April 26, 2019
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Exposure therapy more effective for comorbid PTSD, alcohol use disorder

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Image of Sonya B. Norman
Sonya Norman

Integrated prolonged exposure therapy was more effective at reducing PTSD symptoms among veterans with comorbid PTSD and alcohol use disorder than integrated coping skills therapy, according to findings published in JAMA Psychiatry.

“Rates of alcohol problems are very high among people who have PTSD. Yet, we have very little information about how best to treat people who have both PTSD and alcohol use disorder,” Sonya B. Norman, PhD, from the department of psychiatry at University of California, San Diego, and the VA San Diego Healthcare System, told Healio Psychiatry. “We felt it was very important to do research that could give the field guidance on how best to help this patient population recover.”

In this prospective, randomized clinical trial, Norman and colleagues compared the efficacy of integrated prolonged exposure (I-PE) therapy with present-centered integrated coping skills (I-CS) therapy in reducing PTSD symptoms and percentage of heavy drinking days among 119 veterans with comorbid PTSD and alcohol use disorder (AUD). They examined outcomes before treatment, after treatment and at 3- and 6-month follow-ups.

Both treatments were delivered in 90-minute individual sessions for 12 sessions. The I-PE therapy, known as Concurrent Treatment of PTSD and Substance Use Disorder Using Prolonged Exposure, supplemented prolonged exposure with cognitive behavioral relapse prevention skills for substance use disorder in each session. The I-CS therapy, known as Seeking Safety, was a present-focused, PTSD and substance use disorder integrated therapy teaching cognitive behavioral and interpersonal techniques.

Analysis indicated a reduction in PTSD symptoms after both therapies, but there was a significantly greater decrease for I-PE treatment compared with I-CS treatment (Cohen d = 0.41; P = .002). Although the percentage of heavy drinking days decreased among veterans in either therapy, these changes were not statistically different between I-PE and I-CS treatment.

The results also showed that I-PE therapy resulted in higher rates of PTSD remission than I-CS therapy after treatment (22.2% vs. 6.8%; P = .047) and at 3-month follow-up (25% vs. 6.1%; P = .03). At 6-month follow-up assessment, Norman and colleagues observed a slight group difference in favor of I-PE treatment (33.3% vs. 14.7%; P = .08).

“Having an AUD continues to be a barrier to receiving exposure therapy because of therapist perceptions of patients’ fragility (ie, beliefs that patients will not be able to handle trauma-related memories and may have an increase in alcohol use),” the researchers wrote in the full study.

Norman told Healio Psychiatry that clinicians should work with their patients with PTSD to determine whether to try a trauma-focused treatment like prolonged exposure therapy.

“Do not assume your patient is not ready or is not right for this treatment because of alcohol use,” she said. – by Savannah Demko

Disclosure: Norman reports funding from the VA. Please see the study for all other authors’ relevant financial disclosures.