Category: Comorbidity - Substance Use and Other
Keywords: Alcohol | PTSD Posttraumatic Stress Disorder | Veterans
Presentation Type: Symposium
The intensity of cognitive-behavioral therapies vary from self-management interventions with no therapist contact to protocols that involve both group and individual treatments sessions that span several months. Matching patients to the intensity of intervention often involves a consideration of the setting in which they present to and the severity of their presenting concerns. Many health care systems now embrace the stepped-care model which provides lower intensity interventions first (e.g., brief treatment within primary care) and then “steps up” the level of care to a specialized mental health setting if symptoms do not remit to. Self-management interventions with no therapist contact are one of the lowest intensity CBT interventions. A randomized clinical trial (N=162) testing a web-based, self-managed, CBT intervention for veterans with PTSD symptoms and hazardous alcohol use resulted in reduced heaving drinking compared to primary care treatment as usual (Acosta et al., 2016). The current investigation explored if subgroups of participants were more likely to experience reductions in drinking and PTSD symptoms following the receipt of Web-CBT. A variety of baseline characteristics were explored as predictors of treatment outcome including sociodemographic factors, resilience, coping, social support, and severity of alcohol use, PTSD, insomnia, and psychological distress. Pre-established cut-points on the Alcohol Use Identification Test (AUDIT) and the PTSD Checklist-Specific (PCL-S) were the best predictors of treatment gain. Specifically, participants who scored ≥20 on the AUDIT experienced larger reductions in percent of heaving drinking days (28% vs. 7%) at posttreatment compared to controls (t(63)= -4.06, p≤ 001). Participants who scored ≥50 on the PCL-S experienced a significantly larger decrease on the PCL (13 points vs. 4 points) at post-treatment (t(61)=-2.04, p=.026). These results indicate that patients with higher severity of hazardous alcohol use and PTSD are more likely to benefit from the self-managed Web CBT program. Established cut points on validated measures can be used to guide treatment selection.
Syracuse VA Medical Center
Friday, November 17
3:30 PM – 5:00 PM
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