We know that this can be difficult, especially if you have thought negatively about your drinking for a long time, but it is an important step. Recognise that this is the first step towards an incredibly empowering life decision. Consider activities like organising a drawer, giving your home a quick clean, enjoying a refreshing shower, taking a brisk walk, planning your meals, or engaging in physical somatic movement (dance around the kitchen, go for a run, do some exercise).
As with treatments for AUD, various treatment modalities for PTSD have been studied. Greater attention to members of our society who disproportionately bear the burden of trauma exposure, PTSD and comorbid AUD is warranted. As discussed in the papers presented in this virtual issue, this includes members of racial and ethnic communities as well as military service members and ptsd and alcohol abuse veterans. Data from the Werner et al., (2017) paper suggest that the existing etiological models of AUD development, as well as risk and protective factors, may be different based on racial/ethnic background. A better understanding of AUD etiology among racial/ethnic minority individuals is an important and necessary next step in the development of effective interventions.
What are the symptoms of PTSD?
These observations suggest that CRH antagonists could potentially have a role in the treatment of patients with PTSD and comorbid substance dependence. Although at present no CRH antagonist has been approved for human use, a series of CRH antagonists that can be administered peripherally have been developed and have been shown to cross the blood brain barrier (34, 69). These agents will be important tools for further defining the potential role of CRH antagonism in the treatment of patients with PTSD and substance dependence and will hopefully lead to development of orally active preparations. After experiencing a traumatic event, it’s common to feel differently than you did before. Maybe you’re experiencing unwanted thoughts or flashbacks to the traumatic event. Maybe you even feel the urge to drink to help you forget these stressful memories or help you fall asleep.
Not only is there evidence that sociodemographic factors, such as gender and age, modify this relationship (9–11), but measures of personal resiliency (12) and social support (13) have also been shown to modify this risk. However, it is not clear which of these factors, or others that have previously not been considered, are most important for moderating the risk of substance use with increased PTS symptoms. A combination of psychotherapy and pharmacotherapy may be an effective treatment strategy for service members and veterans with comorbid PTSD and AUD. There was no statistically significant main effect for prolonged exposure therapy on PTSD symptoms and no observed differences in the number of dropouts across conditions. In the same sample, prolonged exposure was more beneficial for those with non–combat-related traumas and higher baseline PTSD severity.39 Also, naltrexone was most beneficial for those with the longest duration of AUD. Most published data support the second model, in which substance use follows or parallels traumatic exposure and the development of PTSD (18).
Sudie E. Back
Overall, a more sophisticated approach is needed for selecting treatments for PTSD/SUD patients. RCTs are an important step to ascertain treatment impact (63), but too often they are seen as the endpoint for treatment recommendations rather than a starting point. We can imagine a more useful treatment comparison grid for frontline providers and programs that would list the different models in columns (RP, EMDR, etc.) and major factors to consider in rows. The latter would include evidence (how many studies, key findings, patient and provider samples, etc.) plus additional rows with implementation factors such as those described in this paper (group versus individual modality, session length, cost, training and certification, concurrent treatments, etc.). PE has had low adoption and implementation in community settings (48,53), and in the Department of Veterans Affairs, which conducted a multi-year roll-out of it (54,55). PTSD exposure therapies have also had premature dropout in general (47,48) and in PTSD/SUD samples (e.g., (14,36,48,55).
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Post-traumatic stress and future substance use outcomes: leveraging antecedent factors to stratify risk
Finally, we were able to include the largest reported number of psychosocial factors as potential modifiers using a novel statistical method, which allowed for a comprehensive understanding of our participants compared to smaller cohorts. Implementing SUD treatments for individuals with co-occurring PTSD and AUD could be a way for providers to address clinical needs without learning another manual-guided treatment. Motivational enhancement therapy also shows promise as a way to increase treatment initiation among veterans and military personnel who are reluctant to enter treatment or address their substance misuse during treatment for PTSD, particularly if they perceive that substance use eases their PTSD symptoms. Among military and veteran populations, the risk for both PTSD and alcohol misuse may vary because of differences in demographic factors, aspects of military culture, and trauma or stress exposure.
- Two of these studies used the alpha-adrenergic medication prazosin and one study used the neurokinin-1 receptor antagonist aprepitant in a proof of concept laboratory study.
- Evidence-based PTSD interventions include prolonged exposure therapy, cognitive processing therapy, eye movement desensitization and reprocessing, psychotherapy incorporating narrative exposure, and present-centered therapy.
- Conversely, risk for who later develops a diagnosis, given exposure, may be different as well.
- There is little doubt that severe childhood adversity may place an individual at life-long risk for a variety of problems, including those related to mental health, physical health, employment, and legal difficulties (Putnam 2006).
- It is noteworthy that the studies involving a medication with a robust behavioral platform seem to have had the best results.
- It is possible these results may not generalize to men; comparisons based on gender were not possible.