Statement of the problem: Alcohol dependence (AD) afflicts nearly 14% of the population. Data consistently show that difficulty coping with mood states is a critical factor in the development and maintenance of alcohol use disorders (AUD). These relationships are particularly robust among individuals with comorbid psychiatric disorders, such as posttraumatic stress disorder (PTSD). Many treatment packages have thus incorporated skills training, and skill acquisition has been posited to be an important mechanism of change leading to improved AUD treatment outcomes. However, the results of studies testing these coping mediation hypotheses have failed to find support for the hypothesized relationships. Potential role of experiential acceptance: Cognitive-behavioral coping skill interventions target negative and positive affective states using two general approaches; increasing either experiential acceptance or cognitive control strategies. Experiential acceptance consists of being willing to experience one's thoughts, feelings, memories, cravings, and bodily sensations without judging them or trying to change them. Preliminary data suggest that experiential acceptance mediates the relationship between treatment program alliance and long-term AUD outcomes and is worthy of further study. Proposed study design: The primary objective of this pilot study is to preliminarily determine whether experiential acceptance is a mechanism of change in decreasing alcohol use in individuals with AD and PTSD following the recommendations of Kazdin and Nock. Sixty individuals with comorbid AD and PTSD will complete a week of baseline daily Interactive Voice Response (IVR) telephone monitoring prior to randomization to one of two brief coping instruction sets: experiential acceptance or cognitive control, which they will be asked to use during two craving mood inductions, one negative and one positive. Following the craving inductions, participants will be asked to practice their randomized coping strategy for five weeks during which time they will provide daily IVR monitoring data and will receive brief weekly telephone coaching contacts. Participants will return to complete a follow-up assessment protocol and debriefing at the end of six weeks of study involvement. Data analyses will examine whether experiential acceptance mediates the relationship between coping instruction and decreased alcohol use. Public health implications: Despite impressive strides in the substance abuse treatment arena in the past 20 years, the personal and societal costs associated with AUDs, particularly when they are comorbid with PTSD, remain enormous. The need to refine our understanding of the active ingredients in existing treatments is of great importance. The proposed studies' emphasis on experiential acceptance will increase specificity, in relation to previous coping skill inquiries in AUD treatment, and allow us to examine whether this particular coping approach is a potentially fruitful avenue for future inquiry in the AUD treatment field. ? ? ?
