Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: Revealing mechanisms of alcohol craving in a cue reactivity paradigm.

Coffey, Scott F.; Stasiewicz, Paul R.; Hughes, Pamela M.; Brimo, Marcella L.

doi:10.1037/0893-164x.20.4.425

Cited by 173Posttraumatic Stress Disorder ResearchSubstance Abuse Treatment and OutcomesAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: Revealing mechanisms of alcohol craving in a cue reactivity paradigm.

Coffey, Scott F., Stasiewicz, Paul R., Hughes, Pamela M., Brimo, Marcella L.·2006·Psychology of Addictive Behaviors

DOI 10.1037/0893-164x.20.4.425

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Abstract

With a sample (N = 43) of participants meeting current diagnostic criteria for both alcohol dependence and posttraumatic stress disorder (PTSD), the authors tested the hypothesis that alcohol craving elicited by a trauma cue might be attenuated if trauma-elicited negative emotion were reduced following trauma-focused imaginal exposure. In a laboratory-based experiment, participants were randomly assigned to either trauma-focused imaginal exposure or imagery-based relaxation. A cue reactivity paradigm was used to assess alcohol craving prior to, and after completion of, the 6 clinical sessions. Attrition was high but did not differ between experimental conditions. For study completers, PTSD symptoms decreased in the exposure condition but not in the relaxation condition. Alcohol craving and distress elicited by trauma images decreased in the exposure condition but did not change in the relaxation condition. Results support the hypothesis that negative emotion is a mechanism of alcohol craving.

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Stress cues similarly elicit craving by inducing anxiety.
“Furthermore, there is evidence that stress cues similarly elicit craving by inducing anxiety (Coffey, Stasiewicz, Hughes, & Brimo, 2006; Fox, Bergquist, Hong, & Sinha, 2007; Sinha & Li, 2007; Sinha et al., 2009; 2003).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Coffey, Stasiewicz, Hughes, & Brimo, 2006

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Background
Randomized controlled trial of cognitive behaviour therapy for comorbid post-traumatic stress disorder and alcohol use disorders
Sannibale, C., Teesson, M., Creamer, M. C., Sitharthan, T., Bryant, R. A., Sutherland, K., Taylor, K., matusko, D. B., Visser, A., & Peek-O’Leary, M. (2013) · Addiction · doi:10.1111/add.12167 · Cited by 119 · see citing works
A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder
Roberts, N. P., Lotzin, A., & Schäfer, I. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2022.2041831 · Cited by 120 · see citing works
Efficacy and acceptability of interventions for co-occurring PTSD and SUD: A meta-analysis
Simpson, T. L., Goldberg, S. B., Louden, D. N., Blakey, S. M., Hawn, S. E., Lott, A. M. K., Browne, K. C., Lehavot, K., & Kaysen, D. L. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102490 · Cited by 108 · see citing works
Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorders
Berenz, E. C., & Coffey, S. F. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0300-0 · Cited by 108 · see citing works
Self-citation
Concurrent treatment with prolonged exposure for co-occurring full or subthreshold posttraumatic stress disorder and substance use disorders: a randomized clinical trial
Ruglass, L. M., Lopez-Castro, T., Papini, S., Killeen, T., Back, S. E., & Hien, D. A. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000462977 · Cited by 105 · see citing works
Epidemiology and Management of Alcohol Dependence in Individuals with Post-Traumatic Stress Disorder
McCarthy, E., & Petrakis, I. L. (2010) · CNS Drugs · doi:10.2165/11539710-000000000-00000 · Cited by 98 · see citing works
A review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences
Korotana, L. M., Dobson, K. S., Pusch, D., & Josephson, T. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.04.007 · Cited by 101 · see citing works
Impulsivity and risk-taking in borderline personality disorder with and without substance use disorders.
Coffey, S., Schumacher, J., Baschnagel, J. S., Hawk, L., & Holloman, G. (2011) · Personality disorders · doi:10.1037/a0020574 · Cited by 98 · see citing works
Self-citation
Craving and physiological reactivity to trauma and alcohol cues in posttraumatic stress disorder and alcohol dependence.
Coffey, S. F., Schumacher, J. A., Stasiewicz, P. R., Henslee, A. M., Baillie, L. E., & Landy, N. C. (2010) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0019790 · Cited by 95 · see citing works
Self-citation
The effect of laboratory manipulations of negative affect on alcohol craving and use: A meta-analysis.
Bresin, K., Mekawi, Y., & Verona, E. (2018) · Psychology of Addictive Behaviors · doi:10.1037/adb0000383 · Cited by 90 · see citing works
The impact of intolerance of emotional distress and uncertainty on veterans with co-occurring PTSD and substance use disorders
Banducci, A. N., Bujarski, S. J., Bonn‐Miller, M. O., Patel, A. B., & Connolly, K. M. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.03.003 · Cited by 88 · see citing works
Trauma-focused exposure therapy for chronic posttraumatic stress disorder in alcohol and drug dependent patients: A randomized controlled trial.
