Prolonged Exposure Therapy Benefits Veterans With PTSD, Alcohol Use Disorder

Integrated prolonged exposure therapy had a greater reduction in PTSD symptoms than integrated coping skills therapy, while both therapies resulted in comparable decreases in drinking.

In veterans with comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), integrated prolonged exposure therapy (I-PE) was well tolerated and had greater efficacy for reducing PTSD symptoms than integrated coping skills (I-CS) therapy, according to results from a study published in JAMA Psychiatry.

The prospective randomized controlled trial included 119 veterans (mean age, 41.6 years; 89.9% male) seeking mental health services at an urban veteran’s affairs facility from February 2013 to May 2017. Veterans received 12 to 16 individual 90-minute sessions of either I-PE (n=63) or I-CS (n=56) therapy. After treatment and at 3- and 6-month posttreatment follow-up, investigators collected data on PTSD symptoms and percentage of heavy drinking days.

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A linear mixed model analysis revealed that PTSD symptoms decreased in all of the veterans, but there was a significantly greater decrease in PTSD symptoms in the veterans receiving I-PE therapy compared with those receiving I-CS therapy (Cohen d = 0.41; P =.002). The percentage of heavy drinking days also improved for all veterans, but there were no statistically significant differences between veterans receiving I-PE and I-CS therapies (Cohen d = 0.04; P=.91).

These findings were limited to a mostly male, veteran population. Results may differ for patients with different backgrounds. These findings also may not generalize to individuals receiving group I-CS treatment or shorter individual sessions.

“The study provides evidence that exposure therapy is more efficacious in treating PTSD than a more commonly available integrated treatment without exposure for comorbid PTSD and AUD,” researchers wrote. “This information is critical because having an AUD continues to be a barrier to receiving exposure therapy because of therapist perceptions of patients’ fragility (ie, beliefs that patients will not be able to handle trauma-related memories and may have an increase in alcohol use).”


Norman SB, Trim R, Haller M, et al. Efficacy of integrated exposure therapy vs integrated coping skills therapy for comorbid posttraumatic stress disorder and alcohol use disorder: a randomized clinical trial [published online April 24, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.0638