Concerning Dianne, there were four major related and intertwining issues: her drinking, her depressive mood, her anxious symptoms and marital problems. In addition, Dianne met criteria for both the avoidant personality disorder and the obsessive-compulsive personality disorder.

Many of Dianne's symptoms (such as sleeping difficulties, muscle tension, poor concentration and low self-esteem) could be accounted for by each of the four problem areas discussed above. We decided to focus our attention on Dianne's drinking as a first step. In general - even with severe comorbid conditions - targeting the drinking problem is the treatment of choice. There is no evidence that, if the patient is not able to control his or her alcohol consumption, targeting other pathology cooccurring with alcohol dependence will be effective and should be considered as a first choice for treatment.

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