Coffey, S. F., Schumacher, J. A., Nosen, E., Littlefield, A. K., Henslee, A. M., Lappen, A., & Stasiewicz, P. R. (2016) · Psychology of Addictive Behaviors · doi:10.1037/adb0000201 · Cited by 84 · see citing works
“Given there is evidence that substance craving in patients with PTSD-SUD can be elicited by trauma-related negative affect (e.g., Coffey et al. 2006), a few minutes of diaphragmatic breathing was completed at the end of each imaginal exposure session to return distress to baseline levels.”
BackgroundMethodSelf-citation
Stress- and cue-elicited craving and reactivity in marijuana-dependent individuals
McRae‐Clark, A. L., Carter, R. E., Price, K. L., Baker, N. L., Thomas, S., Saladin, M. E., Giarla, K., Nicholas, K. S., & Brady, K. T. (2011) · Psychopharmacology · doi:10.1007/s00213-011-2376-3 · Cited by 78 · see citing works
“The finding of increase in craving following a stressor is in line with several reports (Coffey et al. 2006; Fox et al. 2007; Sinha et al. 2009; Childs and de Wit 2010; Buchmann et al. 2010; Perkins and Grobe 1992) in other dependencies, though not all (Brady et al. 2006; Jansma et al. 2000;…”
Result
What works for whom and why: A narrative systematic review of interventions for reducing post-traumatic stress disorder and problematic substance use among women with experiences of interpersonal violence
Bailey, K., Trevillion, K., & Gilchrist, G. (2018) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2018.12.007 · Cited by 76 · see citing works
Predictors of postdeployment alcohol use disorders in National Guard soldiers deployed to Operation Iraqi Freedom.
Kehle, S. M., Ferrier‐Auerbach, A. G., Meis, L. A., Arbisi, P. A., Erbes, C. R., & Polusny, M. A. (2011) · Psychology of Addictive Behaviors · doi:10.1037/a0024663 · Cited by 72 · see citing works
Trauma-focused treatment for posttraumatic stress disorder combined with CBT for severe substance use disorder: a randomized controlled trial
van Dam, D., Ehring, T., Vedel, E., & Emmelkamp, P. M. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-172 · Cited by 71 · see citing works
“Recent evidence suggests that patients with concurrent PTSD and SUD may benefit from trauma-focused interventions, and that these interventions are more effective in reducing symptoms of PTSD than treatment-as-usual [1,32,33].”
Background
Drinking motives among heavy-drinking veterans with and without posttraumatic stress disorder
McDevitt‐Murphy, M. E., Fields, J. A., Monahan, C. J., & Bracken, K. L. (2014) · Addiction Research & Theory · doi:10.3109/16066359.2014.949696 · Cited by 70 · see citing works
Resilience Moderates the Relationship Between Exposure to Violence and Posttraumatic Reexperiencing in Mi’kmaq Youth
Zahradnik, M., Stewart, S. H., O’Connor, R. M., Stevens, D., Ungar, M. T., & Wekerle, C. (2009) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-009-9228-y · Cited by 70 · see citing works
“laboratory-based paradigm has shown that for individuals with both a diagnosis of PTSD and an alcohol use disorder, inducing reexperiencing through exposure to trauma cues increases alcohol cravings (Coffey et al. 2006).”
Method
Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms.
Hruska, B. J., Fallon, W. F., Spoonster, E., Sledjeski, E. M., & Delahanty, D. L. (2011) · Psychology of Addictive Behaviors · doi:10.1037/a0022439 · Cited by 69 · see citing works
Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior
Hellberg, S. N., Russell, T. I., & Robinson, M. J. F. (2019) · Cognitive, Affective, & Behavioral Neuroscience · doi:10.3758/s13415-018-00662-3 · Cited by 65 · see citing works
Examining the interactive effect of posttraumatic stress disorder, distress tolerance, and gender on residential substance use disorder treatment retention.
Tull, M. T., Gratz, K. L., Coffey, S. F., Weiss, N. H., & McDermott, M. J. (2012) · Psychology of Addictive Behaviors · doi:10.1037/a0029911 · Cited by 67 · see citing works
“…distress, number of psychiatric or substance-related hospitalizations, childhood physical or sexual abuse, substance use severity, type of SUD treatment, or the presence of other Axis I disorders (Brady et al., 2001; Coffey et al., 2006; Ford et al., 2007; Najavits, Weiss, Shaw et al., 1998).”
Self-citation
Specific and Nonspecific Psychological Interventions for PTSD Symptoms: A Meta‐Analysis With Problem Complexity as a Moderator
Gerger, H., Münder, T., & Barth, J. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.22059 · Cited by 65 · see citing works
Negative Affect, Emotional Acceptance, and Smoking Cessation
Carmody, T. P., Vieten, C., & Astin, J. A. (2007) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2007.10399889 · Cited by 85 · see citing works
“In addition, trauma-focused imaginal exposure has been shown to reduce alcohol cravings in patients with comorbid alcohol dependence and posttraumatic stress disorder (Coffey et al. 2006).”
