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Some studies suggest that alcohol consumption can increase the likelihood of the development of PTSD in women, due to the increased likelihood of exposure of traumatic events that occurs as a result of alcohol abuse. Evidence-based pharmacological treatments for alcohol use disorders (AUDs) evaluated in well-designed clinical studies are not being adopted in clinical treatment settings as evidenced by the low uptake of the use of medications to treat AUD (Jonas et al. 2014). With new provisions for reimbursement for treatment for addiction under the Affordable Care Act, there may be new contingencies and motivations for agencies to adopt best-practices. However, if evidence-based treatments continue to be only narrowly disseminated and adopted, treatment organizations, some of which are motivated by profit only, may offer treatments that are at best not effective and at worst are harmful (Woodworth and McLellan 2016). Conducting studies in populations with “multi-morbidities” is increasingly recognized as an important area of study. This concept challenges the single disease framework used throughout medicine in education, reimbursement, and research (Barnett et al. 2012).
- There is some promising evidence for the use of the SRI, sertraline to treat PTSD in comorbidity such that this medication was effective in treating PTSD in one (Hien et al. 2015) study and was found to outperform placebo at the trend level in another (Brady et al. 2005).
- Additionally, those with PTSD show memory bias towards trauma- and threat-related stimuli (Paunovic, Lundh & Öst, 2002).
- PTSD symptoms were measured with a self-report questionnaire rather than a diagnostic interview, limiting our ability to draw conclusions about individuals who meet diagnostic criteria for PTSD.
- Generally, studies were conducted over many years and screened large numbers of subjects to reach target samples.
- For example, the Food and Drug Administration (FDA) has approved three drugs – disulfiram, naltrexone, and acamprosate – to treat alcohol use disorders.
Unfortunately, the symptoms of PTSD do not fade over time, these feelings intensify until the person is overwhelmed and unable to function. People with post-traumatic stress disorder (PTSD) often struggle with frequent and intense anxiety symptoms. These strong symptoms of anxiety often lead people with PTSD to rely on unhealthy coping methods, such as drug or alcohol use. There are treatments that can help with PTSD and substance use problems at the same time, and VA has programs for Veterans. Second, although treatments for PTSD and SUD have been disseminated systemwide within the VA, there is a dearth of literature about the effectiveness of these treatments for those in this population who have both conditions.
Trauma and PTSD Can Lead to Problems with Alcohol
Getting the right treatment for this dual diagnosis is the way to a healthy life. The treatment options for people with PTSD and alcoholism include therapy and education. Any event that leaves a person feeling out of control or powerless can lead to PTSD. In addition to CRH, numerous neuropeptides have been shown in various animal models to be affected by stress or to be involved in the stress response. Studies on postmortem brain samples showed that other neuropeptides and their receptors could be suitable targets for PTSD and AUD treatments.
Victims of PTSD are more likely to develop alcoholism to self-medicate symptoms of trauma. Some studies suggest that up to 40 percent of women and men in the United States who have PTSD meet the criteria for an alcohol use disorder (AUD). Factors contributing to addiction to alcohol and PTSD sufferers include the severity and type of PTSD the person experiences. 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.
Three Categories of PTSD Symptoms
More rigorous research has been conducted with Seeking Safety (SS), a non exposure-based, manualized cognitive behavioral intervention for comorbid PTSD and SUDs (e.g., Najavits, 1998; Hien et al., 2004; 2008; additional studies summarized in Table 2). SS is a 24 session manualized therapy that prioritizes establishing and maintaining safety. Other key concepts include ptsd and alcoholism anticipating dangerous situations, setting boundaries, anger management and affect regulation. SS was compared to relapse prevention in a community sample of 107 women with SUDs and either PTSD or sub-threshold PTSD (Hien et al., 2004). Women were randomized to one of the two interventions and individual sessions were delivered twice weekly for 12 weeks.
Similarly, the outcome measures were mostly comparable; reporting on alcohol consumption based on the Time Line Followback Method and PTSD symptoms using Clinician Administered PTSD (CAPS) or its derivative, the PTSD Checklist (PCL). Only two studies reported on a “clinically meaningful change” (Foa et al. 2013, Hien et al. 2015) and one study characterized subjects based on onset of PTSD and onset of alcohol dependence (Brady et al. 2005) but the validity of these subgroups is not well established. Because the studies used similar inclusion/exclusion criteria and similar outcomes, making overall conclusions based on these studies seems reasonable. In summary, PTSD and SUDs commonly co-occur and both non exposure-based and exposure-based integrated interventions have been shown to be safe and effective. Although non exposure-based treatments offer some PTSD symptom reduction, exposure-based treatments including both in vivo and imaginal exposure techniques may offer greater symptom reduction. The recent evidence showing improvement in PTSD positively impacting substance use outcomes clearly supports a more rigorous approach to assessing and treating PTSD among patients with SUDs.
Changes in Diagnostic Criteria
Most (6/10) of the drop-outs left the study because of practical reasons (e.g. time commitment of the study, reimbursement, transportation). The titration was accomplished in 2 weeks, so a 6-week trial should be adequate to evaluate medication response. In this study 30 subjects, including 37% women, were randomized to receive 16 mg of prazosin vs. placebo; 18 subjects were included in the 12-week study before it was re-designed.
Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly comorbid. Although recent clinical studies provide some understanding of biological and subsequent behavioral changes that define each of these disorders, the neurobiological basis of interactions between PTSD and AUD has https://ecosoberhouse.com/article/binge-drinking-how-to-stop-binge-drinking/ not been well-understood. In this review, we summarize the relevant animal models that parallel the human conditions, as well as the clinical findings in these disorders, to delineate key gaps in our knowledge and to provide potential clinical strategies for alleviating the comorbid conditions.
