The impact of treatment condition and the lagged effects of PTSD symptom severity and alcohol use on changes in alcohol craving

Kaczkurkin, Antonia N.; Asnaani, Anu; Alpert, Elizabeth; Foa, Edna B.

doi:10.1016/j.brat.2016.02.001

Cited by 17 publications

(16 citation statements)

References 62 publications

(77 reference statements)

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“…In terms of between-group differences, individuals with OUD reported significantly greater reductions in alcohol craving relative to participants in the non-OUD comparison group. This finding is consistent with the findings of Kaczkurkin, Asnaani, Alpert, and Foa (2016), who demonstrated that individuals with more severe PTSD symptomatology showed greater improvements in alcohol craving over time. Together, these findings suggest that individuals with more severe PTSD and SUD symptomatology have more room for improvement over time.…”

Section: Discussionsupporting

confidence: 91%

Adults with Comorbid Posttraumatic Stress Disorder, Alcohol Use Disorder, and Opioid Use Disorder: The Effectiveness of Modified Prolonged Exposure

Peck

Schumacher

Stasiewicz

et al. 2018

Journal of Traumatic Stress

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Opioid use disorders (OUDs) are a growing problem in the United States. When OUDs co-occur with problematic drinking and posttraumatic stress disorder (PTSD), negative drug-related mental and physical health outcomes may be exacerbated. Thus, it is important to establish whether PTSD treatments with established efficacy for dually diagnosed individuals also demonstrate efficacy in individuals who engage in problematic drinking and concurrent opioid misuse. Adults who met DSM-IV-TR criteria for PTSD and alcohol dependence were recruited from a substance use treatment facility and were randomly assigned to receive either modified prolonged exposure (mPE) therapy for PTSD or a non-trauma-focused comparison treatment. Compared to adults in a non-OUD comparison group (n = 74), adults with OUD (n = 52) were younger, reported more cravings for alcohol, were more likely to use amphetamines and sedatives, were hospitalized more frequently for drug- and alcohol-related problems, and suffered from more severe PTSD symptomatology, depressive symptoms, and anxiety, standardized mean differences = 0.36-1.81. For participants with OUD, mPE was associated with large reductions in PTSD symptomatology, sleep disturbances, and symptoms of anxiety and depression, ds = 1.08-2.56. Moreover, participants with OUD reported decreases in alcohol cravings that were significantly greater than those reported by the non-OUD comparison group, F(1, 71.42) = 6.37, p = .014. Overall, our findings support the efficacy of mPE for PTSD among individuals who engage in problematic drinking and concurrent opioid misuse, despite severe baseline symptoms.

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Section: Discussionsupporting

confidence: 91%

Adults with Comorbid Posttraumatic Stress Disorder, Alcohol Use Disorder, and Opioid Use Disorder: The Effectiveness of Modified Prolonged Exposure

Peck

Schumacher

Stasiewicz

et al. 2018

Journal of Traumatic Stress

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“…In an RCT for concurrent PTSD and SUD treatment, Hien et al (2010) found that SUD improvement reliably followed PTSD improvement, but found no converse association between SUD change and subsequent PTSD improvement. Recently, Kaczkurkin, Asnaani, Alpert, and Foa, (2016) extended growth models to examine the lagged effects of PTSD symptoms on alcohol craving within a trial of integrated treatment combinations for PTSD and SUD (naltrexone vs. placebo, with or without prolonged exposure). When PTSD symptoms (at time t ) were compared to subsequent alcohol craving (at time t + 1), improvement in PTSD symptom severity was associated with diminished alcohol craving; however, no interactions between PTSD symptoms and the four treatment combinations were observed.…”

mentioning

confidence: 99%

Lagged effects of substance use on PTSD severity in a randomized controlled trial with modified prolonged exposure and relapse prevention.

