Taking the Edge Off With Alcohol?

PTSD with alcohol dependence may be effectively treated with medicine and therapy

(RxWiki News) A traumatic event sometimes leads traumatized people to try and ease the pressure by, among other means, drinking too much alcohol. But there are healthier, more effective ways to treat post-traumatic stress disorder.

Individuals diagnosed with post-traumatic stress disorder (PTSD) tend to worsen that problem by becoming too dependent on alcohol, according to authors of a new study about managing both illnesses.

The results of the study showed that individuals with PTSD who underwent extended periods of therapy and took naltrexone, a medication commonly prescribed to combat alcoholism, drank and craved less alcohol.

"Ask your doctor about treatment for PTSD."

Edna Foa, PhD, a clinical psychologist and director of the University of Pennsylvania's Center for the Treatment and Study of Anxiety, led this research.

From February 2001 through June 2009, Dr. Foa and her team of researchers monitored 165 people diagnosed with PTSD, who also were alcohol dependent. They had been traumatized by sexual or physical assault or as a result of military combat. They ranged from 36 through 47 years old.

They were defined as alcohol dependent if they consumed at least 12 alcoholic drinks per week, with at least four drinks consumed in one day.

The 165 patients were randomly assigned to one of four treatment groups:

  • Patients who took naltrexone (brand name Revia) and underwent 12 weekly 90-minute therapy sessions, followed by six therapeutic sessions every other week. This group also received supportive counseling with the sole purpose of helping patients manage their prescribed medication.
  • Patients who took a placebo pill containing no medicine received supportive counseling and underwent the 12 weekly therapy sessions, then the six sessions every other week.
  • Patients who received naltrexone and supportive counseling only.
  • Patients who received a placebo and supportive counseling only.

Members of each group were evaluated at three different points in time: before treatment began; after they had been in treatment for 24 weeks; and six months after treatment ended.

Before the patients began treatment, the researchers determined that those who ended up in the 90-minute therapy sessions and taking naltrexone had spent roughly 70 percent of the previous 90 days drinking too much alcohol.

Patients who ended up in 90-minute sessions and took placebos had spent almost 80 percent of the 90 days prior to treatment drinking too much alcohol.

Those in supportive counseling only who also took either naltrexone or the placebo had spent roughly 75 percent of the prior 90 days drinking too much alcohol.

At the 24-week checkpoint, all four groups combined were spending no more than about 13 percent of their days drinking too much alcohol.

Those taking naltrexone showed the lowest amount of alcohol over-consumption at that point, with roughly 5 percent of their days spent drinking too much, the researchers wrote.

Six months after all treatment ended, alcohol consumption had risen in all four groups. Those in the 90-minute therapy sessions who also took naltrexone, however, showed the least amount of increase. For that group, 10 percent of the previous 90 days had been spent drinking too much alcohol.

Those only in supportive counseling and taking a placebo showed the biggest increase in alcohol consumption six months after treatment ended. At that point, they had spent 30 percent of the previous 90 days drinking too much alcohol.

“Six months after the end of treatment...those in the prolonged exposure therapy plus naltrexone group had the smallest increases,” the researchers wrote. “Our trial demonstrates that...combined treatment with naltrexone and prolonged exposure therapy may decrease the rate of relapse of alcohol dependence for up to six months after treatment discontinuation."

"Medication with an anti-alcoholism medicine such as naltrexone may reduce the craving for alcohol, but medication will not effectively resolve the underlying emotional stress induced by trauma. This requires an appropriate form of psychotherapy, such as exposure therapy. It is, therefore to be expected that combined therapy would have greater efficacy," Peter Strong, PhD, professional psychotherapist and author of The Path of Mindfulness Meditation, told dailyRx News. 

The researchers said their study aimed to spotlight effective treatment for those suffering with PTSD and alcohol dependence at the same time.

According to these researchers, some prior research suggested that long-term therapy, such as the 90-minute sessions that were a part of this treatment, made alcohol-dependent PTSD patients drink more. Some older research also has suggested that alcoholism could not be effectively treated in people with PTSD.

This study was published online August 6 in JAMA.

The National Institute on Alcohol Abuse and Alcoholism helped fund this study. Several of its 10 researchers reported receiving research grants and/or travel expenses from the University of Pennsylvania, National Institutes of Health or US Department of Veterans Affairs (VA). The VA referred some of the study participants to researchers.

Review Date: 
August 6, 2013