Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur and are associated with worse outcomes together than either disorder alone. A lack of consensus regarding recommendations for treating PTSD-AUD exists, and treatment dropout is a persistent problem. Acceptance and Commitment Therapy (ACT), a transdiagnostic, mindfulness- and acceptance-based form of behavior therapy, has potential as a treatment option for PTSD-AUD. In this uncontrolled pilot study, we examined ACT for PTSD-AUD in 43 veterans; 29 (67%) completed the outpatient individual therapy protocol (i.e., ≥ 10 of 12 sessions). Clinician-assessed and self-reported PTSD symptoms were reduced at posttreatment, ds = 0.79 and 0.96, respectively. Self-reported symptoms of PTSD remained lower at 3-month follow-up, d = 0.88. There were reductions on all alcohol-related outcomes (clinician-assessed and self-reported symptoms, total drinks, and heavy drinking days) at posttreatment and 3-month follow-up, dmean = 0.91 (d range: 0.65-1.30). Quality of life increased at posttreatment and follow-up, ds = 0.55-0.56. Functional disability improved marginally at posttreatment, d = 0.35; this effect became significant by follow-up, d = 0.52. Fewer depressive symptoms were reported at posttreatment, d = 0.50, and follow-up, d = 0.44. Individuals experiencing suicidal ideation reported significant reductions by follow-up. Consistent with the ACT theoretical model, these improvements were associated with more between-session mindfulness practice and reductions in experiential avoidance and psychological inflexibility. Recommendations for adapting ACT to address PTSD-AUD include assigning frequent between-session mindfulness practice and initiating values clarification work and values-based behavior assignments early in treatment.

BACKGROUND:If people do not recognize posttraumatic stress disorder (PTSD) symptoms, they may not realize they are suffering from the disorder. Likewise, if people do not know that effective treatments exist, they may be unlikely to seek care. This study examined what people with PTSD symptoms know about PTSD and its treatment. We hypothesized that military service and prior receipt of PTSD treatment would be associated with greater PTSD knowledge.METHODS:We conducted an online survey assessing knowledge in three domains: trauma, PTSD symptoms, and effective PTSD treatments. Participants were 301 adults (50% veterans) who were drawn from a national research panel and screened positive for PTSD.RESULTS:When asked to identify items from a list, participants had better recognition for traumatic events (M = 72.2% of items correct) and PTSD symptoms (M = 62.3%) than for effective PTSD treatments (M = 37.9%). Across domains, participants often identified false items as true. Most participants thought divorce was a trauma that could cause PTSD, that drug addiction was a PTSD symptom, and that support groups are effective PTSD treatments. Prior receipt of PTSD treatment was associated with better symptom recognition (b = .86, P = .003). Being a military veteran was associated with better trauma recognition (b = .56, P = .025), but poorer treatment recognition (b = -.65, P = .034).CONCLUSIONS:People with PTSD symptoms lack knowledge about the disorder, especially regarding effective treatments. Public education about PTSD is needed so that people recognize when to seek care and which treatments to choose.

We present the theoretical rationale for addressing comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) with Acceptance and Commitment Therapy (ACT). We then describe the development of a treatment manual of ACT for PTSD/SUD and the subsequent refinement to this manual following a feasibility study with a small sample of veterans. Treatment retention was similar to what has been observed in studies of other integrated treatments for PTSD/SUD. Overall treatment satisfaction was positive. Pilot outcomes are presented for descriptive purposes. We describe changes we made to the initial manual following the trial to bolster retention and improve the intervention. Revisions were based on feedback from therapists, consultants, and participants and examination of pilot outcome data. Additional strategies for adapting ACT to this challenging clinical presentation are offered.

This article summarizes information about the prevalence of post-traumatic stress disorder (PTSD) in military personnel and Veterans who have served in the Iraq and Afghanistan conflicts as well as the disorder's impact and efforts to prevent it in this population. We examine prevalence in light of epidemiologic methods and discuss associated outcomes, etiology, and factors affecting risk for PTSD. Prevention strategies are presented both in terms of individual-level interventions and operational strategies designed to mitigate the development of PTSD. Our findings indicate that while research into the prevalence and consequences of PTSD in the Iraq and Afghanistan cohort has been significant, relatively little is known about the effectiveness of approaches designed to prevent it.