Treating anxiety disorders in the context of concurrent substance misuse

Decades of research have established that substance use disorders are far more common among those with anxiety disorders than can be explained by chance alone (see Stewart & Conrod, 2008a). Thus, it is the clinical reality for therapists working with anxiety disorder patients that they will encounter some patients who not only are dealing with a clinically signicant anxiety disorder but are also suffering from substance abuse or dependence. On the surface, such anxiety patients can appear to be quite “treatment resistant, " as concurrent substance use disorders (SUDs) are known to interfere with the efcacy of anxiety disorders treatment (e.g., Bruce et al., 2005). As will be evident throughout this chapter, substance misuse can be a part of the avoidance response prole typical of anxiety disorder patients, and substance abuse may, in some cases, serve as a safety behavior. Avoidance responses and safety behaviors are well.