Citation

Possemato K, Mastroleo NR, Balderrama-Durbin C, King P, Davis A, Borsari B, Rauch SAM. Behav. Ther. 2024; 55(3): 570-584.

Copyright

(Copyright © 2024, Association for Behavioral and Cognitive Therapies, Publisher Elsevier Publishing)

DOI

10.1016/j.beth.2023.08.011

PMID

38670669

Abstract

Individuals with posttraumatic stress disorder (PTSD) often engage in harmful alcohol use. These co-occurring conditions are associated with negative health consequences and disability. PTSD and harmful drinking are typically experienced as closely related-thus treatments that target both simultaneously are preferred by patients. Many individuals with PTSD and harmful alcohol use receive primary care services but encounter treatment barriers in engaging in specialty mental health and substance use services. A pilot randomized controlled trial of a brief integrated treatment for PTSD and harmful drinking versus primary care treatment as usual (PC-TAU) took place in three U.S. Department of Veterans Affairs (VA) primary care clinics. The intervention (primary care treatment integrating motivation and exposure [PC-TIME]) combines motivational interviewing to reduce alcohol use and brief prolonged exposure for PTSD delivered over five brief sessions. Participants (N = 63) were veterans with PTSD and harmful drinking. Multilevel growth curve modeling examined changes in drinking (average number of drinks per drinking day and percentage of heavy drinking days) and self-reported PTSD severity at baseline, 8, 14, and 20 weeks. Participants reported high satisfaction with PC-TIME and 70% (n = 23) completed treatment. As hypothesized, a significantly steeper decrease in self-reported PTSD severity and heavy drinking was evident for participants randomized to PC-TIME compared with PC-TAU. Contrary to expectations, no significant posttreatment differences in PTSD diagnoses were observed. PC-TIME participants were less likely to exceed National Institute for Alcoholism and Alcohol Abuse (NIAAA) guidelines for harmful alcohol use posttreatment compared with PC-TAU participants. PC-TIME is a promising brief, primary care-based treatment for individuals with co-occurring PTSD and harmful alcohol use. A full-scale randomized clinical trial is needed to fully test its effectiveness.

Language: en

Keywords

*Alcoholism/therapy/psychology; *Motivational Interviewing/methods; *Primary Health Care/methods; *Stress Disorders, Post-Traumatic/therapy/psychology; *Veterans/psychology/statistics & numerical data; Adult; AUD; Female; Humans; Implosive Therapy/methods; Male; Middle Aged; Motivation; motivational interviewing; Pilot Projects; primary care; prolonged exposure; PTSD; Treatment Outcome; United States/epidemiology