Background
Incentivizing attendance to prolonged exposure for PTSD with opioid use disorder patients: A randomized controlled trial.
Schacht, R. L., Brooner, R. K., King, V. L., KIDORF, M. S., & Peirce, J. M. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000208 · Cited by 60 · see citing works
“As many as one-quarter of participants drop out before therapy starts (Coffey et al., 2006; Foa et al., 2013; Mills et al., 2012), and the average or median number of sessions attended ranges from 33% to 50% of scheduled sessions (Brady et al., 2001; Foa et al., 2013; Mills et al., 2012;…”
Background
A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder
Barawi, K., Lewis, C., Simon, N. A., & Bisson, J. I. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1774240 · Cited by 59 · see citing works
“…significant improvements in PTSD treatment, the complex psychopathology and frequency of co-morbid conditions such as depression can make PTSD difficult to treat (Coffey, Stasiewicz, Hughes, & Brimo, 2006) and suboptimal outcome or even treat-ment failure are not uncommon (Watts et al., 2013b).”
Background
Military sexual trauma, combat exposure, and negative urgency as independent predictors of PTSD and subsequent alcohol problems among OEF/OIF veterans.
Hahn, A. M., Tirabassi, C. K., Simons, R. M., & Simons, J. S. (2015) · Psychological Services · doi:10.1037/ser0000060 · Cited by 56 · see citing works
Cocaine‐related attentional bias following trauma cue exposure among cocaine dependent in‐patients with and without post‐traumatic stress disorder
Tull, M. T., McDermott, M. J., Gratz, K. L., Coffey, S. F., & Lejuez, C. W. (2011) · Addiction · doi:10.1111/j.1360-0443.2011.03508.x · Cited by 57 · see citing works
Self-citation
Changes in PTSD symptomatology during acute and protracted alcohol and cocaine abstinence
Coffey, S. F., Schumacher, J. A., Brady, K. T., & Cotton, B. D. (2006) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2006.08.025 · Cited by 54 · see citing works
Self-citation
Yohimbine increases opioid-seeking behavior in heroin-dependent, buprenorphine-maintained individuals
Greenwald, M. K., Lundahl, L. H., & Steinmiller, C. L. (2012) · Psychopharmacology · doi:10.1007/s00213-012-2868-9 · Cited by 53 · see citing works
“Human laboratory studies have found that acute psychological stressors can increase craving for alcohol (Coffey et al. 2006; Fox et al. 2007) and cocaine (Sinha et al.”
The neurokinin-1 receptor antagonist aprepitant in co-morbid alcohol dependence and posttraumatic stress disorder: a human experimental study
Kwako, L. E., George, D. T., Schwandt, M. L., Spagnolo, P. A., Momenan, R., Hommer, D. W., Diamond, C. A., Sinha, R., Shaham, Y., & Heilig, M. A. (2014) · Psychopharmacology · doi:10.1007/s00213-014-3665-4 · Cited by 54 · see citing works
“The interaction between PTSD and alcohol consumption is clinically important, as individuals with comorbid PTSD and alcoholism show less improvement during treatment, relapse more rapidly to heavy drinking, and have more drinking days posttreatment than alcoholics without PTSD (Coffey et al. 2006).”
Behavioral economic analysis of stress effects on acute motivation for alcohol
Owens, M. M., Ray, L. A., & MacKillop, J. M. (2014) · Journal of the Experimental Analysis of Behavior · doi:10.1002/jeab.114 · Cited by 51 · see citing works
Identifying Triggers of Alcohol Craving to Develop Effective Virtual Environments for Cue Exposure Therapy
Ghiţă, A., Teixidor, L., Monràs, M., Ortega, L., Mondón, S., Gual, A., Paredes, S. M., Urgell, L. V., Porras-García, B., Ferrer‐García, M., et al. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00074 · Cited by 51 · see citing works
Affect intensity and lability: the role of posttraumatic stress disorder symptoms in borderline personality disorder
Marshall‐Berenz, E. C., Morrison, J. A., Schumacher, J. A., & Coffey, S. F. (2011) · Depression and Anxiety · doi:10.1002/da.20798 · Cited by 44 · see citing works
“, substance use disorders); PTSD treatment is related to improvements in co-occurring pathology [45, 46, 47, 48, 49]; and individuals with BPD characteristics are equally likely to complete and benefit from PTSD treatment [50].”
BackgroundSelf-citation
A Preliminary Experimental Investigation of Emotion Dysregulation and Impulsivity in Risky Behaviours
Weiss, N. H., Tull, M. T., Davis, L. T., Searcy, J., Williams, I., & Gratz, K. L. (2015) · Behaviour Change · doi:10.1017/bec.2015.5 · Cited by 38 · see citing works
Does trauma-focused exposure therapy exacerbate symptoms among patients with comorbid PTSD and substance use disorders?
