Additionally, given some particularly high responses with regards to drinking quantity, it is possible that memory bias also affected reporting of drinking patterns. Alcohol behavioral couple therapy46 and behavioral couples therapy for alcoholism and drug abuse47 are manual-guided (also known as manualized) treatments for AUD that incorporate participation of a significant other or romantic partner. The interventions target relationship skills and skills related to reducing AUD severity. Alcohol behavioral couple therapy uses motivational interviewing techniques and focuses on harm reduction, and behavioral couples therapy for alcoholism and drug abuse emphasizes attaining and maintaining abstinence.
- We expected that coping and enhancement drinking motives would moderate the relationship between PTSD symptomatology and drinking.
- This menu of treatments could be based on biomarkers, demographics, and other patient characteristics, and it could identify promising alternatives if first-line treatments fail.
- For instance, cognitive symptoms such as catastrophizing or negative rumination may explain the weaker association between consumption and problems for those with more severe PTSD, as discussed above.
- Generalized estimating equations (GEE; Hardin & Hilbe, 2003) were used to analyze multilevel models given the nested nature of the data (i.e., daily reports of alcohol consumption and PTSD symptoms were nested within individual).
- Other potential confounds include severity and chronicity of illness, type of trauma experienced, other comorbid diagnoses, concomitant psychotropic medications, and whether additional treatment resources were available (e.g., sober housing, robust addiction counseling services, etc.).
Meta-analytic Approach
- It is clear from this meta-analysis, systematic reviews (Hawn, Cusack et al., 2020), and narrative reviews on self-medication (Turner et al., 2018) that the literature lacks longitudinal studies exploring the temporal relationship between PTSD, coping-related drinking motives, and harmful alcohol use.
- In a small randomized controlled trial comparing prazosin to placebo in individuals with co-occurring alcohol use disorder and PTSD, improvements in drinking outcomes favoring prazosin emerged, but no significant between-groups differences were found with regard to PTSD symptoms 81.
- The THQ was administered via self-report at baseline assessment to assess participants’ experience of possible traumatic events (Hooper et al., 2011).
- Because efficacy may be different in those with comorbid conditions, treatments for multi-morbidities need to be tested empirically.
- Investigators may also want to report on a subgroup of participants who completed the minimum therapeutic dose deemed adequate for that particular treatment, but the minimum dose needs to be based on a strong theoretical rationale, supported by empirical data, and defined a priori.
Thus, we set out to investigate the prevalence of PTSD, and its socio-demographic and AUD-related correlates in a treatment sample of AUD in Nepal. Specifically, we examined the relationship between AUD-PTSD comorbidity and serum levels of CRP, inflammatory cytokines, tryptophan metabolism parameters, and BDNF. Several studies have suggested that coping motives for drinking may mediate the relationship between PTSD and harmful alcohol use across various trauma-exposed populations. Among veterans, coping motives have been shown to mediate the relation between PTSD and alcohol consequences (Miller et al., 2017), hazardous drinking (McDevitt-Murphy et al., 2017), alcohol consumption, frequency of use, and heavy drinking (McCabe et al., 2019). In college student samples, coping motives also mediated the relation between PTSD and risky drinking (Aarstad-Marin & Boyraz, 2017) and between alcohol use and problems (Hawn, Bountress et al., 2020). Additionally, Hawn, Bountress and colleagues (2020) found that a more specific measure of “trauma-related drinking to cope” partially mediated the relation between PTSD and alcohol use problems among college students.
Exposure-Based Treatments for Co-occurring SUD and PTSD
There was at best weak evidence to support the use of medications to treat AUD among those with comorbidity with PTSD. 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. One of the three studies clearly found that sertraline was more effective in decreasing PTSD symptoms than placebo (Hien et al. 2015) while another found a trend-level advantage of sertraline over placebo on PTSD outcomes (Brady). The third study (Petrakis et al. 2012) used an active control (the antidepressant desipramine) and compared it to paroxetine; both antidepressants were equally effective in significantly decreasing PTSD symptoms over time but without a placebo comparison it is difficult to fully interpret these data. Neither of the sertraline studies found the serotonergic antidepressant medications more effective than placebo in decreasing alcohol use outcomes.
