Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con un trastorno de ansiedad y un diagnóstico comórbido de trastorno por uso de sustancias

  1. Pilar A. Sáiz
  2. Gerardo Flórez
  3. Manuel Arrojo
  4. Miquel Bernardo
  5. Ana González Pinto
  6. José Manuel Goikolea
  7. Iñaki Zorrilla
  8. Ruth Cunill
  9. Xavier Castells
  10. Elisardo Becoña
  11. Ana López
  12. Marta Torrens
  13. Francina Fonseca
  14. Judit Tirado-Muñoz
  15. Belén Arranz
  16. Marina Garriga
  17. Luis San
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Ano de publicación: 2022

Volume: 34

Número: 2

Páxinas: 157-167

Tipo: Artigo

Outras publicacións en: Adicciones: Revista de socidrogalcohol


This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid anxiety disorders and SUDs while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus anxiety symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Clinical trials are only available for posttraumatic stress disorder (PTSD) and for social anxiety. Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram). Our results suggest that 1) we can (weakly) recommend the use of desipramine over paroxetine to alleviate symptoms of anxiety in patients with a PTSD and alcohol use; 2) In these patients, the use of naltrexone to reduce symptoms of anxiety is also recommended (weak strength); and 3) SSRI antidepressants vs placebo can be recommended to reduce alcohol use (weak recommendation). Our review highlights the need for more research in this area and for larger, multisite studies with generalizable samples to provide more definite guidance for clinical practice.

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