Lancaster, C. L., Grös, D. F., Mullarkey, M. C., Badour, C. L., Killeen, T. K., Brady, K. T., & Back, S. E. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000304 · Cited by 36 · see citing works
“However, the authors did not examine the presence of symptom exacerbation during the process of completing COPE, and prior research suggests that symptom exacerbation (if present) would probably occur closer to the onset of exposure therapy (e.g. Coffey et al., 2002, 2006).”
Background
Co-occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veteran Populations
Carter, A. C., Capone, C., & Short, E. E. (2011) · Journal of Dual Diagnosis · doi:10.1080/15504263.2011.620453 · Cited by 37 · see citing works
“An experimental study ( N = 43) measuring craving before and after exposure-based, integrated treatment revealed that extinction of negative responses to trauma cues led directly to reductions in PTSD and alcohol use disorder symptoms among individuals seeking outpatient treatment for substance abuse (Coffey, Stasiewi…”
Background
An Acute Psychosocial Stressor Does Not Potentiate Alcohol Cue Reactivity in Non-Treatment-Seeking Alcoholics
Thomas, S. E., Randall, P. K., Brady, K. T., See, R. E., & Drobes, D. J. (2010) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2010.01363.x · Cited by 34 · see citing works
“…et al., 1996; Lovallo et al., 2000), and it has been proposed that normalizing the stress response or reducing stress reactivity, either by medication or behavioral treatment, might reduce risk of relapse (Coffey et al., 2006; Kiefer et al., 2006; O’Malley et al., 2002; Stasiewicz et al., 1997).”
BackgroundResultInfluential
Treatment of co-occurring PTSD–AUD: Effects of exposure-based and non-trauma focused psychotherapy on alcohol and trauma cue-reactivity
Nosen, E., Littlefield, A. K., Schumacher, J. A., Stasiewicz, P. R., & Coffey, S. F. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.003 · Cited by 35 · see citing works
Self-citation
Treatment of alcohol use disorder and co-occurring PTSD
Taylor, M., Petrakis, I. L., & Ralevski, E. (2016) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2016.1263641 · Cited by 36 · see citing works
“(53) evaluated imaginal exposure therapy versus imagery-based relaxation in a small sample (n = 43) of patients with comorbid PTSD”
BackgroundInfluential
Exposure therapy for posttraumatic stress disorder in a residential substance use treatment facility.
Henslee, A. M., & Coffey, S. F. (2010) · Professional Psychology Research and Practice · doi:10.1037/a0018235 · Cited by 34 · see citing works
“Treating Trauma in Residential Substance Use Treatment Programs There is growing evidence that exposure therapy is effective in treating the trauma-related symptoms of substance dependent clients (Brady et al., 2001; Coffey et al., 2006; Najavits, Schmitz, Gotthardt, & Weiss, 2005).”
BackgroundMethodInfluentialSelf-citation
Application of the stressor vulnerability model to understanding posttraumatic stress disorder (PTSD) and alcohol-related problems in an undergraduate population.
Hruska, B. J., & Delahanty, D. L. (2012) · Psychology of Addictive Behaviors · doi:10.1037/a0027584 · Cited by 34 · see citing works
“In addition, experimental research using cue-reactivity methodology (Coffey et al., 2002; Coffey et al., 2006) could be used to determine if individuals with PTSD-AUD comorbidity and the vulnerability factors considered in the present study experience greater craving and distress when exposed to…”
Method
Stress Allostasis in Substance Use Disorders: Promise, Progress, and Emerging Priorities in Clinical Research
Fronk, G. E., Sant'Ana, S. J. K., Kaye, J. T., & Curtin, J. J. (2020) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-102419-125016 · Cited by 32 · see citing works
“Stress-induced craving has also been confirmed both for cocaine use disorder and AUD (Coffey et al. 2002, 2006, 2010; Cooney et al. 1997; Fox et al. 2008; Ray 2011; Sinha et al. 2003, 2009), though there have been several null findings for AUD as well ( Jansma et al. 2000, Mason et al. 2008, Pratt…”
BackgroundInfluential
Evaluation of the Alcohol Craving Questionnaire-Now factor structures: Application of a cue reactivity paradigm
Connolly, K. M., Coffey, S. F., Baschnagel, J. S., Drobes, D. J., & Saladin, M. E. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.03.019 · Cited by 31 · see citing works
“Although craving is often assessed as a unitary construct, commonly measured with a single self-report visual analog scale (e.g., Coffey et al., 2006), recent evidence suggests that craving assumes multiple dimensions, which generally correspond to behavioral, cognitive and emotional factors (e.g.,…”
BackgroundInfluentialSelf-citation
Methodology of a randomized double-blind clinical trial for comorbid posttraumatic stress disorder and alcohol dependence
Foa, E., & Williams, M. T. (2010) · Mental Health and Substance Use · doi:10.1080/17523281003738661 · Cited by 34 · see citing works
“, 2003) and comorbid PTSD-AD (Coffey et al., 2006; Heinala et al. 2001).”
