Alcohol Treatment for Couples with PTSD

Overseen By Julianne Flanagan

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Medical University of South Carolina

Must not be taking: Lithium, Methadone, Alpha blockers, others

Disqualifiers: Alcohol use disorder, Psychotic disorders, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

140 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial requires that you stop taking certain medications like lithium, methadone, alpha or beta blockers, or cholinergic/anticholinergic drugs, as they could affect the study results.

What data supports the effectiveness of the treatment Alcohol Administration for couples with PTSD?

The research shows that a combined therapy approach, which includes behavioral couples therapy for alcohol use disorder and cognitive-behavioral conjoint therapy for PTSD, led to significant reductions in PTSD symptoms and heavy drinking among veterans and their partners. This suggests that similar couple-based therapies can be effective for treating PTSD and alcohol use issues together. ^{1 2 3 4 5}

Is the alcohol treatment for couples with PTSD safe?

Research suggests that couple-based therapies for PTSD and alcohol use disorder are generally safe, with minimal adverse effects reported. In one study, only a small percentage of participants experienced negative effects, indicating that these treatments are typically well-tolerated. ^{1 5 6 7 8}

How does the Alcohol Administration treatment for couples with PTSD differ from other treatments?

The Alcohol Administration treatment for couples with PTSD is unique because it combines behavioral couples therapy for alcohol use disorder with cognitive-behavioral conjoint therapy for PTSD, addressing both conditions simultaneously in a couple's context, which is not commonly done in standard treatments. ^{1 5 9 10 11}

What is the purpose of this trial?

Intimate partner violence (IPV) is a serious public health problem that results in significant health and economic burdens including mortality, morbidity, and poor treatment outcomes. A well-developed field of research suggests that alcohol misuse and posttraumatic stress disorder (PTSD) can lead to IPV. Individuals with PTSD and/or problematic drinking behaviors are at risk for IPV because of several factors that are common symptoms of PTSD. Because individuals with PTSD often drink alcohol to "self-medicate" or cope with distressing PTSD symptoms, PTSD co-occurs with alcohol misuse and alcohol use disorder at extraordinarily high rates. However, few studies have examined the combined effects of alcohol misuse and PTSD on any form of violence. This study will examine the effects of alcohol misuse and posttraumatic stress disorder (PTSD) on alcohol-related intimate partner violence (IPV). We will examine these associations among couples (N=70) in a controlled laboratory setting using validated, standardized methods in a 'real-world' settings using 28 days of ecological momentary assessment (EMA).

Eligibility Criteria

This trial is for couples where at least one partner has experienced physical IPV in their current relationship and heavy drinking episodes. Participants must be 21 or older, of any gender or ethnicity, and not operate machinery post-visit. Couples with one partner having PTSD are also included.

Inclusion Criteria

One of us in the relationship has been diagnosed with PTSD.

I am 21 years old or older and my gender or race does not limit my participation.

You must have had at least two occasions of drinking a lot of alcohol in the past month and must have consumed a specific amount of alcohol during a test in the lab.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Alcohol Administration Paradigm

Participants will complete an alcohol administration paradigm with peak breath alcohol concentration of .09-.10 g/dL BrAC

2 hours

Ecological Momentary Assessment

Participants will undergo 28 days of ecological momentary assessment to examine naturalistic intimate partner aggression

28 days

Follow-up

Participants are monitored for safety and effectiveness after the main study activities

4 weeks

Treatment Details

Interventions

• Alcohol Administration

Trial Overview The study investigates the impact of alcohol misuse and PTSD on intimate partner violence (IPV) among couples. It involves controlled lab assessments and a 28-day real-world evaluation using ecological momentary assessment (EMA).

Participant Groups

Group I: alcohol administration paradigm Experimental Treatment 1 Intervention

Participants will complete an alcohol administration paradigm (peak breath alcohol concentration=.09-.10 g/dL BrAC)

Who Is Running the Clinical Trial?

Medical University of South Carolina

Lead Sponsor

Trials

994

Recruited

7,408,000+

Findings from Research

Behavioral couples therapy (BCT) was effective for both veterans with combat-related PTSD and those with substance use disorder (SUD) alone, showing significant improvements in relationship satisfaction and reductions in drinking and psychological distress after treatment.

Both groups demonstrated high compliance with BCT, attending many sessions and engaging in additional support like Alcoholics Anonymous, indicating that BCT can be a promising treatment option for veterans with comorbid PTSD and SUD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral couples therapy for comorbid substance use disorders and combat-related posttraumatic stress disorder among male veterans: an initial evaluation. Rotunda, RJ., O'Farrell, TJ., Murphy, M., et al.[2018]

An 18-month group therapy program for women partners of combat veterans with PTSD utilized group psychotherapy and feminist theory to address key themes such as rescuing, dissociation, and individuation.

The exploration of transference and countertransference within the group setting was beneficial in enhancing both individual therapy outcomes and the overall group process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group therapy for partners of combat veterans with post-traumatic stress disorder. Armstrong, MA., Rose, P.[2019]

The Couple HOPES intervention, designed for couples where one partner has PTSD, showed significant improvements in PTSD symptoms (g = .72) and relationship satisfaction (g = .34) among 17 couples, indicating its potential efficacy.

Participants reported no adverse events and high satisfaction with the intervention, suggesting it is a safe and feasible option for addressing PTSD and enhancing relationship dynamics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An uncontrolled trial of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement. Monson, CM., Wagner, AC., Crenshaw, AO., et al.[2022]

Behavioral couples therapy (BCT) combined with individually based treatment (IBT) significantly reduced PTSD severity in women with drug use disorders over a 1-year follow-up, demonstrating its efficacy in addressing PTSD symptoms.

