Although more randomized controlled trials of integrative treatments are needed, the studies to date clearly demonstrate that for the majority of alcohol-dependent patients with trauma/PTSD, the inclusion of trauma interventions confers substantial therapeutic benefits. Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are highly prevalent and debilitating psychiatric conditions that commonly co-occur. Individuals with comorbid AUD and PTSD incur heightened risk for other psychiatric problems (e.g., depression and anxiety), impaired vocational and social functioning, and poor treatment outcomes. This review describes evidence-supported behavioral interventions for treating AUD alone, PTSD alone, and comorbid AUD and PTSD. Evidence-based behavioral interventions for AUD include relapse prevention, contingency management, motivational enhancement, couples therapy, 12-step facilitation, community reinforcement, and mindfulness.
- Post-traumatic stress disorder is a serious mental health condition triggered by traumatic events.
- There was a significant difference in completion rate between medication groups, such that the desipramine-treated individuals had better retention than the paroxetine-treated participants (65.2% vs 36.5%) and there was significantly better medication compliance with desipramine compared to paroxetine.
- In addition to the incorporation of prolonged exposure therapy into residential SUD treatment, two integrated treatments that incorporate exposure-based techniques have been tested among individuals with PTSD and SUDs.
- Some may indulge in a nightly glass of wine but find it challenging to stop at one.
For this reason, it is important to evaluate both risk for exposure as well as risk for a disorder among those exposed. Studies show that the relationship between PTSD and alcohol use problems can start with either issue. For example, people with PTSD have more problems with alcohol both before and after they develop PTSD. Also, drinking problems put people at risk for traumatic events that could lead to PTSD.
Treating both PTSD and SUD
Although benzodiazepines are effective in providing immediate relief of anxiety symptoms, they are generally not considered a first-line treatment for patients with alcohol dependence given the abuse potential of benzodiazepines. During the initial phase of treatment, when latency of onset of antidepressants is an issue, benzodiazepines may be considered as adjunctive medication. The amount of benzodiazepines prescribed to the patient should be limited, and the patient should be closely monitored for relapse or nonmedical use of benzodiazepines or other medications. In a larger national multisite community study, SS was compared to a women’s health education (WHE) control group (Hien et al., 2009).
What Are Common Causes of PTSD?
In addition, the study did not assess other potential comorbid psychiatric conditions. It is possible that our findings may be a reflection of other underlying conditions such as depression. Also, given the overrepresentation of low income participants and ethnic minorities, it is unclear whether the composition of the sample may reflect a sampling bias.
Numerous assessment tools have been developed and investigated for PTSD and SUDs, many of which are beyond the scope of this review. Thus, the following sections on assessment focus on the most common and empirically-supported measures relevant to diagnostics, treatment planning, and treatment monitoring for comorbid PTSD and SUDs. Elevated rates of comorbid depressive and anxiety disorders in patients with PTSD greatly complicate any effort to develop writing a goodbye letter to addiction a model of the relationship between PTSD and substance use. High rates of comorbidity suggest that PTSD and substance use disorders are functionally related to one another. Two primary pathways have been described to explain these high rates of comorbidity. To sustain their habit, some substance abusers repetitively place themselves in dangerous situations and, as a result, experience high levels of physical and psychological trauma (5).
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Naltrexone was effective in decreasing craving in those studies that evaluated it (Foa et al. 2013, Petrakis et al. 2012). Topiramate was promising as it was effective in decreasing alcohol use, but thus far has only been evaluated for comorbidity in one small study. Finally, individual preference is a critical consideration when matching people with treatment modalities. Soldiers with PTSD who experienced at least one symptom of AUD may be disinhibited in a way that leads them to make risky decisions, including the potential for aggression or violence. One study conducted with veterans of the wars in Iraq and Afghanistan demonstrated a link between PTSD and AUD symptoms and nonphysical aggression.42 Veterans with milder PTSD symptoms who misused alcohol were more likely to perpetrate nonphysical aggression than veterans who did not misuse alcohol.
A recent study (Petrakis, Rosenheck, & Desai, 2011) using national administrative data from the Department of Veterans Affairs indicated that, among Veterans who had served in Vietnam era or later, almost half (41.4%) with an SUD were dually diagnosed with PTSD. Our study adds to the growing research literature documenting relationships between PTSD and health outcomes (Schnurr and Green 2004; Trief et al. 2006). Our research suggests that PTSD has a unique impact on health concerns in recently battered women, even after controlling for acute injury and length of the use and taking into consideration the potential moderating role of alcohol use.
