Treatment of co-occurring PTSD–AUD: Effects of exposure-based and non-trauma focused psychotherapy on alcohol and trauma cue-reactivity

• We examined changes in trauma/alcohol cue-reactivity after psychotherapy for PTSD–SUD.
• Exposure therapy reduced distress elicited by trauma cues more than non-trauma therapy.
• Both therapies were associated with reduced craving and salivation reactivity.
• Change in trauma cue-elicited distress predicted change in craving, salivation.
• Findings support integration of exposure-based PTSD therapies into SUD treatment.

Laboratory studies have shown that exposure to trauma memories increases both craving and salivation responses to alcohol cues among individual with co-occurring posttraumatic stress disorder (PTSD) and alcohol dependence (AD). The purpose of the present study was to examine 1) whether this cue reactivity is dampened following exposure-based treatment for PTSD and 2) how changes in reactivity to trauma cues correspond to changes in alcohol cue-reactivity.Adults with current PTSD and AD (N = 120) were randomly assigned to 9–12 sessions of either Trauma-focused Exposure Therapy (EXP) for PTSD or Health & Lifestyles (HLS, a non-trauma focused comparison treatment), concurrent with 6-week residential AD treatment-as-usual. Participants completed trauma and alcohol cue-reactivity laboratory sessions before and after treatment.Compared to HLS, individuals receiving EXP showed significantly greater reductions in negative affect elicited by trauma cues following treatment. Both treatments demonstrated similar, moderate to large reductions in craving and salivary reactivity over time. Interestingly, latent change in trauma cue-elicited distress over the course of treatment predicted latent change in both trauma cue-elicited alcohol craving and salivation.Overall, findings highlight the utility of integrating trauma-focused therapies like EXP into substance use treatment in the interests of reducing PTSD symptoms and distress associated with trauma cues.