Pharmacotherapy plus behavioural therapy ease PTSD, alcohol use severity

The combination of alcohol-targeted pharmacotherapies and trauma-focused behavioural therapies results in early and sustained improvements in patients with post-traumatic stress disorder (PTSD) and alcohol use disorder, suggest the results of a recent study.

The research team conducted a systematic search of PsycINFO, Medline, and ClinicalTrials.gov through December 2020 for trials targeting PTSD, alcohol, or other drug use disorders, or both disorders (36 studies; n=4,046). Moderated nonlinear factor analysis was conducted to estimate the primary outcomes, namely severity scores for PTSD, alcohol use, and drug use.

The researchers used propensity score weight‒adjusted multilevel models. They then estimated model-predicted effect sizes for each treatment, as well as the comparative effect sizes for each active arm against treatment as usual, at the end of treatment and at 12-month follow-up.

At the end of treatment, the combination of trauma-focused therapy and pharmacotherapy for substance use disorders resulted in the largest comparative effect sizes for PTSD severity (d, ‒0.92, 95 percent confidence interval [CI], ‒1.57 to ‒0.30) and alcohol use severity (d, ‒1.10, 95 percent CI, ‒1.54 to ‒0.68).

Other treatments, such as pharmacotherapies for alcohol or other drug use disorders, trauma-focused integrated therapies, and trauma-focused nonintegrated therapies, also produced large comparative effect sizes.

“Further treatment development is indicated for combining behavioural and pharmacological treatments for synergized impact and understanding the mechanisms of action and conditions under which each treatment type is optimized,” the researchers said.