Concurrent Within-Person Correlates of Binge Drinking
In the same sample, prolonged exposure was more beneficial for those with non–combat-related traumas and higher baseline PTSD severity.39 Also, naltrexone was most beneficial for those with the longest duration of AUD. Primarily, the present study used an EMA procedure in a large sample of undergraduate students who reported a prior potentially traumatic experience to examine core tenets of three influential models of PTSD and high-risk alcohol use in an at-risk, young adult population. To i) enhance generalizability to undergraduate student populations and ii) characterize fluctuations in symptom severity over time, the present study used a dimensional model of PTSD. Based on the self-medication model, it was hypothesized that participants would report acute intraindividual elevations in PTSD symptom severity during days on which they engaged in high-risk alcohol use (i.e., binge drinking). Based on the susceptibility model, it was hypothesized that binge episodes would predict elevated subsequent psychological distress (e.g., PTSD symptom severity) on the following day.
Other Mental Health Issues
Third, this analysis was limited by the scope of the current literature, which overwhelmingly utilizes cross-sectional data analyses. Though our meta-analysis found that coping-related drinking mediated PTSD-harmful alcohol relationships in both cross-sectional and longitudinal designs, we would be more confident in our findings if we could have included additional longitudinal studies. This is important to note, since the self-medication hypothesis conceptually depends both on the mediating influence of coping motives, and on PTSD preceding harmful alcohol use in time. The inclusion of information on drinking motives in models evaluating the daily relationships between PTSD symptoms and alcohol consumption may clarify why the self-medication and mutual maintenance findings, in particular, have been so mixed. The evaluation of drinking motives may also help identify for whom each of these models are most relevant or may suggest ways that the existing models need to be refined so that they are more accurate and have better clinical applicability. First, to reflect high-risk alcohol use in undergraduate students, the inclusion criteria required prior exposure to a potentially traumatic experience but did not require peritraumatic distress.
- As shown in Model 5, there were significant interactions between PTSD symptom severity and both coping motives and enhancement motives in predicting same-day drinking; social motives and conformity motives did not significantly interact with PTSD severity in predicting same-day drinking.
- This concept challenges the single disease framework used throughout medicine in education, reimbursement, and research (Barnett et al. 2012).
- Up to a third of those who survive traumatic accidents, illness, or disaster report drinking problems.
Product Reviews
Taken together, the papers included in this virtual issue on AUD and PTSD raise important issues regarding best practices for the assessment and treatment of comorbid AUD/PTSD, and highlight areas in need of additional research. First, all patients presenting with AUD should be assessed for trauma exposure and PTSD diagnosis. Data from the Ralevski et al., (2016) paper demonstrate the powerful effects that trauma reminders have on craving and alcohol consumption and, therefore, treatment needs to address both the AUD and PTSD drinking and ptsd symptoms. With regard to behavioral treatments, exposure-based interventions are recommended given the greater improvement in PTSD symptoms observed, coupled with significant reductions in SUD severity experienced.
- This second explanation makes sense in the context of evidence for latent classes of PTSD that differ based upon overall, chronic symptomatology (e.g., Cloitre et al., 2014; Galatzer-Levy, Nickerson, Litz, & Marmar, 2013).
- Another important area for future research is the need to elucidate underlying neurobiological mechanisms of action and moderators of the various integrated and combined interventions.
- Research finds that PTSD and drinking can lead to worse PTSD symptoms, relationship difficulties, other mental health issues, violence, and even suicide or death.
- Topiramate was promising as it was effective in decreasing alcohol use, but thus far has only been evaluated for comorbidity in one small study.
Behavioral Treatments for Comorbid AUD and PTSD
In the larger alcohol literature, motivational models of alcohol use have been helpful in improving our understanding of the reasons individuals may choose to drink alcohol (Cooper, 1994). Studies that compare other outcomes related to treatment retention and symptom improvement, such as sleep, mood symptoms, somatic medical conditions, and safety profiles (including violence and suicidality), would also be helpful. The literature currently lacks studies that examine the association between premorbid functioning and the ability to engage in manual-guided, evidence-supported therapies. Also needed is examination of how adding PTSD-focused treatment to AUD treatment will be feasible in terms of treatment costs, training requirements, and staff workload. Studies examining outcomes of integrated treatments among people with comorbid AUD and PTSD, when compared with people who have PTSD and substance use disorder involving multiple substances, is necessary to identify and target specific alcohol-related treatment needs. Finally, given the heterogeneous nature of AUD120 and the complex etiology, course, and treatment of both AUD and PTSD, studies that examine commonalities underlying effective behavioral treatments are essential.