It is recommended that all trials report on participants who complete the entire treatment protocol. 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. Initial and ongoing assessment is critical to understanding the needs and progress of Veterans with PTSD and SUD. Measurement based care (MBC; 29) or the use of patient-reported information collected as part of routine care, can be used to inform clinical care and shared decision making, individualize treatment, and assess progress toward recovery goals.
Additional analyses
Primary outcomes were substance use, PTSD severity, and retention, of which all were favorable for patients receiving the CBT for PTSD. 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 ptsd and alcohol abuse 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. Evidence-based PTSD interventions include prolonged exposure therapy, cognitive processing therapy, eye movement desensitization and reprocessing, psychotherapy incorporating narrative exposure, and present-centered therapy.
- Therapists delivering the interventions in all for studies were experienced and carefully selected research clinicians with at least masters’ level degrees and most with doctorates.
- Moreover, it is also recommended to have separate models for men and women to prevent bias and incorrect trajectory assignment for the underrepresented group (in this case women).
- SDPT, CTPCD and SS were developed as stand alone therapies and recruited subjects via newspaper advertisements and postings.
Couples therapy
Treatment is halted when a participant decides to stop or when the end of the timeframe is reached. In summary, although prior studies indicated PE is an effective PTSD treatment for patients with co-occurring PTSD and SUD, effects were small and treatment drop-out rates were high. EMDR and ImRs are other promising treatment options for PTSD, that have not yet been examined in this difficult to treat patient group.
Recognizing the Signs of Alcohol Abuse in Individuals with PTSD
As discussed in the papers presented in this virtual issue, this includes members of racial and ethnic communities as well as military service members and veterans. Data from the Werner et al., (2017) paper suggest that the existing etiological models of AUD development, as well as risk and protective factors, may be different based on racial/ethnic background. A better understanding of AUD etiology among racial/ethnic minority individuals is an important and necessary next step in the development of effective interventions. Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) are both first line treatments for PTSD that have been studied extensively and shown to be effective treatments for reducing PTSD symptoms 8, also in patients with severe co-occurring disorders such as psychotic disorders 9. Unfortunately, despite the high prevalence, patients in treatment for SUD are often excluded from randomized controlled trials (RCTs) evaluating PTSD treatments 10.
- Yet, although gender and/or sex have been included as prognostic features, only few studies investigated differential prognostic value of risk and protective factors for later PTSD outcomes between men and women (e.g., 36, 43,44,45).
- The differing theories behind sequential versus integrated treatment of comorbid AUD and PTSD are presented, as is evidence supporting the use of integrated treatment models.
- No therapy courses or therapists were disqualified on the basis of poor adherence or lack of competence.
- This is the first study to perform external validation of machine learning prognostic models (full and minimal feature sets) based on self-report data in a broad recently trauma-exposed adults, for men and women separately.
- Under the guidance of Charles R. Marmar, MD, center director, our researchers use advanced and novel computational methods, biomarker analysis, and imaging approaches to further their knowledge.
- The effect of timing of PTSD treatment on the primary outcome will be evaluated (simultaneous vs sequential) with (G)LMMs.
- Although substance use is not an official symptom of PTSD, about 59% of people diagnosed with PTSD develop issues with substance use and dependence.
- We found no significant t-test differences on baseline demographic or clinical characteristics (PTSD and substance use severity) between the two groups.
- Alcohol use disorder affects about a third of individuals in the United States at some point in their lives.
- Researchers are evaluating the safety of extended daily cannabidiol, assessing the impact of cannabidiol on neuropsychological domains implicated in alcohol use disorder, and generating preliminary data on the impact of cannabidiol on alcohol consumption.
- Each VA medical center has an SUD-PTSD Specialist who is trained to treat both conditions.
To limit this possibility, only disclosure of the timing will be given after randomization and disclosure of the treatment type will be done at the start of their first session of PTSD treatment, so that the therapist can motivate the patient for this kind of treatment. Another limitation is that the power might be too low to detect small differences in effectiveness between types of PTSD treatment. Finally, due to the COVID-19 outbreak, temporarily adjustments in both treatment as well as measurements had to be made. Besides effects of these changes on measurements, there is possibly also a general effect of COVID-19 and the lockdown measures on the well-being of the participants. Therefore, at measurements during this period, it may be difficult to distinguish effects of treatment changes from general effects of this period. Due to the COVID-19 outbreak in March 2020, the Jellinek treatment centers were entirely closed for new treatments for 6 weeks.
The Epidemiology of Post-Traumatic Stress Disorder and Alcohol Use Disorder
The self-report questionnaires that are administered are described in the following section and listed in Table 1. Alongside PE, EMDR or ImRs, all study participants receive regular SUD treatment. Standard care for SUD treatment includes both cognitive behavioral therapy (CBT) 46 as well as Acceptance and Commitment Therapy (ACT) 47. Regular outpatient SUD treatment consists of 13 individual 50-min sessions (CBT or ACT) delivered by a psychologist (MSc) or cognitive behavioural therapist https://ecosoberhouse.com/ (BSc or MSc), supervised by a licensed healthcare psychologist. Regular inpatient SUD treatment consists of a 12-week CBT-based therapy program, of which the patient spends the first 6 weeks in the treatment facility receiving 24-h care. Patients in SUD day treatment follow a similar 12-week therapy program, for 3-days a week, 6-h a day.