Development of a novel, integrated cognitive-behavioral therapy for co-occurring posttraumatic stress and substance use disorders: A pilot randomized clinical trial
Vujanovic, A. A., Smith, L. J., Green, C. E., Lane, S. D., & Schmitz, J. M. (2017) · Contemporary Clinical Trials · doi:10.1016/j.cct.2017.12.013 · Cited by 29 · see citing works
“, [24–30]], (2) empirical support for cue reactivity as a mechanism of change in PTSD/SUD treatment [25,26,31,32], and (3) theoretical models purporting DT as a pertinent treatment target and change mechanism in PTSD/SUD [33].”
Background
The Impact of Co-occurring Post-traumatic Stress Disorder and Substance Use Disorders on Craving: A Systematic Review of the Literature
Renaud, F., Jakubiec, L., Swendsen, J. D., & Fatseas, M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.786664 · Cited by 29 · see citing works
“Moreover, laboratory studies have also shown that exposure to stress-related events among individuals with alcohol use disorder (AUD) reliably elicits craving in a manner that is as powerful as alcohol-related cues (30, 31).”
BackgroundInfluential
Distress tolerance: Associations with trauma and substance cue reactivity in low-income, inner-city adults with substance use disorders and posttraumatic stress.
Vujanovic, A. A., Wardle, M. C., Bakhshaie, J., Smith, L. J., Green, C. E., Lane, S. D., & Schmitz, J. M. (2018) · Psychology of Addictive Behaviors · doi:10.1037/adb0000362 · Cited by 29 · see citing works
“Overall, this literature suggests that desensitization to trauma cues via intervention, for example, can have implications for not only PTSD symptom severity but also substance use cravings and urges (e.g., Coffey et al., 2006).”
Background
Craving and emotional responses to trauma and cannabis cues in trauma-exposed cannabis users: Influence of PTSD symptom severity
Romero‐Sanchiz, P., Mahu, I. T., Barrett, S. P., Salmon, J. P., Al‐Hamdani, M., Swansburg, J. E., & Stewart, S. H. (2021) · Addictive Behaviors · doi:10.1016/j.addbeh.2021.107126 · Cited by 27 · see citing works
Substance use disorders and PTSD: Examining substance use, PTSD symptoms, and dropout following imaginal exposure
Jarnecke, A. M., Allan, N. P., Badour, C. L., Flanagan, J. C., Killeen, T. K., & Back, S. E. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.10.020 · Cited by 27 · see citing works
The impact of treatment condition and the lagged effects of PTSD symptom severity and alcohol use on changes in alcohol craving
Kaczkurkin, A. N., Asnaani, A., Alpert, E., & Foa, E. B. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.02.001 · Cited by 25 · see citing works
“However, the analyses in the Coffey et al. (2006) study were based on completers only and the experimental paradigm did not include a follow-up period.”
BackgroundMethodResultInfluential
Trauma‐ and Stress‐Induced Response in Veterans with Alcohol Dependence and Comorbid Post‐Traumatic Stress Disorder
Ralevski, E., Southwick, S. M., Jackson, E. D., Jane, J. S., Russo, M., & Petrakis, I. L. (2016) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.13120 · Cited by 25 · see citing works
“…have shown that (i) stress reliably elicits craving (Fox et al., 2008; Sinha et al., 2009) and is as powerful as alcohol cues in eliciting craving (Coffey et al., 2006), (ii) cue-induced craving, and higher levels of stress-induced anxiety, predict shorter time to relapse (Sinha et al., 2011) and…”
BackgroundInfluential
Cue-Elicited Affect and Craving
Nosen, E., Nillni, Y. I., Berenz, E. C., Schumacher, J. A., Stasiewicz, P. R., & Coffey, S. F. (2012) · Behavior Modification · doi:10.1177/0145445512446741 · Cited by 24 · see citing works
“When examining alcohol cue-elicited craving in the context of trauma cues (i.e., TA-TN responses), negative affect was positively correlated with craving, a finding consistently demonstrated in previous work (Coffey et al., 2002; Coffey et al., 2006; Saladin et al., 2003).”
ResultSelf-citation
Characterization of comorbid PTSD in treatment-seeking alcohol dependent inpatients: Severity and personality trait differences
Sells, J. R., Waters, A. J., Schwandt, M. L., Kwako, L. E., Heilig, M. A., George, D. T., & Ramchandani, V. A. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.03.016 · Cited by 24 · see citing works
“Individual trauma-focused CBT (including prolonged exposure) alongside SUD treatment (which can include naltrexone or coping skills development), are promising integrated concurrent treatments for AD/PTSD+ (Coffey et al., 2006; Foa et al., 2013; Mills et al., 2012).”
