Integration of Cognitive Processing Therapy for PTSD and cognitive-behavioral therapy for co-occurring alcohol use disorder: Design and methodology of a randomized controlled trial

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BACKGROUND: The prevalent comorbidity of alcohol use disorder (AUD) with posttraumatic stress disorder (PTSD) is characterized by more severe symptomatology, greater functional impairment, increased suicide risk, and poorer treatment outcomes as compared to either disorder alone. Trauma-focused, cognitive-behavioral interventions delivered alongside interventions for substance use disorders are recommended to reduce PTSD severity and substance use. Cognitive Processing Therapy (CPT) for PTSD and cognitive-behavioral therapy (i.e., Relapse Prevention [RP]) for AUD are two of the most widely used and efficacious treatments for these conditions. There are few effective integrated treatments available for PTSD/AUD comorbidity. The present study addresses this critical gap by further developing and evaluating a 12-session, manualized treatment that integrates CPT and RP for the treatment of co-occurring PTSD/AUD. Primary outcomes include reduction in alcohol use frequency and quantity and reduction in PTSD symptom severity at the end of treatment (session 12). Secondary outcomes are evaluated using ecological momentary assessment (EMA) to elucidate underlying mechanisms of change, including daily alcohol related cognitions and behaviors, PTSD symptoms, and distress tolerance. METHOD: This paper describes the rationale, design, and methodology of a Stage II randomized controlled trial that compares a novel integrated CPT + RP intervention to RP-alone among adults (N = 200) with comorbid PTSD/AUD. CONCLUSION: This study will provide new information to advance the field of PTSD/AUD comorbidity and innovate clinical practice, which may lead to improved treatment outcomes for co-occurring PTSD/AUD.

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