Overall Comments on Psychosocial Interventions

As a general principle comorbid mental disorders should be treated according to the clinical practice guidelines for those specific disorders. Care should be coordinated and integrated, but little evidence supports use of specific packages that integrate the content of psychological interventions.  There are notable exceptions (e.g. comorbid PTSD & alcohol) to this which are covered below. 

Some considerations are: 

  • Where possible the same health professional should provide treatment for both alcohol use and comorbid disorders and if not;
  • Any combination of specific techniques should be coordinated.

It may be that, among people who are severely alcohol dependent, a focus on comorbid mental disorders may divert attention from the crucial immediate task of reducing alcohol consumption early in treatment and hence interfere with longer term outcome.  There is an alternative view that that engaging people with treatment for their comorbid disorder might be a way to get some initial gains, build momentum and rapport that then orients the person to be ready to work on the alcohol use disorder.   

As a general rule when people are learning new ways to manage distress and emotions, they often experience greater distress and stronger emotions. Particularly when they are trying not to cope by drinking, it is likely that they will feel worse in the short term.  Psychoeducation about the likely experiences of abstinence or reduced drinking is an important part of any intervention. 

Specific psychological interventions that have strong empirical support for treating mental disorders uncomplicated by comorbidity are cognitive behavioural therapy, behaviour therapy, cognitive therapy, and interpersonal therapy. Other psychotherapies may be effective but there is generally insufficient evidence to recommend their use. 

Chapter Recommendation Grade of recommendation
21.16 Provide psychoeducation about the nature and prevalence of comorbid mental disorders in alcohol use disorders and the likelihood of improvement with abstinence or significant reductions in alcohol use GPP