Background
Understanding the role of childhood abuse and neglect as a cause and consequence of substance abuse: the German CANSAS network
Schäfer, I., Pawils, S., Drießen, M., Härter, M. C., Hillemacher, T., Klein, M., Muehlhan, M., Ravens‐Sieberer, U., Schäfer, M., Scherbaum, N., et al. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1304114 · Cited by 24 · see citing works
Adults with Comorbid Posttraumatic Stress Disorder, Alcohol Use Disorder, and Opioid Use Disorder: The Effectiveness of Modified Prolonged Exposure
Peck, K. R., Schumacher, J. A., Stasiewicz, P. R., & Coffey, S. F. (2018) · Journal of Traumatic Stress · doi:10.1002/jts.22291 · Cited by 23 · see citing works
Self-citation
Treatment of PTSD and substance abuse comorbidity.
Souza, T. M., & Spates, C. R. (2008) · The Behavior Analyst Today · doi:10.1037/h0100643 · Cited by 23 · see citing works
Effectiveness of EMDR in patients with substance use disorder and comorbid PTSD: study protocol for a randomized controlled trial
Schäfer, I., Chuey-Ferrer, L., Hofmann, A., Liebermann, P., Mainusch, G., & Lotzin, A. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1255-9 · Cited by 23 · see citing works
“As patients may use substances to regulate PTSDrelated symptoms [12, 52], it could be expected that trauma-focused treatment might also reduce SUD symptoms.”
Background
Positive and negative affect change following psychotherapeutic treatment for anxiety-related disorders: A systematic review and meta-analysis
Hoffman, S. N., Rassaby, M. M., Stein, M. B., & Taylor, C. T. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.01.086 · Cited by 22 · see citing works
Trauma- und Gewaltfolgen – psychische Auswirkungen
Maercker, A. R. A., & Hecker, T. (2015) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-015-2259-6 · Cited by 22 · see citing works
Does Stress Increase Imitation of Drinking Behavior? An Experimental Study in a (Semi‐)Naturalistic Context
Larsen, H., Engels, R. C. M. E., Granic, I., & Huizink, A. C. (2012) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2012.01942.x · Cited by 22 · see citing works
“, the underlying mechanism of cuereactivity) are inconsistent (e.g., Brady et al., 2006; Coffey et al., 2006; Pratt and Davidson, 2009; Sinha et al., 2009; see a discussion of this in Thomas et al., 2011b), future research is necessary.”
Background
Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders
Vinci, C., Mota, N. P., Berenz, E. C., & Connolly, K. M. (2016) · Military Psychology · doi:10.1037/mil0000100 · Cited by 20 · see citing works
“Further, treatment dropout for individuals diagnosed with PTSD and SUD are high (Back et al., 2001; Coffey et al., 2006).”
Background
Using the research domain criteria framework to track domains of change in comorbid PTSD and SUD.
Zambrano‐Vazquez, L., Levy, H. C., Belleau, E. L., Dworkin, E. R., Sharp, K. M. H., Pittenger, S. L., Schumacher, J. A., & Coffey, S. F. (2017) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000257 · Cited by 20 · see citing works
Self-citation
Prolonged exposure therapy for posttraumatic stress disorder among individuals in a residential substance use treatment program: A case series.
Berenz, E. C., Rowe, L., Schumacher, J. A., Stasiewicz, P. R., & Coffey, S. F. (2012) · Professional Psychology Research and Practice · doi:10.1037/a0026138 · Cited by 20 · see citing works
“One exception is the Veterans Health Administration (VHA), which now mandates that all VA PTSD programs must be able to address the needs of clients with cooccurring SUDs (Veterans Health Administration, 2008).”
ResultInfluentialSelf-citation
The Effect of Trauma Cue Exposure on Cocaine Cravings among Cocaine Dependent Inpatients with and without Posttraumatic Stress Disorder: Exploring the Mediating Role of Negative Affect and Discrete Negative Emotional States
Tull, M. T., Kiel, E. J., McDermott, M. J., & Gratz, K. L. (2013) · Journal of Experimental Psychopathology · doi:10.5127/jep.028812 · Cited by 20 · see citing works
Race-specific associations between trauma cognitions and symptoms of alcohol dependence in individuals with comorbid PTSD and alcohol dependence
Williams, M. T., Jayawickreme, N., Sposato, R., & Foa, E. B. (2011) · Addictive Behaviors · doi:10.1016/j.addbeh.2011.08.008 · Cited by 20 · see citing works
Self-medicating low mood with alcohol use: Examining the role of frequency of alcohol use, quantity consumed and context of drinking
Hugh, R. M., & McBride, O. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106557 · Cited by 18 · see citing works
Maximizing the utility of a single site randomized controlled psychotherapy trial
Norman, S. B., Haller, M. M., Spadoni, A. D., Drummond, S. P. A., Risbrough, V. B., Hamblen, J. L., Trim, R. S., & Blanes, E. X. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.04.011 · Cited by 18 · see citing works
“Published data from Coffey and colleagues [16] examining treatment effects of exposure based therapy against imagery based relaxation, indicated an effect size of .”
