on the developmental pathways and relationships between substance use and co-occurring psychiatric disorders, screening tools and interventions, and the full range of co-occurring disorders make the book ideal for instructional use
  • Information on risk factors for the development of a substance use disorder in adolescence, including psychiatric disorders in childhood such as disruptive behaviour disorders, mood, anxiety disorders, etc.

Clinically useful and scientifically rigorous, Youth Substance Abuse and Co-occurring Disorders should stimulate further discussion and advancement of the field, ultimately resulting in improved and more effective services and intervention modalities for these youth.

Implementation of the Mental Health Gap Action Programme (mhGAP) within the Fijian Healthcare System: A Mixed-Methods Evaluation



To facilitate decentralisation and scale-up of mental health services, Fiji’s Ministry of Health and Medical Services committed to implementing the World Health Organization’s mental health Gap Action Programme (mhGAP). mhGAP training has been prolific; however, it remains unclear, beyond this, how successfully Fiji’s national mental health program has been implemented. We aim to evaluate Fiji’s mental health program to inform Fiji’s national mental health program and to develop an evidence-base for best practice.


The study design was guided by the National Implementation Research Network and adhered to the Consolidated Framework for Implementation Research. CFIR constructs were selected to reflect the objectives of this study and were adapted where contextually necessary. A mixed-methods design utilised a series of instruments designed to collect data from healthworkers who had undertaken mhGAP training, senior management staff, health facilities and administrative data.


A total of 66 participants were included in this study. Positive findings include that mhGAP was considered valuable and easy to use, and that health workers who deliver mental health services had a reasonable level of knowledge and willingness to change. Identified weaknesses and opportunities for implementation and system strengthening included the need for improved planning and leadership.


This evaluation has unpacked the various implementation processes associated with mhGAP and has simultaneously identified targets for change within the broader mental health system. Notably, the creation of an enabling context is crucial. If Fiji acts upon the findings of this evaluation, it has the opportunity to not only develop effective mental health services in Fiji but to be a role model for other countries in how to successfully implement mhGAP.

Atención de las Urgencias en Salud Mental

Esta publicación forma parte de la serie “Recomendaciones para la Red Integrada de Salud Mental con base en la Comunidad”, y tiene como objetivo acercar sugerencias y recomendaciones como herramientas de trabajo que orienten a la asistencia de las personas que refieran o presenten un padecimiento mental (incluyendo consumo problemático de sustancias y/o adicciones), sin ningún tipo de menoscabo o discriminación en toda institución de salud y en la zona o ámbito comunitario de atención de dicha institución. Se halla enmarcado en la Convención de los Derechos de las Personas con Discapacidad y la Ley Nacional de Salud Mental N°26.657, su decreto reglamentario N°603/2013, entendiendo que la atención de la Salud Mental no debe llevarse a cabo en instituciones monovalentes, sino en el ámbito más cercano a la comunidad de la persona que la requiere. Estas Recomendaciones incluyen sugerencias para la práctica clínica, como también herramientas básicas a los equipos de salud para atender y dar respuesta a las urgencias en salud mental.

Applications open: 2019 Neuroscience, Mental Health and Addiction Collaborative Research Seed Funding

Applications are now open for the 2019 round of UNSW Medicine Neuroscience, Mental Health and Addiction Theme and SPHERE Clinical Academic Group (CAG) Collaborative Research Seed Funding.

The UNSW Medicine Neuroscience, Mental Health and Addiction Theme and SPHERE CAG aims to address the burdens imposed by neurological, mental health, and drug and alcohol disorders. It constitutes a network of internationally recognised researchers and clinicians leading in the understanding and treatment of complex clinical conditions with physical, behavioural, mental and social dimensions across the lifespan.

In the 2019 funding round, Neuroscience, Mental Health and Addiction will seek to award eight research proposals, two from each sub-theme:

  • Children and Adolescent Wellbeing
  • Complex and Difficult to Treat Diseases
  • Healthy Ageing
  • Brain Sciences and Translational Neuroscience
Jose Luis Vazquez Martinez

Participación de la Dra. Nayeli Páez Martínez en el Seminario: “La epidemia de Enfermedades Crónicas no Transmisibles en México

Alcohol and NCDs – Harm and Solutions: Factsheet

IOGT International has released a new factsheet to illustrate how alcohol fuels the global NCDs tsunami – based on the latest scientific evidence – and to outline cost-effective solutions for change.

The factsheet includes information about the links between alcohol and cancer, cardiovascular disease, digestive problems, diabetes and mental health. The resource also highlights measures that can be implemented to reduce the harm caused by alcohol.