Findings for medications that were hypothesized to treat both disorders were also contradictory. Treatment of alcohol use disorder (AUD) is complicated by the presence of psychiatric comorbidity including posttraumatic stress disorder (PTSD). This is a critical review of the literature to date on pharmacotherapy treatments of AUD and PTSD. As the FDA noted in its briefing documents, PTSD is a condition affecting an estimated 13 million Americans that may arise following intensely distressing life events, such as threats of death, severe injury, or sexual violence. Besides intrusive memories, hyperarousal, and avoidant behavior, persons with PTSD have a higher risk of suicidal ideation and behavior. Research on the factors leading to participant dropout and on ways of increasing treatment engagement and retention is critical.
Medications targeting Alcohol Use Outcomes
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 https://ecosoberhouse.com/boston-sober-house-roxbury/ 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. To understand how trauma can lead to emotional distress and affect alcohol consumption, it is important to understand the biochemical changes that occur during and after an experience of uncontrollable trauma. During uncontrollable trauma, an increase in endogenous opioids (endorphins) helps to numb the pain of the trauma.
PTSD and Alcohol: How Does Alcohol Affect PTSD Symptoms?
Prolonged exposure involves repeated, prolonged, imaginal exposure to the trauma memory or memories that arise during therapy. During treatment, the role of avoidance in the maintenance of PTSD was explained to Margaret, and she was encouraged to confront her traumatic past through prolonged, systematic exposure to the memories and to gradually confront the situations she had been avoiding in her daily life. During discussions of her exposure exercises, Margaret became more aware of the frequent association between her reexperiencing symptoms and her urges to drink, which through the combination of medication and the development of less avoidant coping strategies, she was generally able to resist. Over a three-month course of treatment, Margaret exhibited progressively less distress during imagined exposure, her memories for the traumatic events gradually became less disjointed, and she eventually expressed a sense of resolution regarding these events. As a result, she felt much more capable of combating temptations to drink, which she continued to encounter from a variety of triggers not related to PTSD.
Psychotherapy for PTSD and AUD
- PTSD may be experienced by combat veterans and those who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, or other similar events.
- Explaining your decision to friends is a vital step in your journey towards a more empowered, healthier you.
- Furthermore, research shows that AA individuals experience more severe symptoms of AUD as compared to EA individuals (Mulia et al., 2009).
Some studies highlight the impairment caused by alcohol consumption on processing emotional faces. One such study involved a sample of 85 social drinkers who were described as being low or high trait anger based on their responses to the anger expression index of the State-Trait Anger Expression Inventory-2 (STAXI-2) (Eastwood et al., 2020). They first consumed alcohol and were asked to recognize the emotions of different faces on a computer task.
Treatment for Alcohol usage disorders and PTSD
Motivational enhancement therapy also shows promise as a way to increase treatment initiation among veterans and military personnel who are reluctant to enter treatment or address their substance misuse during treatment for PTSD, particularly if they perceive that substance use eases their PTSD symptoms. A couples therapy called “project VALOR,” which stands for “veterans and loved ones readjusting,” involves 25 sessions of cognitive behavioral therapy for PTSD and alcohol misuse, enhanced for significant others. Two OEF/OIF veterans received VALOR therapy in two separate case studies.49 These veterans greatly reduced their alcohol use at the start of treatment or shortly before beginning the treatment, and their PTSD symptoms alcoholism and anger substantially decreased over the course of treatment. In one case study of an OEF/OIF veteran, researchers examined the effectiveness of concurrent treatment of PTSD and SUD using prolonged exposure (COPE) therapy.45 COPE involves 12, 90-minute sessions that integrate relapse prevention with prolonged exposure therapy. The veteran who received the therapy reported reduced alcohol use throughout treatment, scored in the nonclinical range for PTSD at the end of treatment, and maintained treatment gains at a 3-month follow-up. Among military and veteran populations, the risk for both PTSD and alcohol misuse may vary because of differences in demographic factors, aspects of military culture, and trauma or stress exposure.
Concurrent treatment of PTSD and substance use disorders using prolonged exposure (COPE)
These interventions are flexible and can be applied in individual or group therapy formats. CBTs for AUD focus on the identification and modification of maladaptive cognitions and behaviors that contribute to alcohol misuse.21 Behavioral treatments for people with AUD also target motivation for change and improvement of specific skills to reduce the risk for relapse. Finally, AUD and PTSD are two of the most common mental health disorders afflicting military service members and veterans. As such, continued research on the development of effective screening, prevention and treatment interventions for service members and veterans is critically needed. Based on the work of Stein and colleagues (2017), pre-enlistment screening to identify service member with alcohol misuse or AUD will also likely help identify those at risk of developing PTSD, or other mental health problems (e.g., depression, panic disorder), during military service.
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Women’s Increased Risk for Trauma-Induced Emotional Distress and Alcoholism
