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

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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.

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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“, 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 30
“, [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
“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
“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 30
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
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 26
“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
“…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
“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
“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
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
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
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 26
“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
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
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
“, 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
“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
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
“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
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
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 20
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 17
“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
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
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 21
“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
“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
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
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
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 17
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
“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
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 15
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
“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
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 16
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
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
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
“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

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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