PROJECT SUMMARY
The relationship between alcohol use (AU) and aggression (AGG) is widely recognized. In fact,
epidemiologic data demonstrate that 40% of individuals with Alcohol Use Disorder (AUD) in the
community display clinically significant levels of AGG. Moreover, aggression frequency in
individuals with AUD+AGG increases as overall alcohol consumption increases, making alcohol-
facilitated aggression a major public health threat. While the relationship between AUD and AGG
may be bidirectional, our data indicate that more than 90% of those with AUD+AGG report the
onset of problematic aggression before the onset of problematic drinking. As such, premorbid
AGG represents a risk factor for the development and maintenance of problematic drinking. In
addition, experimental studies suggest that alcohol increases aggression primarily in those who
are already aggressive. To date, the literature contains little treatment research in those with
AUD+AGG. More importantly, AUD treatments, in general, minimally focus on treating AGG in
AUD, including considering it an optional element of care. Fortunately, full cognitive behavioral
treatments for AGG exist, notably CRCST (Cognitive Restructuring, Relaxation and Coping Skills
Training) which we have shown has good efficacy in reducing aggression in those with AGG. In
addition, based on our work in aggression, we posit that individuals with AUD+AGG constitute an
important subgroup of those with AUD and that this comorbidity (AUD+AGG) represents a target
for a personalized medicine approach for AUD. At this time, we have developed a provisional
Integrated CBT manual containing the most critical elements for treating AUD and for treating
AGG. In this R34 project, we will refine our Integrated CBT-AUD+AGG Treatment Manual in a
small study in patients with AUD+AGG and then conduct a pilot RCT comparing this integrated
CBT AUD+AGG intervention with CBT-AUD Alone (from Project MATCH). The goal of this study
is to obtain acceptability, feasibility, and effect size data, which will be used inform the next steps
in this program of research (e.g., a large scale clinical trial).
