A controlled examination of two coping skills for daily alcohol use and PTSD symptom severity among dually diagnosed individuals

• Cognitive restructuring (CR) and experiential acceptance (EA) coping skills were examined in a sample with comorbid PTSD/AD.
• CR and EA coping skills were associated with decreased daily drinking compared to control across a 5-week follow-up period.
• Individuals who were taught CR skills consumed less alcohol on a given day than those who were taught EA skills.
• Neither CR nor EA skills were associated with a decrease in PTSD symptom severity across the 5-week follow-up period.
• Results support prioritizing CR and EA skills during initial treatment sessions with individuals with comorbid PTSD/AD.

Investigations of targeted coping skills could help guide initial treatment decisions for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol dependence (AD) who often endorse worse coping skills than those with AD but not PTSD. Although improvement in coping skills is associated with enhanced alcohol use outcomes, no study has evaluated the utility of teaching specific coping skills in the context of comorbid PTSD/AD. We compared the effects of teaching two coping skills (cognitive restructuring [CR] and experiential acceptance [EA]) or an attention control condition on drinking and PTSD symptoms among 78 men and women with comorbid PTSD/AD during a 5-week daily follow-up assessment. Both CR and EA skills were associated with decreased drinking compared to control, and that change in drinking over time did not significantly differ between those who received CR and EA. Individuals who received CR skills, however, consumed less alcohol on a given day than those who received EA skills. Neither CR nor EA was associated with a decrease in PTSD symptom severity. These results provide preliminary support for clinicians to prioritize CR and EA skills during initial treatment sessions when working with individuals with PTSD/AD, and offer ideas for continued investigation and intervention refinement.