Hien¹,

Smith²,

Owens³

et al. 2018

Journal of Consulting and Clinical Psychology

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Objective: To advance understanding the effectiveness of evidence-based treatments for comorbid posttraumatic stress and substance use disorders (PTSD and SUD), research must provide a more nuanced picture of how substance use affects change in PTSD symptoms over the course of treatments, and whether prolonged exposure techniques can be efficacious during active substance use. A dataset that included patients with PTSD/subthreshold PTSD and SUD treated with an exposure-based intervention provided an opportunity to conduct a secondary analysis to test how patients’ substance use impacted PTSD change over treatment. Method: We applied growth models to week-to-week PTSD symptom and substance use changes during treatment and follow-up of a randomized controlled trial of two cognitive behavioral treatments for PTSD and SUD: Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE) and Relapse Prevention Therapy (RPT). Cross-lagged analyses were used to determine whether prior week substance use impacted subsequent PTSD symptom severity. Results: Both treatments evidenced significant reductions in PTSD symptom severity. In the context of continued substance use, results suggest that individuals still benefit from exposure-based treatment. Conclusion: Results provide evidence that RPT and COPE both led to significant reductions in PTSD, providing further support that exposure-based techniques tailored for SUD can be conducted without jeopardizing PTSD or SUD outcomes. Implications for clinical decision-making around treatment selection are discussed.

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“…In clinical settings, patients presenting for treatment with PTSD/SUD comorbidity are commonly referred to SUD-only treatment first, and some are later referred to PTSD treatment [ 15 , 16 ]. However, prior research shows that integrated and concurrent treatments for PTSD/SUD can effectively reduce symptoms of PTSD while also significantly decreasing symptoms of SUD [ 12 , 17 , 18 , 19 , 20 ]. It may be that integrated treatments are more effective for complex symptom presentations, such as that observed in PTSD/SUD comorbidity, than treatments designed to treat one disorder exclusively.…”

Section: Introductionmentioning

confidence: 99%

“…It may be that integrated treatments are more effective for complex symptom presentations, such as that observed in PTSD/SUD comorbidity, than treatments designed to treat one disorder exclusively. Importantly, reductions in PTSD symptoms following treatment of PTSD/SUD are associated with corresponding reductions in SUD symptoms [ 12 , 18 , 19 ]. In contrast, reductions in SUD symptoms have not been associated with corresponding reductions in PTSD symptoms [ 12 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Integrated Treatment of PTSD and Substance Use Disorders: The Mediating Role of PTSD Improvement in the Reduction of Depression

Korte

Bountress

Tomko

et al. 2017

JCM

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Posttraumatic stress disorder (PTSD) represents one of the most common mental health disorders, particularly among veterans, and is associated with significant distress and impairment. This highly debilitating disorder is further complicated by common comorbid psychiatric disorders, such as substance use disorders (SUD). Individuals with PTSD and co-occurring SUD also commonly present with secondary symptoms, such as elevated depression. Little is known, however, about how these secondary symptoms are related to treatment outcome. The aim of the present study, therefore, was to examine (1) the effects of treatment of comorbid PTSD/SUD on depressive symptoms; and (2) whether this effect was mediated by changes in PTSD severity or changes in SUD severity. Participants were 81 U.S. military veterans (90.1% male) with PTSD and SUD enrolled in a randomized controlled trial examining the efficacy of an integrated, exposure-based treatment (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure; n = 54) versus relapse prevention (n = 27). Results revealed significantly lower depressive symptoms at post-treatment in the COPE group, as compared to the relapse prevention group. Examination of the mechanisms associated with change in depression revealed that reduction in PTSD severity, but not substance use severity, mediated the association between the treatment group and post-treatment depression. The findings underscore the importance of treating PTSD symptoms in order to help reduce co-occurring symptoms of depression in individuals with PTSD/SUD. Clinical implications and avenues for future research are discussed.

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The impact of treatment condition and the lagged effects of PTSD symptom severity and alcohol use on changes in alcohol craving

Cited by 17 publications

References 62 publications

Adults with Comorbid Posttraumatic Stress Disorder, Alcohol Use Disorder, and Opioid Use Disorder: The Effectiveness of Modified Prolonged Exposure

Adults with Comorbid Posttraumatic Stress Disorder, Alcohol Use Disorder, and Opioid Use Disorder: The Effectiveness of Modified Prolonged Exposure

Lagged effects of substance use on PTSD severity in a randomized controlled trial with modified prolonged exposure and relapse prevention.

Integrated Treatment of PTSD and Substance Use Disorders: The Mediating Role of PTSD Improvement in the Reduction of Depression

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