title: Posttraumatic stress disorder and alcohol dependence: does order of onset make a difference?
abstract: Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) are frequently comorbid and the order in which they develop may affect the clinical presentation and response to treatment. This study compared 73 treatment-seeking participants who developed PTSD prior to developing AD ("PTSD-first") with 64 participants who developed AD prior to developing PTSD ("AD-first") on demographics, clinical presentation, and response to treatment for PTSD and AD. All participants received BRENDA, a medication management and motivational enhancement intervention and were randomly assigned to either prolonged exposure (PE) for PTSD plus BRENDA or BRENDA alone and to either naltrexone (NAL) for AD or placebo (PBO). Results showed that participants with AD-first were more likely to report low income, meet criteria for antisocial or borderline personality disorder, report an index trauma of physical assault, compared to those with PTSD-first. Conversely, participants with PTSD-first were more likely to report an index trauma of sexual assault or a combat experience. Notably, no group differences were observed in treatment outcome despite some differences in clinical presentation.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, PA, USA.
authors.forename: Carmen P
authors.initials: CP
authors.lastname: McLean
authors.affiliation: Department of Psychiatry, University of Pennsylvania, PA, USA; Department of Psychology, National Taiwan University, Taipei, Taiwan. Electronic address: suyijen@ntu.edu.tw.
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Su
authors.affiliation: Department of Psychiatry, University of Pennsylvania, PA, USA.
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology* / Q000628:therapy; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone
keywords: Alcohol dependence; Naltrexone; Onset; Posttraumatic stress; Prolonged exposure