People with post-traumatic stress disorder who also abuse alcohol benefit when both problems are treated simultaneously, a new study suggests.
Until now, mental health experts have been reluctant to treat post-traumatic stress disorder (PTSD) until patients have stopped drinking for fear that psychotherapy might stir up memories that would spark an urge to drink, the researchers said.
“A combination of a medication that reduces the urge for drinking and psychotherapy is very effective in reducing both the PTSD and the drinking,” said lead researcher Edna Foa, a professor of clinical psychology at the University of Pennsylvania.
“Even six months after the treatment stopped, the combined treatment of naltrexone to reduce drinking and prolonged exposure therapy for PTSD helped patients maintain their gains in reducing their drinking more than the therapy alone or the medication alone,” she said.
PTSD symptoms, which can be triggered by the memory of a terrifying event, may include flashbacks, nightmares and severe anxiety.
About 65 percent of patients with PTSD are also battling substance abuse, according to the study, which was published Aug. 7 in the Journal of the American Medical Association. The two often go hand in hand as people with PTSD turn to alcohol or drugs to try to quell their emotional reactions.
“This is an important study because of the high co-morbidity between PTSD and alcohol dependence and because clinicians have traditionally struggled with the notion of how best to treat this clinical population,” said Simon Rego, director of psychology training at Montefiore Medical Center and Albert Einstein College of Medicine in New York City.
The fear has been that addressing the PTSD triggers might exacerbate the alcohol dependence, while treating the alcohol dependence might exacerbate the PTSD symptoms, he said.
“As a result, these patients, who tend to have worse physical and mental health than patients with either disorder alone, have not received the adequate attention or care they deserve,” Rego said.
For the study, Foa’s team compared the effectiveness of the drug naltrexone, which is a treatment for alcohol dependence, combined with prolonged exposure therapy — a PTSD treatment that involves facing the disturbing recollections, situations or places that patients avoid. The two approaches were tried separately and together, along with supportive counseling.
Prolonged exposure therapy may reduce drinking by improving PTSD symptoms that can lead patients to self-medicate with alcohol, the researchers said.
In the study, 165 people with PTSD and alcohol dependence were assigned randomly to either prolonged exposure therapy plus naltrexone, prolonged exposure therapy plus a placebo pill, supportive counseling plus naltrexone or supportive counseling plus placebo. Prolonged exposure therapy consisted of 12 weekly 90-minute sessions followed by six bi-weekly sessions.
Drinking declined in all four groups, the researchers found. Patients receiving naltrexone, however, had the fewest drinking days while those taking the placebo had the most.
PTSD symptoms also declined in all the groups. The effect of prolonged exposure therapy alone was not significant, they said.
Six months after treatments were stopped, all the groups showed increases in drinking, but those who had prolonged exposure therapy plus naltrexone drank less than those in the other groups, the researchers found.
A New York City psychiatrist suggested the findings could change standard practice.
“Therapists working with patients with PTSD and alcohol dependence should strongly consider using prolonged exposure therapy along with naltrexone,” said Dr. Bryan Bruno, acting chairman of the department of psychiatry at Lenox Hill Hospital.