Background
Mediators of interpersonal violence and drug addiction severity among methamphetamine users in Cape Town, South Africa
Hobkirk, A. L., Watt, M. H., Green, K. T., Beckham, J. C., Skinner, D. G., & Meade, C. S. (2014) · Addictive Behaviors · doi:10.1016/j.addbeh.2014.11.030 · Cited by 18 · see citing works
The Effects of Prolonged Exposure on Substance Use in Patients With Posttraumatic Stress Disorder and Substance Use Disorders
Peirce, J. M., Schacht, R. L., & Brooner, R. K. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22546 · Cited by 19 · see citing works
An Update on the Efficacy of Cognitive-Behavioral Therapy, Cognitive Therapy, and Exposure Therapy for Posttraumatic Stress Disorder
Mello, P. G., Silva, G. R., Donat, J. C., & Kristensen, C. H. (2013) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.46.4.b · Cited by 17 · see citing works
“Exposure Therapies versus Other Treatments We obtained nine studies [17, 20-22, 27, 37, 38, 41, 43] comparing ET to other types of treatment.”
Method
Emotional Processing in Individuals with Substance Use Disorder and Posttraumatic Stress Disorder
Kemmis, L. K., Wanigaratne, S., & Ehntholt, K. A. (2017) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-016-9727-6 · Cited by 16 · see citing works
“In the USA, an integrated exposure-based treatment model has been advanced for SUDPTSD (Najavits et al. 2005; see also Coffey et al. 2006; Mills et al. 2012).”
BackgroundMethod
Examining the Role of Antisocial Personality Disorder in Intimate Partner Violence Among Substance Use Disorder Treatment Seekers With Clinically Significant Trauma Histories
Dykstra, R. E., Schumacher, J. A., Mota, N. P., & Coffey, S. F. (2015) · Violence Against Women · doi:10.1177/1077801215589377 · Cited by 16 · see citing works
Self-citation
Post-traumatic stress and alcohol use disorders: recent advances and future directions in cue reactivity
Vujanovic, A. A., Lebeaut, A., Zegel, M., Smit, T., & Berenz, E. C. (2019) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2019.04.003 · Cited by 16 · see citing works
Substanzbezogene Störungen als Ursache und als Folge früher Gewalt
CANSAS Study Group, Schäfer, I., Barnow, S., & Pawils, S. (2015) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-015-2264-9 · Cited by 15 · see citing works
Anxiety Psychopathology and Alcohol Use among Adolescents: A Critical Review of the Empirical Literature and Recommendations for Future Research
Blumenthal, H., Leen‐Feldner, E. W., Badour, C. L., & Babson, K. A. (2011) · Journal of Experimental Psychopathology · doi:10.5127/jep.012810 · Cited by 15 · see citing works
Posttraumatic Stress Disorder and Substance Use Disorder: Neuroimaging, Neuroendocrine, and Psychophysiological Findings
Coffey, S. F., Read, J. P., & Norberg, M. M. (2007) · Springer eBooks · doi:10.1007/978-0-387-74290-8_3 · Cited by 14 · see citing works
“To follow up on the findings described above, Coffey and colleagues (Coffey et al., 2006) tested the hypothesis that alcohol craving elicited by a trauma cue might be attenuated if trauma-elicited negative affect was reduced following trauma-focused imaginal exposure.”
BackgroundSelf-citation
Trauma und Sucht: Implikationen für die Psychotherapie
Potthast, N., & Catani, C. (2012) · SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice · doi:10.1024/0939-5911.a000191 · Cited by 14 · see citing works
University of Rhode Island Change Assessment–Trauma: Preliminary psychometric properties in an alcohol‐dependent PTSD sample
Hunt, Y. M., Kyle, T. L., Coffey, S. F., Stasiewicz, P. R., & Schumacher, J. A. (2006) · Journal of Traumatic Stress · doi:10.1002/jts.20161 · Cited by 14 · see citing works
Self-citation
Treating PTSD in pregnant and postpartum rural women with substance use disorders.
Dworkin, E. R., Zambrano‐Vazquez, L., Cunningham, S. R., Pittenger, S. L., Schumacher, J. A., Stasiewicz, P. R., & Coffey, S. F. (2017) · Rural Mental Health · doi:10.1037/rmh0000057 · Cited by 14 · see citing works
“Indeed, an adapted PE protocol for populations with co-occurring PTSD-SUD evidenced reductions in trauma symptoms in both an experimental study and a clinical trial (Brady et al., 2001; Coffey et al., in press; Coffey et al., 2006).”
