Alcoholism and PTSD can be treated together

Despite fears that exposure therapy for posttraumatic stress disorder (PTSD) would worsen alcoholism, a new study found that both conditions can be safety treated at the same time.

Researchers found that people with PTSD and alcoholism benefited the most from the simultaneous treatments to reduce alcohol cravings and lessen distress, compared to people on other treatment regimens.

“What we found is that those people that got (medication) plus prolonged exposure therapy for alcohol dependence together with the treatment for PTSD did the best for maintaining their low level of drinking,” lead author Dr. Edna Foa, from the University of Pennsylvania in Philadelphia, told us.

There has, however, been some disagreement about how to best care for people with both conditions and whether PTSD and alcoholism can safely be treated together.

“If you are trying to treat the alcohol addiction without any treatment of the PTSD what will happen is that they will stop drinking and the PTSD will become more severe, so what they will do is start drinking again,” Dr. Foa said.

“There is a vicious cycle between alcohol dependence and PTSD,” she added.

There has also been concern, however, that PTSD treatment involving repeated exposure to the traumatic memory will exacerbate alcohol abuse in those who drink to “self-medicate” their PTSD.

To determine whether using exposure therapy to treat PTSD and naltrexone to treat alcoholism at the same time would lead to an increase in drinking, Dr. Foa and her colleagues recruited 165 people with PTSD and alcoholism between February 2001 and June 2009 and assigned them to one of four treatment groups.

One group of 40 received naltrexone and prolonged exposure therapy. Another group of 40 received exposure therapy and placebo pills, and a third group of 42 received naltrexone and general support counseling, which is not as comprehensive as exposure therapy. A fourth group of 43 received placebo pills and support counseling.

After six months of treatment, the proportion of days in a given period that participants consumed alcohol dropped in each group. Those receiving naltrexone – with or without exposure therapy – benefited the most, the authors reported in a paper released August 6th in the Journal of the American Medical Association.

At the beginning of the study, participants drank alcohol on 71%-79% of days. That fell to about 13% of days among those not taking naltrexone and 5% among those on the medication.

The largest decrease in alcohol cravings also occurred among people taking naltrexone, according to the researchers.

There was no significant difference in PTSD symptoms among those who went through exposure therapy, compared to basic counseling.

But combined prolonged exposure therapy and naltrexone appeared to protect against alcoholism relapse.

Six months after treatment stopped, participants who had basic counseling with or without naltrexone were drinking on 22%-27% of days, whereas people in the exposure therapy group were drinking on about 19% of days if they had taken the placebo or about 9% of days if they had taken naltrexone.

“I’m hoping this is going to encourage the people who are treating the PTSD and alcohol dependence to do simultaneous treatment… instead of treating one after the other, which isn’t so effective,” Dr. Foa said.

Dr. Yuval Neria, director of the Trauma and PTSD program at the New York State Psychiatric Institute in New York City, agreed.

“This may encourage physicians – specifically those in the (Veterans Affairs) setting – to prescribe patients to both drug and evidence-based therapy,” Dr. Neria, who was not involved with the new study, said.

“There is really a large population with PTSD who may have comorbid alcohol abuse -especially war veterans coming back from Iraq and Afghanistan. I would say this is good news for them,” he said.

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