Naltrexone plus prolonged exposure therapy helps alcohol-dependent PTSD patients

In a study of patients with alcohol dependence and post-traumatic stress disorder (PTSD), treatment with naltrexone resulted in a decrease in the percentage of patient drinking days. Prolonged exposure therapy was not associated with an exacerbation of alcohol-use disorder.

Lead author Edna B. Foa, professor of psychology in psychiatry and director, Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman School of Medicine, examined the effects of naltrexone, a medication used in alcohol-use reeducation, and prolonged exposure, the most validated psychosocial treatment for PTSD, and their combination in individuals with comorbid alcohol dependence and PTSD. Patients were randomly assigned to one of four treatments: prolonged exposure, naltrexone, prolonged exposure plus naltrexone, and pill placebo. All patients received supportive counseling. 

Findings

“Naltrexone was effective in decreasing the percentage of days drinking in people with alcohol dependence and posttraumatic stress disorder during active treatment,” said Foa. “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 yields a superior outcome than each treatment would alone."

The study was conducted to examine the validity of the common view in the field that treating patients with alcohol dependence in ways that deal directly with their traumatic experience will result in deterioration of their mental health and cause them to drink more rather than less, Foa said. 

“The findings of the study indicated that prolonged exposure therapy, a trauma-focused treatment for PTSD, was not associated with increased drinking or alcohol craving,” she said. “In fact, reduction in PTSD severity and drinking was evident for all four treatment groups. This finding contradicts the common view that trauma-focused therapy is contraindicated for individuals with alcohol dependence and PTSD, because it may exacerbate PTSD symptoms and thereby lead to increased alcohol use.

“Patients with comorbid PTSD and alcohol dependence should receive treatment that addresses simultaneously the two disorders rather than treatment that addresses only one of the two disorders,” she continued. “Prolonged exposure therapy for PTSD helps patients maintain a low level of drinking rather than increasing drinking and therefore should be provided to these patients.”