Integrated Behavioral Treatments
There are several general issues to consider when treating co-occurring alcohol dependence and trauma/PTSD. When pharmacological agents are used, treatment should generally follow routine clinical practice for the treatment of PTSD. Regardless, relapse is common, and it is critical to consider the potential toxic interactions that may occur between the prescribed medication and alcohol. Given the high co-occurrence of alcohol and illicit drug use, potential toxic interactions between the prescribed medication and other substances of abuse must also be addressed. The pharmacological agent with the least abuse liability potential should be chosen for this population.
We expected a significant interaction wherein the protective effects of light, less frequent alcohol use would be present, but only for those women without PTSD. In those women with PTSD, we expected to find increased health concerns, even with lower amounts of alcohol use. Couple treatment for AUD and PTSD (CTAP) is a 15-session manualguided (also known as “manualized”) therapy that integrates behavioral couples therapy for AUD with cognitive behavioral conjoint therapy for PTSD.48 In an uncontrolled trial, 13 male veterans and their female partners enrolled, and 9 couples completed the CTAP program.
In an open pilot trial among 46 male Vietnam Veterans participating in a partial hospitalization program, Transcend participants demonstrated significant improvement from baseline with respect to PTSD symptoms at post-treatment, 6, and 12 month follow-up. Transcend participants also experienced improvements in SUD symptoms, including decreased alcohol consumption, decreased polysubstance drug use, and decreased episodes of drinking to intoxication. Although these findings are promising, they remain preliminary, as Transcend has yet to be evaluated in a randomized controlled trial. Research also documents high rates of comorbid PTSD/SUD among Veterans (Centers for Disease Control and Prevention, 1988; Shipherd, Stafford, & Tanner, 2005).
The first study by Stein and colleagues (2017) reports on alcohol misuse and AUD prior to enlistment in the Army, and highlights the strong association between prior AUD and subsequent development of PTSD among newly enlisted soldiers. The second study is a laboratory study (Ralevski et al., 2016) among military veterans with AUD and PTSD. It is among the first studies to examine the effects of trauma cues and stress (non-trauma) cues on alcohol craving, mood, physiological and neuroendocrine responses, and demonstrates the powerful effects of trauma cues on alcohol craving and consumption.
Assisting PTSD alcoholic family members may be especially difficult because people aren’t labels, they’re just a loved one struggling with an alcohol addiction. However, one of the greatest predictors of positive treatment outcomes is social support. Making a loved one feel supported and understood can increase the likelihood of effective treatment.
One of the studies reviewed was based on sub-group secondary analyses that were not the study’s original focus (Petrakis et al. 2006) and another was a 4-week inpatient study in which PTSD symptoms, but not alcohol consumption, were evaluated (Kwako et al. 2015). Given the paucity of studies we opted to include the latter two studies in this review (See Table 1). The results of these two studies do not significantly alter the conclusions/recommendations except to help suggest future research directions. How different are the outcomes of the disorders when one or the other develops first? Are there particular traumatic experiences that provide some resilience against developing AUD?
Although intoxication and withdrawal symptoms vary across abused substances, all substance use disorders share key features. They include a maladaptive pattern of substance use leading to failure to fulfill work, school, or home obligations; legal problems; and are you an enabler substance-related interpersonal problems. Substance dependence further includes tolerance, withdrawal symptoms upon cessation of use, unsuccessful efforts to control use, and continued use despite persistent substance-related physical or psychological problems.
Behavioral Treatments for AUD
They meticulously evaluate and review all medical content before publication to ensure it is medically accurate and aligned with current discussions and research developments in mental health. Medication might also be part of the treatment regimen for PTSD and alcohol use disorder. For example, the Food and Drug Administration (FDA) has approved three drugs – disulfiram, naltrexone, and acamprosate – to treat alcohol use disorders. Traumatic or stressful events trigger the release of endorphins, which are neurotransmitters that assist why do i bruise so easily in reducing stress and pain.[4] However, when the traumatic or stressful event subsides, the increased levels of endorphins also begin to decline. People with PTSD sometimes turn to alcohol to replace the lower level of endorphins. Of the two studies evaluating prazosin, one suggested that prazosin was effective in decreasing alcohol use (Simpson et al. 2015) and the other did not (Petrakis et al. 2016); however, the latter was limited by a potential confound of sober housing which may have overwhelmed any medication effect.