Recent studies have suggested meaningful relationships between alcohol abuse and dependence, victimization and post-traumatic stress disorder (PTSD). It has been suggested that as many as 30% of alcoholic individuals have been the victims of childhood or adult physical or sexual assault. While PTSD can result from a variety of traumatic events, crime-related events, including childhood sexual and physical assault, are a common cause of PTSD (CR-PTSD) and will be the focus of this proposal. It is likely that untreated CR-PTSD can worsen the course of alcohol use disorders and make it difficult to decrease consumption and attain abstinence. The goal of the proposed study is to investigate the use of a medication, sertraline, which has been shown in preliminary studies to decrease alcohol consumption and to decrease the symptoms of CR-PTSD, in individuals with concurrent CR-PTSD and an alcohol use disorder. The study will be a 12 week placebo-controlled double-blind study with a 1 week placebo wash-out. All subjects will receive 12 sessions of concurrent cognitive behavioral therapy for alcoholism. Subjects will include 122 individuals who meet DSM-IV criteria for alcohol abuse or dependence and current CR-PTSD. Comprehensive evaluation will be done at study entry, treatment termination, 6,9, and 12 months after study entry. Outcome will be evaluated along multiple dimensions.
The specific aims of this proposal are the following: (1) To use state-of-the-art psychological and psychiatric instruments to determine histories of trauma, sequelae of trauma and psychiatric symptoms among individuals presenting for alcohol treatment. (2) To conduct a 12-week double-blind placebo-controlled outpatients clinical trial of sertraline in individuals with concurrent alcoholism and CR-PTSD. (3) To evaluate the efficacy of the experimental treatment over the course of one year as measured by changes in substance use, CR-PTSD symptoms and psychiatric symptoms as well as psychosocial indicators. In summary, this project targets the treatment of individuals with alcohol use disorders who have been victims of violence and have current CR-PTSD. The efficacy of a pharmacologic treatment targeting both decreased alcohol consumption and decreased CR-PTSD symptomatology will be explored. The overall goal of the project is to further explore the relationship between CR-PTSD and alcoholism and to improve treatment outcome for this population.
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