Assessments that followed have used the foundational structure and question format of the DIS to interview participants. They include the CIDI, AUDADIS, and, recently, the Psychiatric Research Interview for Substance alcoholism symptoms and Mental Disorders. In fact, the DIS has continued to be revised based on the DSM and the International Classification of Diseases, making it one of the most durable standardized diagnostic assessments in the field.
Posttraumatic stress disorder, alcohol use, and physical health concerns
- The use of medication to treat SUD and PTSD has largely focused on the treatment of either disorder alone 58.
- Before these developments, sequential treatment was the only form of behavioral intervention employed.
- The study sample was not selected for PTSD, and thus, a limited number of participants were available for subgroup analysis.
- Subjects in this study were 88 outpatients, with PTSD and current AD; they were mostly male (90%) veterans with an average age in their mid-40’s.
- The second study is a laboratory study (Ralevski et al., 2016) among military veterans with AUD and PTSD.
While several theories have been proposed to explain the common co-occurrence of SUD and PTSD, the self-medication theory has received the most empirical support to date 13. This theory posits that individuals with PTSD incur a heightened risk for substance use and developing substance use disorders due to their propensity to drink alcohol or use drugs to mitigate the distressing symptoms and sequelae of PTSD. Support for this theory has been garnered by studies demonstrating that PTSD typically emerges before co-occurring substance use disorders 14, 15 as well as evidence indicating that PTSD symptom management is a primary rationale for substance use among individuals with co-occurring SUD and PTSD 16, 17. Individuals who develop PTSD often experience flashbacks, nightmares, hypervigilance, and emotional numbness.
Mental Health Resources
The nation’s specialized psychiatry and addiction treatment facilities are concentrated in the major cities and serve patients from across the country. Another trial evaluated retention based on participant provision of a urine sample at the end of 12 weeks. Federal approval of the treatment suffered a setback earlier this year, however, when a federal advisory panel considering its drug application raised concerns about the way the MAPS clinical trials were conducted and assessed, saying they may have elevated the results.
Availability of data and materials
Prolonged Exposure (PE) is a highly efficacious, evidence-based, cognitive-behavioral therapy for PTSD 30. Although some studies have included individuals with SUD in clinical trials examining the efficacy of PE to treat PTSD, findings regarding the effect of PE on substance use have not typically been reported 31–33. One study by Schnurr and colleagues reported on the impact of PE on SUD symptoms as a secondary outcome in a study examining the use of PE in comparison to present centered therapy in a sample of female veterans 34. Despite reductions in PTSD symptoms, there were no significant changes in substance use outcomes at either post-treatment or the six month follow-up. Similarly, Pacella and colleagues reported no significant reductions in substance use in a sample of HIV patients receiving PE 35.
What is Alcohol Use Disorder?
- Between six and eight of every ten (or 60% to 80% of) Vietnam Veterans seeking PTSD treatment have alcohol use problems.
- Therefore, we do not know the extent that risk factors may increase the risk for one disorder or both, or whether these risk factors may have additive or interactive effects.
- Generally, studies were conducted over many years and screened large numbers of subjects to reach target samples.
- In fact, studies have found that up to one-third of people with PTSD also struggle with AUD.
Military and veteran populations have a critical need for interventions that aim to reduce the burden of co-occurring PTSD and AUD. Treating these conditions simultaneously has been challenging and complex in the general population, and military service adds additional risk factors for the likelihood of their onset and maintenance. Although promising interventions exist, more research is needed to assess the degree to which current interventions are effective for service members and veterans. Also, new interventions that target this population should be developed and tested. Implementing SUD treatments for individuals with co-occurring PTSD and AUD could be a way for providers to address clinical needs without learning another manual-guided treatment. Motivational enhancement therapy also shows promise as a way to increase treatment initiation among veterans and military personnel who are reluctant =https://ecosoberhouse.com/ to enter treatment or address their substance misuse during treatment for PTSD, particularly if they perceive that substance use eases their PTSD symptoms.
Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) 36 is one such modality that synthesizes empirically-validated cognitive-behavioral treatment for SUD with PE. Back and colleagues first reported in detail on the acceptability and feasibility of using COPE through a case study on an Iraq Veteran with PTSD and co-occurring alcohol use disorder 37. Mills and colleagues conducted a randomized clinical trial of COPE among Australian civilians and found COPE to be superior in reducing PTSD and substance use symptoms compared to treatment-as-usual 24•. Recently, Back and colleagues completed a randomized clinical trial evaluating the efficacy of COPE among Veterans. Participants were randomized to receive COPE or cognitive-behavioral relapse prevention 38. Preliminary results indicate significant reductions in SUD and PTSD symptoms, and indicate that reductions in PTSD symptoms during treatment account for more than half of the variance in substance use reduction 39•.
- Of the 2,493 participants, about 16% were exposed to at least one qualifying traumatic event.8 Of this group, about 8.4% developed PTSD.15 Also, individuals who met criteria for PTSD were more likely to report alcohol-related problems than those who did not meet PTSD criteria.
- Factors such as a person’s previous mental health history, level of support, and the severity of the trauma can all influence the likelihood of developing the disorder.
- Military and Veteran Populations, Dworkin and colleagues report on the frequency of co-occurring PTSD and AUD in military personnel and veterans, and they examine population-specific factors contributing to the development of PTSD and AUD.
- This review will provide a description of psychosocial, pharmacological, and combined interventions that have been examined to treat co-occurring SUD and PTSD.
For patients with alcohol use disorder, it’s important to look at their pasts ptsd and alcohol abuse for any signs of trauma. Because these two issues are so intimately connected, it is essential that treatment address them both. PTSD treatment without concurrent alcohol treatment can lead to ongoing substance abuse and a return to PTSD symptoms. If you address your drinking while still avoiding a traumatic past, you are unlikely to have much success. A recent study looked at a population with PTSD and compared those with past combat experience and those without. Those with combat in their pasts were more likely to use alcohol to cope with PTSD symptoms.
- Less than 20% of respondents who experienced AUD in their lifetime ever sought treatment for the condition.
- Another crucial aspect to consider is the level of support available to individuals following a traumatic event.
- The Emerson et al. (2017) study is the first to examine the association between AUD and PTSD in American Indian and Alaskan Natives (AIAN) as compared to non-Hispanic Whites.
- Up to three quarters of people who survived abuse or violent traumatic events report drinking problems.
A number of factors may have influenced the findings noted in this review, including gender differences, veteran vs. civilian status, and the various behavioral platform employed. In summary, Petrakis and colleagues conclude that clinicians can be reassured that medications that are approved to treat AUD can be used safety and with some efficacy in patients with PTSD, and vice versa. Addressing both disorders, either by pharmacological interventions, behavioral interventions or their combination, is encouraged and likely to yield the most effective outcomes for patients with comorbid AUD/PTSD. For additional review of the two papers addressing behavioral and pharmacological treatments for comorbid SUD and PTSD, refer to Norman and Hamblen (2017). Topiramate, a GABA receptor agonist and a glutamate receptor antagonist, has been explored separately in individuals with substance use disorders (alcohol in particular) and PTSD. Only recently has topiramate been examined to target co-occurring alcohol use disorder and PTSD 96–98.