Integration of Cognitive Processing Therapy and Relapse Prevention for Alcohol Use Disorder and Co-Occurring PTSD: A Randomized Clinical Trial - PROJECT SUMMARY/ABSTRACT
A substantial proportion of individuals with alcohol use disorder (AUD) also meet criteria for posttraumatic stress
disorder (PTSD). The co-occurrence of AUD/PTSD is characterized by more severe symptomatology, greater
functional impairment, increased suicide risk, and poorer treatment outcomes as compared to either disorder
alone. Trauma-focused, cognitive-behavioral interventions delivered alongside interventions for substance use
disorders are most effective in reducing PTSD severity and substance use. Cognitive Processing Therapy (CPT)
for PTSD and Relapse Prevention (RP) for AUD are two of the most widely used and efficacious behavioral
treatments for these conditions. The investigators successfully developed and pilot tested a therapy manual that
combines CPT with RP. The preliminary data demonstrate safety, feasibility, high rates of retention (80.0%) and
patient satisfaction. Moreover, our data from a recent national survey of frontline mental health providers (N =
76) indicate that CPT is the most commonly used trauma-focused treatment for PTSD and providers are highly
interested in an integrative CPT-RP intervention, conferring strong potential for uptake in real-world practice
settings. In fact, due to the lack of an available, empirically developed, manualized CPT-RP treatment, 84.0% of
frontline providers report attempting on their own to create such a treatment to use with their patients. This may
result in highly variable and suboptimal implementation and outcomes. In response to provider input and positive
preliminary data, the proposed study directly addresses this critical need by evaluating a new integrative CPT-
RP treatment for individuals with co-occurring AUD and PTSD. At present, only one trauma-focused, integrative
intervention is available for AUD/PTSD and it uses Prolonged Exposure (PE) to reduce PTSD symptoms. In
comparison to PE, CPT is more widely used, often preferred by clinicians, equally as effective in reducing PTSD
symptoms, and associated with lower dropout rates. Thus, the new CPT-RP intervention could have wider reach
and greater acceptability than exposure-based treatments. Treatment choice is related to improved treatment
outcomes, and therefore, there is an immediate need to add to the portfolio of evidence-based, trauma-focused,
integrative treatments for AUD/PTSD. The primary objective of this Stage II study is to examine the efficacy of
CPT-RP, as compared to RP alone, in reducing (1) alcohol use frequency and quantity and (2) PTSD symptom
severity among individuals with current AUD/PTSD. To accomplish this, we will employ a manualized
intervention, randomized study design, and standardized repeated dependent measures of clinical outcomes at
multiple time points. Putative mechanisms of behavior change will be evaluated via daily monitoring. The
proposed study aligns closely with the mission of NIAAA in that it aims to produce maximally efficacious
behavioral interventions for AUD and comorbid psychiatric disorders such as PTSD. The findings from this study
will provide new information to advance the science of AUD/PTSD comorbidity and innovate clinical practice.
