Acceptance and Commitment Therapy for Co‐Occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veterans: Pilot Treatment Outcomes

Abstract

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co‐occur and are associated with worse outcomes together than either disorder alone. A lack of consensus regarding recommendations for treating PTSD–AUD exists, and treatment dropout is a persistent problem. Acceptance and Commitment Therapy (ACT), a transdiagnostic, mindfulness‐ and acceptance‐based form of behavior therapy, has potential as a treatment option for PTSD–AUD. In this uncontrolled pilot study, we examined ACT for PTSD–AUD in 43 veterans; 29 (67%) completed the outpatient individual therapy protocol (i.e., ≥ 10 of 12 sessions). Clinician‐assessed and self‐reported PTSD symptoms were reduced at posttreatment, ds = 0.79 and 0.96, respectively. Self‐reported symptoms of PTSD remained lower at 3‐month follow‐up, d = 0.88. There were reductions on all alcohol‐related outcomes (clinician‐assessed and self‐reported symptoms, total drinks, and heavy drinking days) at posttreatment and 3‐month follow‐up, dmean = 0.91 (d range: 0.65–1.30). Quality of life increased at posttreatment and follow‐up, ds = 0.55–0.56. Functional disability improved marginally at posttreatment, d = 0.35; this effect became significant by follow‐up, d = 0.52. Fewer depressive symptoms were reported at posttreatment, d = 0.50, and follow‐up, d = 0.44. Individuals experiencing suicidal ideation reported significant reductions by follow‐up. Consistent with the ACT theoretical model, these improvements were associated with more between‐session mindfulness practice and reductions in experiential avoidance and psychological inflexibility. Recommendations for adapting ACT to address PTSD–AUD include assigning frequent between‐session mindfulness practice and initiating values clarification work and values‐based behavior assignments early in treatment.

The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature

“…Two studies have shown ACT as an effective therapy for alcohol use disorder. Meyer et al in 2018 carried out an uncontrolled pilot study of 43 veterans with post-traumatic stress disorder (PTSD) [28]. At the end of 10 to 12 sessions of ACT with TAU, the veterans demonstrated a significant reduction in the total number of drinks and heavy drinking days [28].…”

“…Meyer et al in 2018 carried out an uncontrolled pilot study of 43 veterans with post-traumatic stress disorder (PTSD) [28]. At the end of 10 to 12 sessions of ACT with TAU, the veterans demonstrated a significant reduction in the total number of drinks and heavy drinking days [28]. Ehman and Gross in 2018 also conducted a case study on a 29-year-old woman who was a college student and had AUD.…”

“…The study by Meyer et al was prone to type 1 error because of its limited sample size. The lack of controls would introduce bias from confounding variables [28]. The results obtained were from self-reporting which may lead to reporting bias.…”

“…Finally, the study had a high attrition rate of 33%. This high attrition rate would affect the external validity of this article [28]. The study by Ehman and Gross is a case study whose outcome cannot be generalized to the entire population [29].…”

“…These studies utilized in-person interventions, web-based solutions, or mobile apps to deliver therapy to participants [11,12,23,30]. The outcomes were a significant reduction in smoking, decreased cravings, and increased psychological flexibility [12,23,28]. The studies had limitations like small sample size, lack of blinding, and very high attrition rates.…”