Alcohol dependence and PTSD: Simultaneous Treatment Improves Outcomes Interview with Edna B. Foa, PhD
Department of Psychiatry, University of Pennsylvania, Philadelphia What are the main findings of the study?

Dr. Foa: Naltrexone was effective in decreasing the percentage of days drinking in people with alcohol dependence and posttraumatic stress disorder during active treatment.  Six months after treatment discontinuation, participants who received prolonged exposure therapy for PTSD drank less than those who did not receive prolonged exposure.  Participants who received a combined treatment of prolonged exposure and naltrexone had the lowest drinking level after six-month treatment discontinuation. The main message of the study is that simultaneous treatment of alcohol dependence and PTSD yield superior outcome than each treatment alone. Importantly, the findings indicated that prolonged exposure therapy was not associated with increased drinking or alcohol craving, a concern that has been voiced by some investigators. In fact, reduction in PTSD severity and drinking was evident for all four treatment groups. This finding contradicts that common view that trauma-focuses therapy is contraindicated for individuals with alcohol dependence and PTSD, because it may exacerbate PTSD symptoms and thereby lead to increased alcohol use. Were any of the findings unexpected?

Dr. Foa: Yes. We expected that participants who received prolonged exposure therapy would  show greater reduction in PTSD symptoms during the active phase of the treatment than those who did not received exposure therapy.   But the findings showed that that all participants showed significant but equal reduction in PTSD severity. There are two possible reasons for this finding.

First, all participants received counseling and this may have masked the effects of exposure therapy.

Second, many participants did not attend all exposure therapy sessions and thus did not received sufficient dose of this therapy What recommendations do you have for future research as a result of this study?

Dr. Foa: Patients with comorbid PTSD and alcohol dependent should receive treatment that addresses simultaneously the two disorders rather than treatment that address only one of the two disorders.

Prolonged exposure therapy for PTSD helps patients maintain low level of drinking  rather than increase drinking and therefore should be provided to these patients


Foa EB, Yusko DA, McLean CP, et al. Concurrent Naltrexone and Prolonged Exposure Therapy for Patients With Comorbid Alcohol Dependence and PTSD: A Randomized Clinical Trial. JAMA. 2013;310(5):488-495. doi:10.1001/jama.2013.8268.

Last Updated on March 19, 2014 by Marie Benz MD FAAD