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焦虑障碍合并物质使用障碍的治疗

Authors
Sudie E Back, PhD
Megan M Moran-Santa Maria, PhD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD
Translators
杜江, 副主任医师

引言

焦虑障碍和物质使用障碍(substance use disorder, SUD)通常同时存在[1-3]。两者间的联系是多方面的。焦虑障碍可能增加发生SUD的风险，并且可能改变SUD的表现和治疗结局。同样，SUD也可能改变焦虑障碍的表现和治疗结局。

这些共病的复杂性强调了全面理解每种障碍的症状、恰当的诊断和使用有效的治疗方法，以及考虑可能有毒性的药物间相互作用、药物滥用倾向和患者依从性的重要性。

本专题将总结焦虑障碍合并SUD的治疗。焦虑障碍合并SUD的流行病学、发病机制、临床表现、病程和诊断将单独介绍。单独、无共病的各种焦虑障碍的治疗将单独介绍。单独、无共病的各种SUD的治疗也将单独介绍。。 (参见“强迫症的药物治疗”和“成人强迫症的心理治疗”和“惊恐障碍的药物治疗”和“惊恐障碍的心理治疗”和“广泛性焦虑障碍的药物治疗”和“成人社交焦虑障碍的药物治疗”和“成人创伤后应激障碍的药物治疗”和“成人创伤后应激障碍的心理治疗”和“阿片类物质使用障碍的药物治疗”和“大麻使用障碍：治疗、预后及远期药理效应”和“酒精使用障碍的药物治疗”和“酒精使用障碍的心理社会治疗”和“Brief intervention for unhealthy alcohol and other drug use”和“成人可卡因使用障碍：流行病学、药理学、临床表现、医疗后果和诊断”)

概述

临床试验已确定了能有效治疗单独的无共病焦虑障碍和单独的无共病SUD的药物和心理治疗方法。然而，临床试验证据(见下文)通常不足以确定这些干预措施在治疗焦虑障碍合并SUD中的有效性。

治疗SUD而不处理焦虑障碍，可能使患者在面对焦虑症状时易出现复发。治疗焦虑障碍而不处理并监测SUD，将可能导致治疗无效。焦虑症状可能作为复发的诱发因素，而破坏治疗结局。SUD患者需要学会在不滥用物质的情况下来处理和/或接受焦虑症状的技巧。例如，在酒精或药物的影响下完成暴露疗法或其他引发焦虑的家庭作业的惊恐障碍患者，将不会在其做任务期间出现焦虑情绪的升高或下降，也不会学习到他们能够在不使用酒精或药物时承受焦虑情绪。

                                    

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-26.
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