The Impact of Hazardous Drinking Among Active Duty Military With Posttraumatic Stress Disorder: Does Cognitive Processing Therapy Format Matter?

Abstract

This study was a secondary data analysis of clinical trial data collected from 268 active duty U.S. military service members seeking cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) at Fort Hood, Texas, related to combat operations following September 11, 2001. Our primary aim was to evaluate changes in PTSD symptom severity and alcohol misuse as a function of baseline hazardous drinking and treatment format (i.e., group or individual). At baseline and posttreatment, PTSD was assessed using the PTSD Symptom Scale–Interview Version and PTSD Checklist for DSM‐5. Hazardous drinking was categorically defined as an Alcohol Use Disorder Identification Test total score of 8 or higher. Employing intent‐to‐treat, mixed‐effects regression analysis, all groups reported reduced PTSD symptom severity, Hedges’ gs = −0.33 to −1.01, except, unexpectedly, nonhazardous drinkers who were randomized to group CPT, Hedges’ g = −0.12. Hazardous drinkers who were randomized to individual therapy had larger reductions in PTSD symptoms than nonhazardous drinkers who were randomized to group CPT, Hedges’ g = −0.25. Hazardous drinkers also reported significant reductions in alcohol misuse, regardless of treatment format, Hedges’ gs = −0.78 to −0.86. This study builds upon an emerging literature suggesting that individuals with PTSD and co‐occurring alcohol use disorder can engage successfully in CPT, which appears to be an appropriate treatment for these individuals whether it is delivered individually or in a group format. However, as a portion of participants remained classified as hazardous drinkers at posttreatment, some individuals may benefit from integrated treatment.

Treatment responder status and time to response as a function of hazardous drinking among active-duty military receiving variable-length cognitive processing therapy for posttraumatic stress disorder.

“…There were also no differences in dropout between those with and without hazardous drinking, nor did those with hazardous drinking drop out any earlier. Taken together, these findings replicate and extend prior research demonstrating CPT to be an effective treatment for active-duty service members and veterans with comorbid PTSD and hazardous alcohol use (Dondanville et al., 2019; Held et al., 2021; Kaysen et al., 2014; Straud et al., 2021). Prior research has mostly indicated that those with hazardous drinking have achieved similar symptom outcomes as those without, although some prior studies have shown slightly less pronounced effects (e.g., Dondanville et al., 2019; Held et al., 2021).…”

“…In this study, we defined hazardous drinking as those meeting NIAAA guidelines for heavy drinking, which were informed by the largest survey conducted on alcohol and comorbid psychiatric and medical conditions (Warren & Hewitt, 2010). It should also be noted that we did not formally assess whether reducing drinking was a treatment goal for those exhibiting hazardous drinking, and, although our results are consistent with previous studies demonstrating decreases in alcohol use following CPT (Dondanville et al., 2019; Straud et al., 2021), because this study had no comparison condition, it is not possible to conclude that the reductions in problematic alcohol use were due to the therapy. There were also unequal sample sizes, with a smaller portion of the sample comprised of those with hazardous drinking.…”

“…The results reported here add to the overall preponderance of evidence showing that those with hazardous drinking benefit as much from CPT as those without and adds that they also do not differ in the number of sessions needed. With regard to dropout, some previous studies have shown dropout to be a significant problem for those with PTSD and substance use (Kline et al., 2021; Roberts et al., 2016), whereas other studies have not shown this to be the case (Dondanville et al., 2019; Straud et al., 2021). These results are consistent with the latter findings that those with hazardous drinking were no more likely to dropout and adds that they also had no difference in time to dropout.…”

“…Recent research has shown that individuals with hazardous drinking do benefit from CPT, with similar PTSD symptom reduction as nonhazardous drinkers, as well as reductions in drinking (Dondanville et al, 2019;Straud et al, 2021). Dondanville et al (2019) examined active-duty service members receiving CPT in a group format and observed that, although those with hazardous drinking improved slightly less in PTSD severity than those without, the effect size difference was small-to-medium and not statistically significant.…”

“…Recent research has shown that individuals with hazardous drinking do benefit from CPT, with similar PTSD symptom reduction as nonhazardous drinkers, as well as reductions in drinking (Dondanville et al., 2019; Straud et al., 2021). Dondanville et al.…”