Cognitive Processing Therapy or Relapse Prevention for comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A randomized clinical trial

Authors

Tracy L. Simpson, VA Puget Sound Health Care, University of Washington
Debra L. Kaysen, University of Washington, Stanford University School of Medicine
Charles B. Fleming, University of Washington
Isaac C. Rhew, University of Washington
Anna E. Jaffe, University of Nebraska-LincolnFollow
Sruti Desai, University of Washington
Denise A. Hien, Rutgers University
Lucy Berliner, University of Washington
Dennis Donovan, University of Washington
Patricia A. Resick, Duke Health

Document Type

Article

Date of this Version

11-29-2022

Citation

Simpson TL, Kaysen DL, Fleming CB, Rhew IC, Jaffe AE, Desai S, et al. (2022) Cognitive Processing Therapy or Relapse Prevention for comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A randomized clinical trial. PLoS ONE 17(11): e0276111. https://doi.org/ 10.1371/journal.pone.0276111

Comments

Open access.

Abstract

Objective

To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD.

Method

Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days.

Results

At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days.

Conclusion

Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care

Trial registration

The trial is registered at clinicaltrials.gov (NCT01663337).