Posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) co-occur frequently which is a concern given that individuals with PTSD and AUD are more treatment resistant and prone to substance relapse following treatment compared to individuals with only AUD. This relationship may be explained by theories positing that individuals with PTSD and AUD use alcohol to cope with distressing PTSD symptoms. Theories of PTSD suggest that emotional engagement, or evoking key emotional experiences related to the trauma memory, is crucial in resolving PTSD symptoms. However, trauma-related symptoms and emotions are often not addressed in treatment for AUD. Thus, lack of emotional engagement may contribute to alcohol relapse through a cycle where unresolved PTSD symptoms maintain alcohol cravings and use. Given the treatment refractory nature of AUDs when comorbid with PTSD, understanding underlying mechanisms explaining how symptoms of PTSD may contribute to alcohol relapse and how we may best intervene with this population is of great clinical importance. The overall goal of this study is to examine emotional engagement with the trauma memory during treatment for AUD as a predictor of decreased relapse to alcohol use following treatment. More specifically, the proposed research will investigate the direct relationship between emotional engagement with the trauma memory and self-reported alcohol cravings and relapse at 3-months post-treatment for AUD, the relationship between beliefs about ability to tolerate trauma-related emotions, coping motives for alcohol use and self-reported alcohol cravings and relapse at 3-months post-treatment for AUD, and whether these coping beliefs mediate the relationship between emotional engagement, alcohol cravings, and relapse to alcohol use. This study will enroll 100 women currently in treatment for alcohol dependence with co-occurring trauma histories and symptoms of PTSD. Assessments will be conducted at pre-treatment, post-treatment, and at 3-month follow-up time points. In order to explore study aims, emotional engagement will be manipulated through a three session narrative writing assignment designed to elicit emotional engagement with the memory and level of emotional engagement will be assessed with both self-report and coding measures. In addition, beliefs about ability to tolerate trauma-related distress and coping motives for alcohol use as well as cravings and relapse will be examined. Overall, this study seeks to better understand mechanisms of relapse to alcohol use in women with PTSD and AUD, and has the potential to identify important intervention targets for this difficult to treat population.
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