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

Objective: A common concern is whether individuals with posttraumatic stress disorder (PTSD) and hazardous drinking will respond to PTSD treatment or need a higher dose. In a sample of active-duty military, we examined the impact of hazardous drinking on cognitive processing therapy (CPT) outcomes and whether number of sessions to reach good end-state or dropout differed by drinking status. Method: Participants included 127 service members participating in a clinical trial of variable-length CPT. The Quick Drinking Screen was used to characterize drinking. Participants were categorized as treatment responders when they reached good end-state (DSM-5) or nonresponders if they completed 24 sessions or 18 weeks of treatment without good end-state. Survival analyses were used to compare time to dropout or good end-state between those with and without hazardous drinking. Results: Those with hazardous drinking were as likely as those without to reach good end-state and no more likely to drop out. There were no differences in number of sessions to reach good end-state or dropout. On a gold-standard assessment, those with hazardous drinking evidenced more PTSD symptom reduction than those without. The overall proportion of participants with hazardous drinking decreased (30.7% to 18.6%), as did mean number of drinks per drinking day and drinks on the heaviest drinking day among those initially drinking hazardously. Conclusions: Results support using CPT for military personnel with PTSD and hazardous drinking and indicate that those with hazardous drinking can benefit from PTSD treatment without additional treatment sessions. Clinical Impact Statement Clinicians are encouraged to consider evidence-based treatments for posttraumatic stress disorder, such as cognitive processing therapy, even when patients drink alcohol heavily. Heavy alcohol use was not associated with worse treatment outcomes. Among patients who responded to treatment, there was no difference in the number of sessions to reach a good clinical outcome or dropout based on drinking status.

Automated summary

The study found that military personnel with hazardous drinking issues were equally likely to achieve good outcomes with cognitive processing therapy as those without, and were not more likely to drop out. Participants with hazardous drinking also showed greater reduction in PTSD symptoms.