In a study of 61 women who received 26 therapy sessions over 13 weeks, those in the BCT+IBT group showed notable improvements in PTSD severity compared to the IBT-only group, although the proportion of participants diagnosed with PTSD post-treatment did not differ between the two groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Behavioral Couples Therapy Versus Individual Recovery Counseling for Addressing Posttraumatic Stress Disorder Among Women With Drug Use Disorders. Schumm, JA., O'Farrell, TJ., Murphy, MM., et al.[2020]

In a study involving 9 couples, the Couple Treatment for Alcohol Use Disorder and Posttraumatic Stress Disorder (CTAP) showed promising results, with 8 veterans experiencing significant reductions in PTSD symptoms and a notable decrease in heavy drinking days (effect size d = 1.01).

CTAP also led to clinically reliable reductions in depression for both veterans and their partners, suggesting that this integrated therapy may effectively address comorbid PTSD and alcohol use disorder while also impacting relationship dynamics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Couple Treatment for Alcohol Use Disorder and Posttraumatic Stress Disorder: Pilot Results From U.S. Military Veterans and Their Partners. Schumm, JA., Monson, CM., O'Farrell, TJ., et al.[2018]

A couples-based treatment called structured approach therapy (SAT) significantly reduced PTSD symptoms in returning veterans compared to a standard educational intervention, with over half of the veterans in the SAT group no longer meeting PTSD criteria after treatment.

SAT also improved relationship dynamics and reduced anxiety for both veterans and their partners, highlighting its effectiveness not just for PTSD but also for enhancing relationship quality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of structured approach therapy in reducing PTSD in returning veterans: A randomized clinical trial. Sautter, FJ., Glynn, SM., Cretu, JB., et al.[2019]

In a study of 40 female survivors of intimate partner violence with PTSD and alcohol use disorder, older women and those with fewer dependents were more likely to engage in treatment, highlighting demographic factors that influence treatment retention.

Greater PTSD symptoms related to avoidance/numbing and longer histories of heavy drinking were also linked to higher treatment engagement, suggesting that specific symptom profiles may affect a person's likelihood to participate in therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment Engagement: Female Survivors of Intimate Partner Violence in Treatment for PTSD and Alcohol Use Disorder. Myers, US., Browne, KC., Norman, SB.[2018]

In a study involving 353 women in substance abuse treatment, the integrated PTSD treatment (Seeking Safety) did not result in significantly more adverse events compared to a non-trauma-focused intervention (Women's Health Education), indicating that it is safe to implement PTSD treatment in these settings.

Both interventions had low rates of adverse events (9.6% for Seeking Safety and 7.2% for Women's Health Education), suggesting that addressing PTSD in substance abuse programs does not worsen psychiatric or substance use symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment. Killeen, T., Hien, D., Campbell, A., et al.[2021]

Many military service members and veterans with alcohol problems also experience post-traumatic stress disorder (PTSD), highlighting the need for integrated treatment approaches.

Research indicates that treating alcohol problems and PTSD simultaneously may be more effective than addressing each issue separately, suggesting that combined therapies could improve outcomes for affected individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nature and Treatment of Comorbid Alcohol Problems and Post Traumatic Stress Disorder Among American Military Personnel and Veterans. Allen, JP., Crawford, EF., Kudler, H.[2018]

Over half (52.20%) of respondents with PTSD reported moderate to excessive alcohol use during the war, with 22.92% consuming more alcohol post-war than before, indicating a strong link between PTSD and increased alcohol consumption as a form of self-medication.

Treating alcoholism in PTSD patients is challenging due to the complex interplay of trauma and addiction, which can create significant emotional strain on healthcare providers, similar to the experiences of those treating patients with other severe conditions like AIDS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

PTSD and alcoholism. Gruden, V., Gruden, V., Gruden, Z.[2015]

In a 12-week pilot study involving 24 veterans with PTSD and alcohol use disorder, zonisamide (400 mg) was found to be well-tolerated and easily administered alongside cognitive processing therapy (CPT), which also addressed drinking behavior.

While both groups showed significant decreases in drinking outcomes and PTSD symptoms, there was no significant advantage of zonisamide over placebo, although a higher rate of abstinence was observed in the zonisamide group (50% vs 33%).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Zonisamide as an Adjunctive Treatment to Cognitive Processing Therapy for Veterans With Posttraumatic Stress Disorder and Comorbid Alcohol Use Disorder: A Pilot Study. Petrakis, I., Ralevski, E., Arias, AJ., et al.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Behavioral couples therapy for comorbid substance use disorders and combat-related posttraumatic stress disorder among male veterans: an initial evaluation. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Group therapy for partners of combat veterans with post-traumatic stress disorder. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

An uncontrolled trial of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Efficacy of Behavioral Couples Therapy Versus Individual Recovery Counseling for Addressing Posttraumatic Stress Disorder Among Women With Drug Use Disorders. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Couple Treatment for Alcohol Use Disorder and Posttraumatic Stress Disorder: Pilot Results From U.S. Military Veterans and Their Partners. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Efficacy of structured approach therapy in reducing PTSD in returning veterans: A randomized clinical trial. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Treatment Engagement: Female Survivors of Intimate Partner Violence in Treatment for PTSD and Alcohol Use Disorder. [2018]

8. United States pubmed.ncbi.nlm.nih.gov

Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Nature and Treatment of Comorbid Alcohol Problems and Post Traumatic Stress Disorder Among American Military Personnel and Veterans. [2018]

10. Croatia pubmed.ncbi.nlm.nih.gov

PTSD and alcoholism. [2015]

11. England pubmed.ncbi.nlm.nih.gov

Zonisamide as an Adjunctive Treatment to Cognitive Processing Therapy for Veterans With Posttraumatic Stress Disorder and Comorbid Alcohol Use Disorder: A Pilot Study. [2021]