How to Treat PTSD and Alcohol Dependence Together

man suffering from PTSD drinking alcohol and smokingPost-traumatic stress disorder (PTSD) is a mental health condition involving flashbacks, difficulty sleeping and a variety of emotional responses when faced with subsequent stressful situations. Complicating treatment is PTSD’s tendency to appear in combination with other mental disorders like anxiety, depression or substance abuse. In the case of the latter, experts believe that patients are often using substances like alcohol or drugs to self-medicate against the negative effects of PTSD. PTSD can have its origin in any tragic event, whether the patient was a victim or bystander. Such events can include military combat, a car accident or even a traumatic hospital experience. A study from the Perelman School of Medicine at the University of Pennsylvania examined whether the use of prolonged exposure therapy (PE) to treat PTSD would result in increased alcohol consumption. The study results, printed in JAMA, provide evidence that the use of PE among patients with PTSD and alcohol dependence does not increase the experience of cravings or lead to more drinking. The study was a single-blind, randomized clinical trial utilizing not only PE but also naltrexone to maximize patient recovery. Lead author and clinical psychology professor Edna B. Foa, Ph.D., is the developer of prolonged exposure therapy. During PE, patients are exposed to the type of environment they have been avoiding, including recounting memories, situations and people that cause distress. Foa explains that while PTSD and alcohol dependence often appear together in patients, there has been reluctance to treat the combined symptoms together because of the fear that PE would increase alcohol consumption. However, the results of the study show that PE led to a longer low drinking level compared to those who did not receive this therapy. With hundreds of thousands of individuals struggling with comorbid PTSD and alcohol dependence, the study’s findings could have a far-reaching impact as 65 percent of individuals with PTSD also abuse substances. The eight-year study, from 2001 to 2009, included 165 patients diagnosed with both PTSD and alcohol dependence. The researchers divided the patients into four groups: PE in addition to treatment with naltrexone; PE plus placebo; supportive counseling in combination with naltrexone; and supportive counseling with placebo. Prolonged exposure therapy consisted of 12 weekly, 90-minute sessions, followed by six additional sessions conducted on a bi-weekly basis. All patients were given supportive counseling sessions. Across all patients, there was a decrease in the percentage in drinking days as well as reports of reduced cravings during the treatment period. Patients treated with naltrexone had fewer drinking days than patients given the placebo. The findings show that, overall, there were lower rates of relapse for alcohol dependence when PE and naltrexone were combined, with a relapse rate of 5.4 percent versus 13.3 percent for those given the placebo. The patients in the study also experienced a positive reaction to the therapy related to symptoms of PTSD, but the improvement was not significant. This finding was inconsistent with multiple earlier studies that showed the treatment as an effective strategy for PTSD recovery. The important finding from this study was evidence that prolonged exposure therapy did not lead to increased levels of drinking or alcohol cravings. This is the first study to examine the use of naltrexone in combination with an evidence-based therapy in patients with both PTSD and alcohol dependence.

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