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Cited by 45Posttraumatic Stress Disorder ResearchSubstance Abuse Treatment and OutcomesPsychotherapy Techniques and Applications

Predictors of dropout in concurrent treatment of posttraumatic stress disorder and alcohol dependence: rate of improvement matters

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Zandberg, Laurie J., Rosenfield, David, Alpert, Elizabeth, McLean, Carmen P., Foa, Edna B.·2016·Behaviour Research and Therapy
DOI 10.1016/j.brat.2016.02.005PMC PMC4828304
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Abstract

Objective The present study examined predictors and moderators of dropout among 165 adults meeting DSM-IV criteria for posttraumatic stress disorder (PTSD) and alcohol dependence (AD). Participants were randomized to 24 weeks of naltrexone (NAL), NAL and prolonged exposure (PE), pill placebo, or pill placebo and PE. All participants received supportive AD counseling (the BRENDA manualized model).Method Logistic regression using the Fournier approach was conducted to investigate baseline predictors of dropout across the entire study sample. Rates of PTSD and AD symptom improvement were included to evaluate the impact of symptom change on dropout.Results Trauma type and rates of PTSD and AD improvement significantly predicted dropout, accounting for 76% of the variance in dropout. Accidents and "other" trauma were associated with the highest dropout, and physical assault was associated with the lowest dropout. For participants with low baseline PTSD severity, faster PTSD improvement predicted higher dropout. For those with high baseline severity, both very fast and very slow rates of PTSD improvement were associated with higher dropout. Faster rates of drinking improvement predicted higher dropout among participants who received PE.Conclusions The current study highlights the influence of symptom trajectory on dropout risk. Clinicians may improve retention in PTSD-AD treatments by monitoring symptom change at regular intervals, and eliciting patient feedback on these changes.

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  • In a trial of prolonged exposure with naltrexone for comorbid PTSD and alcohol dependence, both fast and slow PTSD symptom improvement and fast drinking improvement were associated with early dropout.

    “in a clinical trial of prolonged exposure with naltrexone for comorbid posttraumatic stress disorder (PTSD) and alcohol dependence, both fast and slow rates of PTSD symptom improvement, as well as fast rates of drinking improvement, were each associated with early dropout (Zandberg et al., 2016).”

    From Identifying attendance patterns in a smoking cessation treatment and their relationships with quit success (2017) · cites this paper as Zandberg et al., 2016

    The Abstract Results and Discussion report higher dropout with both very fast and very slow PTSD improvement among participants with high baseline PTSD severity, and with faster drinking improvement among participants receiving prolonged exposure. The claim omits those conditions and calls the outcome “early dropout,” whereas the reported associations concern dropout during treatment, not specifically early dropout. The Methods also show that prolonged exposure and naltrexone were separate randomized factors, not a treatment everyone received together; page numbers are unavailable in our copy. (LLM, conf=0.88)

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  1. Sobell LC Sobell MB 1992 Timeline follow-back: A technique for assessing self-reported alcohol consumption Measuring alcohol consumption: Psychosocial and biochemical methods 41 72 Totowa, NJ Humana Press

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Authors
Zandberg, L. J., Rosenfield, D., Alpert, E., McLean, C. P., & Foa, E. B.
Affiliations
  • University of Pennsylvania (US)
  • Southern Methodist University (US)
Corresponding author
Zandberg, Laurie J.
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2016-05
Volume
80
Pages
1-9
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2016.02.005
PMC
PMC4828304
OpenAlex
W2292706676
Cited by
45
References
57
Citations by year
2026: 3 · 2025: 4 · 2024: 3 · 2023: 4 · 2022: 5 · 2021: 6 · 2020: 4 · 2019: 3 · 2018: 9 · 2017: 4
FWCI
7.14
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Alcohol Abuse and Alcoholism (R01AA012428)
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, treatment discontinuation, predictors of dropout, prolonged exposure therapy, naltrexone, supportive counseling, symptom improvement, symptom trajectories, trauma type, physical assault, treatment retention
MeSH terms
Adult, Alcoholism, Combined Modality Therapy, Female, Humans, Implosive Therapy, Male, Middle Aged, Naltrexone, Patient Dropouts, Predictive Value of Tests, Severity of Illness Index, Stress Disorders, Post-Traumatic, Treatment Outcome

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