Alcohol use disorder (AUD) frequently co-occurs with posttraumatic stress disorder (PTSD) among U.S.
military veterans. Compared to veterans with AUD only, veterans with AUD/PTSD have greater symptom
severity, more psychosocial functioning difficulties, and higher risk of suicide. Many people with AUD/PTSD
perform behaviors aimed at avoiding unpleasant emotions (e.g., drinking to avoid trauma-related nightmares,
skipping social events to avoid anxiety-provoking crowds). These “avoidance behaviors” provide temporary
relief from unpleasant emotions, but they maintain AUD/PTSD and interfere with long-term functioning.
Although treatments for AUD/PTSD exist, they focus on reducing symptoms (not improving functioning) and
have dropout rates as high as 50%. Originally developed to treat depression, Behavioral Activation (BA) is an
intervention that increases daily participation in rewarding, alcohol-free activities relevant to patients’ social,
vocational, and health-related values. Randomized controlled trials (RCTs) adapting BA for other disorders
have shown that BA is efficacious for adults with alcohol/drug use disorders and acceptable to veterans with
PTSD, but BA has not been used to treat co-occurring AUD/PTSD. Additionally, because RCTs of AUD/PTSD
treatments typically emphasize significant mean group differences in AUD/PTSD outcomes, less is known
about the degree to which these treatments yield clinically significant improvements at the individual level.
Individual-level improvements in AUD/PTSD should be evident not only in subjective clinical assessments, but
also in objective measures of geospatial activity. Specifically, patients’ daily geospatial activity is likely to
change as they decrease their avoidance behaviors and increase their engagement in various social,
vocational, and health-promoting activities. Advances in geospatial methods, coupled with discreet and
portable Global Positioning System (GPS) trackers, have made it possible to objectively measure people’s
spatial movement within their communities. Yet although geospatial methods have been used to identify social
determinants of alcohol use, they have not been used to measure response to AUD or AUD/PTSD treatment.
As the long-term objectives of this work are to identify a more acceptable AUD/PTSD treatment option and
improve the measurement of AUD/PTSD recovery, this R34 project will address the following specific aims:
(1) adapt BA for use with veterans with AUD/PTSD; (2) evaluate the feasibility, acceptability, and preliminary
effects of BA (relative to Relapse Prevention) for veterans with AUD/PTSD in a pilot RCT; and (3) explore
geospatial analysis of GPS-collected data as a new approach to measuring AUD/PTSD treatment response.
This study will advance research and practice by piloting a novel application of BA and a novel measure of
AUD/PTSD recovery. This project aligns with the National Institute on Alcohol Abuse and Alcoholism’s special
interest in investigating treatments for patients with AUD and co-occurring disorders, dimensions of functioning
and well-being associated with recovery, and innovative methods for evaluating AUD treatment and recovery.
