Cited by 137Posttraumatic Stress Disorder ResearchSubstance Abuse Treatment and OutcomesPsychotherapy Techniques and Applications

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Efficacy of Integrated Exposure Therapy vs Integrated Coping Skills Therapy for Comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A Randomized Clinical Trial

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Norman, Sonya B., Trim, Ryan, Haller, Moira, Davis, Brittany C., Myers, Ursula S., Colvonen, Peter J., Blanes, Erika, Lyons, Robert, Siegel, Emma Y., Angkaw, Abigail C., Norman, Gregory J., Mayes, Tina·2019·JAMA Psychiatry

DOI 10.1001/jamapsychiatry.2019.0638PMC PMC6487906

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Abstract

Importance: Co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common and associated with psychiatric and functional problems. Understanding whether exposure therapy is tolerable and efficacious for treating PTSD and AUD is critical to ensure that best practice treatments are available. Objective: To compare the efficacy of integrated (ie, targeting both PTSD and alcohol use) prolonged exposure (I-PE) therapy with present-centered integrated coping skills (I-CS) therapy, a more commonly available treatment, in reducing PTSD symptoms and alcohol use. Design, Setting, and Participants: This prospective randomized clinical trial with masked assessments considered 186 veterans seeking Veterans Affairs mental health services. A total of 119 veterans with PTSD and AUD were randomized. Data were collected from February 1, 2013, to May 31, 2017, before treatment, after treatment, and at 3- and 6-month follow-ups. Intention-to-treat analyses were performed. Interventions: Veterans underwent I-PE (Concurrent Treatment of PTSD and Substance Use Disorder Using Prolonged Exposure) or I-CS (Seeking Safety) therapy. Main Outcomes and Measures: A priori planned outcomes were PTSD symptoms (Clinician Administered PTSD Scale for DSM-5) and percentage of heavy drinking days (Timeline Follow-Back) before treatment, after treatment, and at 3- and 6-month follow-ups. Results: A total of 119 veterans (mean [SD] age, 41.6 [12.6] years; 107 [89.9%] male) were randomized. Linear mixture models found that PTSD symptoms decreased in both conditions, with a significantly greater decrease for I-PE treatment compared with I-CS treatment (treatment × time interaction, -2.83; F3,233.1 = 4.92; Cohen d = 0.41; P = .002). The percentage of heavy drinking days improved in both conditions but was not statistically different between I-PE and I-CS treatment (treatment × time interaction, 1.8%; F3,209.9 = 0.18; Cohen d = 0.04; P = .91). Conclusions and Relevance: The I-PE arm had a greater reduction in PTSD symptoms than the I-CS arm and comparable drinking decreases. The study provides evidence that exposure therapy is more efficacious in treating PTSD than a more commonly available integrated treatment without exposure for comorbid PTSD and AUD. Trial Registration: ClinicalTrials.gov identifier: NCT01601067.

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Authors: Norman, S. B., Trim, R., Haller, M., Davis, B. C., Myers, U. S., Colvonen, P. J., Blanes, E., Lyons, R., Siegel, E. Y., Angkaw, A. C., Norman, G. J., & Mayes, T.
Affiliations: University of California San Diego (US)
James A. Haley Veterans' Hospital (US)
Ralph H. Johnson VA Medical Center (US)
VA San Diego Healthcare System (US)
San Diego State University (US)
The University of Texas at Austin (US)
ORCID: Norman, Sonya B.
Trim, Ryan
Davis, Brittany C.
Myers, Ursula S.
Colvonen, Peter J.
Lyons, Robert
Siegel, Emma Y.
Angkaw, Abigail C.
Norman, Gregory J.
Mayes, Tina
Venue: JAMA Psychiatry
Publisher: American Medical Association (AMA)
Published: 2019-08-01
Volume: 76
Issue: 8
Pages: 791
ISSN: 2168-622X (ISSN-L)
DOI: 10.1001/jamapsychiatry.2019.0638
PMC: PMC6487906
OpenAlex: W2942415626
Cited by: 136
References: 56
Citations by year: 2026: 14 · 2025: 15 · 2024: 15 · 2023: 18 · 2022: 21 · 2021: 27 · 2020: 23 · 2019: 3
FWCI: 21.61
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Psychiatry (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Clinical Science Research and Development
National Institute on Alcohol Abuse and Alcoholism (T32AA013525)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: post-traumatic stress disorder, alcoholism, comorbidities, prolonged exposure therapy, Seeking Safety, veterans, heavy drinking, PTSD symptom reduction, treatment efficacy comparison, addiction treatment, trauma-focused psychotherapy, treatment tolerability, linear mixing model, treatment response heterogeneity
MeSH terms: Adaptation, Psychological, Adult, Alcoholism, Female, Follow-Up Studies, Humans, Implosive Therapy, Male, Middle Aged, Stress Disorders, Post-Traumatic, United States, United States Department of Veterans Affairs, Veterans, Comorbidity, Cognitive Behavioral Therapy, Outcome Assessment, Health Care

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Efficacy of Integrated Exposure Therapy vs Integrated Coping Skills Therapy for Comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A Randomized Clinical Trial

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