Laboratory research has provided further evidence supporting the self-medication theory of comorbid PTSD and alcohol use disorder. Studies have found that physiological arousal in general, both within and without the context of trauma cues, led to increased craving for alcohol and other substances (Coffey et al., 2002; Steindl, Young, Creamer, & Crompton, 2003). In a cue-reactivity experiment among dually diagnosed individuals, severity of PTSD predicted increased craving during exposure to personalized trauma-related and substance cues (Saladin et al., 2003).

We provide many options for Veterans seeking treatment for substance use problems ranging from unhealthy alcohol use to life-threatening addiction. There is no single ideal type of program for the treatment of co-occurring PTSD and SUD. To improve access to optimal care, in 2008 VA authorized funding for an SUD specialist to augment each facility’s specialty PTSD treatment services. These specialists work with PTSD specialty treatment providers to coordinate treatment planning and delivery of services and provide clinical care. Several studies have found limited success with adding a selective serotonin reuptake inhibitor (SSRI) to SUD treatment as usual (21-23). One recent study found that the combination of PE plus naltrexone was more effective in reducing drinking 6 months following treatment completion than either treatment was alone (24).

Research Regarding the Treatment of Co-Occurring PTSD and SUD

Motivational enhancement therapy also shows promise as a way to increase treatment initiation among veterans and military personnel who are reluctant to enter treatment or address their substance misuse during treatment for PTSD, particularly if they perceive that substance use eases their PTSD symptoms. Couple treatment for AUD and PTSD (CTAP) is a 15-session manualguided (also known as “manualized”) therapy that integrates behavioral couples therapy for AUD with cognitive behavioral conjoint therapy for PTSD.48 In an uncontrolled trial, 13 male veterans and their female partners enrolled, and 9 couples completed the CTAP program. Among military and veteran populations, the risk for both PTSD and alcohol misuse may vary because of differences in demographic factors, aspects of military culture, and trauma or stress exposure. Relatively little research has addressed risk factors for co-occurring PTSD and AUD. Therefore, we do not know the extent that risk factors may increase the risk for one disorder or both, or whether these risk factors may have additive or interactive effects.

Let your loved one know that you will be there to support him or her through therapy and after. Many people with PTSD start to feel numb or say that they don’t have any feelings other than https://ecosoberhouse.com/article/binge-drinking-how-to-stop-binge-drinking/ anger. It is important that you allow yourself to experience your feelings instead of pushing them away. This includes feelings that most of us don’t like, such as sadness, fear, and grief.

We offer counseling and other therapy options, like:

Don’t be afraid if he or she starts to show more emotions when treatment starts. Showing emotions is actually a sign that your loved ptsd and alcoholism one is getting better, not worse! It may look like your loved one is “getting worse” or “falling apart,” but this isn’t true.

Self-compassion has been posited to activate the self-soothing system, which may reduce the overwhelming negative emotions that can arise following difficult experiences (Gilbert & Irons, 2005). In the context of trauma, individuals who fear self-compassion may experience a greater challenge moderating these trauma-related emotions. Inability to regulate these emotions may result in more severe posttraumatic reactions, potentially motivating maladaptive ways of responding (e.g., alcohol use).

Treatment of Co-Occurring PTSD and Substance Use Disorder in VA

The veteran described in the case participated in integrated Cognitive Behavioral Therapy treatment for PTSD and alcohol use disorder. A strong focus on the relationship between his PTSD symptoms and alcohol use was maintained throughout the course of treatment. The veteran began Cognitive Processing Therapy, which included both cognitive and exposure elements of treatment, after building trust in the therapeutic process, and he became increasingly more amenable to various treatment modalities, including Seeking Safety.