Testing a PTSD m-Health Intervention to Improve Alcohol Treatment Outcomes

Project Summary/Abstract
Posttraumatic stress disorder (PTSD) commonly co-occurs with alcohol use disorder (AUD), affecting 30-60%
of those seeking AUD treatment, and may be especially salient for women with AUD. AUD patients with
comorbid PTSD have poorer outcomes following treatment, including earlier relapse, greater substance use,
and poorer psychosocial functioning, compared with those without PTSD. Although there are a small number
of evidence-based psychotherapies that may reduce PTSD symptoms, men and women in AUD treatment
rarely receive them, even in residential AUD settings. Barriers related to cost, time, and clinician expertise
severely limit the availability of PTSD interventions in AUD treatment settings. Consequently, there is great
need for low-cost, primarily self-guided, and scalable PTSD treatments that can be delivered within existing
AUD treatment structures. PTSD Coach is a promising mobile health (m-Health) application (app) that could
address treatment gaps for men and women with AUD and comorbid PTSD. Recent preliminary data from a
community sample of individuals with PTSD symptoms, without inclusion criteria related to alcohol use,
showed that the group randomly assigned to use the app had significantly greater improvements in PTSD
symptoms relative to those in a waitlist control (Cohen’s d=0.41), and a further pilot showed that brief clinical
app support/facilitation (i.e., 4, 20-minute sessions) may boost these treatment effects. Despite its potential to
improve both PTSD and alcohol-related outcomes, PTSD Coach with brief clinical support has not been tested
as a treatment for patients with comorbid PTSD in the AUD treatment setting. Therefore, the objectives of this
project are to test whether the use of the PTSD Coach app intervention package (PTSD app + brief support) in
the residential AUD treatment setting can improve PTSD symptoms, and help sustain AUD treatment gains
during recovery. Given that prior research has found AUD-, PTSD-, and treatment-differences between men
and women, the proposed study will also evaluate potential differences in treatment effects between men and
women. To accomplish these goals, we will randomize 150 men and 150 women (total n=300) with AUD and
co-occurring PTSD in residential addictions treatment to either the PTSD Coach intervention package or the
enhanced usual care (EUC) control. All participants will complete a baseline assessment and follow-ups at 1-
(post-treatment),3-, 6-, and 12-months post-randomization. Delivering the PTSD Coach intervention during
residential AUD treatment provides an ideal opportunity for patients to benefit from the app during a period of
relative stability. This project is significant because it targets a comorbid, high-needs AUD treatment
population, improves access to care, and utilizes an m-Health intervention approach that is readily scalable.
Incorporating a promising, publicly available PTSD app into AUD treatment to address co-morbidity among
AUD patients is highly innovative. The findings from this study could have substantial public health impact by
improving treatment outcomes for patients with AUD and comorbid PTSD.

Grant Number: 5R01AA028213-05
NIH Institute/Center: NIH
Principal Investigator: KIPLING BOHNERT