Symptom Improvement in Co-Occurring PTSD and Alcohol Dependence

Medical University of South Carolina, Department of Psychiatry, Charleston, South Carolina 29425, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 10/2006; 194(9):690-6. DOI: 10.1097/01.nmd.0000235794.12794.8a
Source: PubMed


This study investigated the temporal course of improvement in PTSD and alcohol dependence symptoms among individuals participating in a 12-week outpatient treatment study. Participants were 94 individuals with comorbid PTSD and alcohol dependence enrolled in a double-blind, placebo-controlled medication trial. Outcome measures included PTSD symptoms (as measured by the Clinician Administered PTSD Scale, Impact of Events Scale, and Civilian Mississippi Scale for PTSD) and alcohol use severity (as measured by the Time Line Follow Back). Study completion rates were significantly higher for individuals who demonstrated improvement in both disorders. Improvements in PTSD had a greater impact on improvement in alcohol dependence symptoms than the reciprocal relationship. Improvement in hyperarousal PTSD symptoms, in particular, was related to substantially improved alcohol use. Examination of the temporal course of symptom improvement revealed that alcohol symptoms tended to start improving either before or in conjunction with PTSD symptoms. Although preliminary in nature, these findings suggest that co-occurring PTSD symptoms may have a strong impact on alcohol dependence treatment outcome, and that PTSD treatment may be important to optimizing outcomes for patients with comorbid PTSD and alcohol dependence.

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Available from: Sudie E Back, Apr 22, 2014
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    • "Thus, integrated treatments should target first on the alleviation of PTSD (avoidance) symptoms, which will help to improve the problematic use of alcohol and/or substances even prior to specific addiction treatment rather than vice versa (Back, Brady, Sonne, & Verduin, 2006). This, however, is still somewhat problematic since patients are mostly required to be abstinent before dealing with their traumatic experiences (Back et al., 2006). "
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    ABSTRACT: This study examined the role of posttraumatic stress disorder (PTSD) symptoms of re-experience, avoidance, and hyperarousal in the relationship between different types of trauma and alcohol use disorders (AUD). We used data from 731 trauma-exposed individuals who participated in the first wave of the PsyCoLaus-study. Trauma characteristics were assessed relatively to the occurrence of lifetime PTSD symptoms and AUD. The results suggest that lifetime and childhood sexual abuse as well as overall childhood trauma were directly linked to AUD and PTSD symptoms, in particular to avoidance symptoms. From single symptom clusters PTSD avoidance was found to specifically mediate the trauma-AUD pathway. Both childhood and sexual trauma strongly contribute to the comorbidity of PTSD and AUD and avoidance-type symptoms appear to play a central role in maintaining this association. Hence, the alleviation of avoidance symptoms might be an important target for therapeutic intervention among victims of sexual abuse before specific addiction treatment is initiated. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Aug 2015 · Child abuse & neglect
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    • "They found that additional therapy for anxiety significantly reduced anxiety symptoms and avoidance behavior but did not affect alcohol relapse rates. With regard to post-traumatic stress disorder (PTSD), while reductions in alcohol consumption have reportedly mediated PTSD responsiveness [17], early improvement in PTSD symptoms appears to have a greater impact on improvement in alcohol dependence than the reciprocal relationship, which has prompted recommendations for integrated treatment [18]. To this degree, Mills et al. [19] examined integrated prolonged exposure treatment versus usual care for comorbid PTSD and substance dependence and observed a reduction in PTSD severity but no group differences in changes to substance use, depression, or anxiety. "
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    ABSTRACT: A major barrier to successful treatment in alcohol dependence is psychiatric comorbidity. During treatment, the time to relapse is shorter, the drop-out rate is increased, and long-term alcohol consumption is greater for those with comorbid major depression or anxiety disorder than those with an alcohol use disorder with no comorbid mental disorder. The treatment of alcohol dependence and psychological disorders is often the responsibility of different services, and this can hinder the treatment process. Accordingly, there is a need for an effective integrated treatment for alcohol dependence and comorbid anxiety and/or depression. We aim to assess the effectiveness of a specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting. Following a three-week stabilization period (abstinence or significantly reduced consumption), participants will undergo complete formal assessment for anxiety and depression. Those patients with a diagnosis of an anxiety and/or depressive disorder will be randomized to either 1) integrated intervention (cognitive behavioral therapy) for alcohol, anxiety, and/or depression; or 2) usual counseling care for alcohol problems. Patients will then be followed up at weeks 12, 16, and 24. The primary outcome measure is alcohol consumption (total abstinence, time to lapse, and time to relapse). Secondary outcome measures include changes in alcohol dependence severity, depression, or anxiety symptoms and changes in clinician-rated severity of anxiety and depression. The study findings will have potential implications for clinical practice by evaluating the implementation of specialized integrated treatment for comorbid anxiety and/or depression in an alcohol outpatient service.Trial registration: Identifier: NCT01941693.
    Full-text · Article · Nov 2013 · Addiction science & clinical practice
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    • "In a controlled study evaluating a concurrent PTSD and SUD treatment, Mills et al. (2012) found that individuals with PTSD and SUDs who received substance use treatment as usual with an added exposure component reduced their PTSD symptoms at nine-month follow-up to a significantly greater degree than those receiving only treatment as usual. Promising effects of combined treatments have been found among individuals who report alcohol misuse (e.g., Back, Dansky, Carroll, Foa, & Brady, 2001; Back et al., 2006, 2012; Hien, Campbell, Ruglass, Hu, & Killeen, 2010; McGovern et al., 2009; Zlotnick, Najavits, Rohsenow, & Johnson, 2003). However, the majority of the integrated treatment research has consisted of uncontrolled studies, pilot studies, and case studies. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUD) frequently present comorbidly in veteran populations. Traditionally those with alcohol dependence have been excluded from PTSD treatment outcome studies, thus we do not know how those with alcohol dependence may tolerate or respond to PTSD-specific interventions; no studies to date have examined the extent to which cognitive PTSD interventions are tolerated or effective for those with comorbid PTSD/AUD. The present study examines the extent to which CPT is tolerated by and effective in treating PTSD symptoms for veterans with PTSD and AUD, as compared to veterans with PTSD only in an outpatient treatment setting. Data were obtained through chart review of 536 veterans diagnosed with PTSD who had received at least 1 session of CPT at a Midwestern US Veterans Affairs hospital. Nearly half (n=264, 49.3%) of the veterans in the study exhibited a current or past AUD diagnosis. Participants were grouped into the following diagnostic groups: current AUD (past 12months), past AUD (prior to 12months), and no AUD. Participants completed an average of 9 sessions of CPT with no significant difference between AUD diagnostic groups on the number of CPT sessions completed. Individuals with past AUD had higher initial symptoms of self-reported PTSD symptoms than those with no AUD. All groups reported significant reductions in PTSD symptoms and depression over time. Overall, the results suggest that CPT appears well tolerated among veterans with comorbid AUD and is associated with significant reductions in symptoms of PTSD and depression in an outpatient treatment setting.
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