MethodSelf-citation
The relationship between perceived stress and cue sensitivity for alcohol
Snelleman, M., Schoenmakers, T. M., & van de Mheen, D. (2014) · Addictive Behaviors · doi:10.1016/j.addbeh.2014.07.024 · Cited by 13 · see citing works
The role of childhood trauma and stress reactivity for increased alcohol craving after induced psychological trauma: an experimental analogue study
Trautmann, S., Kräplin, A., Dieterich, R., Richter, J., & Muehlhan, M. (2018) · Psychopharmacology · doi:10.1007/s00213-018-4979-4 · Cited by 13 · see citing works
Trauma- and Stress-Induced Craving for Alcohol in Individuals Without PTSD
Ralevski, E., Southwick, S. M., & Petrakis, I. L. (2019) · Alcohol and Alcoholism · doi:10.1093/alcalc/agz092 · Cited by 14 · see citing works
Psychotherapie bei Abhängigkeits- erkrankungen und Posttraumatischer Belastungsstörung
Schäfer, I., Schulze, C., & Stubenvoll, M. (2011) · SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice · doi:10.1024/0939-5911.a000138 · Cited by 13 · see citing works
Developing Signs of Safety: A Deaf-Accessible Counseling Toolkit for Trauma and Addiction
Anderson, M. L., Glickman, N., Craig, K. S. W., Crane, A. K. S., Wilkins, A. M., & Najavits, L. (2021) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.2596 · Cited by 7 · see citing works
“little is known about the functioning of Deaf clients with this particular comorbidity, hearing individuals with comorbid trauma and SUD have greater physical and social impairment, higher rates of mood, anxiety, and personality disorders, and increased substance craving in response to trauma symptoms compared with th…”
Background
Prolonged exposure therapy for PTSD in individuals with opioid use disorder: A randomized pilot study
Peck, K. R., Badger, G. J., Cole, R., Higgins, S. T., Moxley‐Kelly, N., & Sigmon, S. C. (2023) · Addictive Behaviors · doi:10.1016/j.addbeh.2023.107688 · Cited by 13 · see citing works

Treatment of co-occurring PTSD–AUD: Effects of exposure-based and non-trauma focused psychotherapy on alcohol and trauma cue-reactivity
Nosen, E., Littlefield, A. K., Schumacher, J. A., Stasiewicz, P. R., & Coffey, S. F. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.003 · Cited by 35 · see citing works
Self-citation
Negative affect and alcohol craving in trauma‐exposed young adult drinkers
Berenz, E. C., Zakeri, S. E., Demos, A. P., Paltell, K. C., Bing‐Canar, H., Kevorkian, S. S., & Ranney, R. M. (2021) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.14641 · Cited by 9 · see citing works
Craving and physiological reactivity to trauma and alcohol cues in posttraumatic stress disorder and alcohol dependence.
Coffey, S. F., Schumacher, J. A., Stasiewicz, P. R., Henslee, A. M., Baillie, L. E., & Landy, N. C. (2010) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0019790 · Cited by 95 · see citing works
Self-citation
Cue-Elicited Affect and Craving
Nosen, E., Nillni, Y. I., Berenz, E. C., Schumacher, J. A., Stasiewicz, P. R., & Coffey, S. F. (2012) · Behavior Modification · doi:10.1177/0145445512446741 · Cited by 24 · see citing works
Self-citation
Trauma‐ and Stress‐Induced Response in Veterans with Alcohol Dependence and Comorbid Post‐Traumatic Stress Disorder
Ralevski, E., Southwick, S. M., Jackson, E. D., Jane, J. S., Russo, M., & Petrakis, I. L. (2016) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.13120 · Cited by 25 · see citing works

Authors: Coffey, S. F., Stasiewicz, P. R., Hughes, P. M., & Brimo, M. L.
Affiliations: University of Mississippi Medical Center (US)
University at Buffalo, State University of New York (US)
ORCID: Stasiewicz, Paul R.
Venue: Psychology of Addictive Behaviors
Publisher: American Psychological Association (APA)
Published: 2006-12
Volume: 20
Issue: 4
Pages: 425-435
ISSN: 0893-164X (ISSN-L)
1939-1501
DOI: 10.1037/0893-164x.20.4.425
OpenAlex: W2081541741
Semantic Scholar: 9abb540d1db2654567f1f105ab47130d68ead760
Cited by: 172
References: 69
Citations by year: 2026: 3 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 12 · 2020: 12 · 2019: 6 · 2018: 13 · 2017: 14 · 2016: 13 · 2015: 12 · 2014: 7 · 2013: 15 · 2012: 14
FWCI: 3.69
Type: journal article
Language: en
Open access: closed
Locations: Psychology of Addictive Behaviors (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute on Alcohol Abuse and Alcoholism (AA13308)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: post-traumatic stress disorder, alcoholism, alcohol craving, cue reactivity, negative emotions, comorbidities, PTSD treatment
MeSH terms: Adult, Alcoholism, Arousal, Cues, Desensitization, Psychologic, Female, Humans, Imagination, Male, Middle Aged, Motivation, Pain Measurement, Patient Dropouts, Stress Disorders, Post-Traumatic, Comorbidity

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Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: Revealing mechanisms of alcohol craving in a cue reactivity paradigm.

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