title: Concurrent treatment of posttraumatic stress disorder and alcohol dependence: Predictors and moderators of outcome.
abstract: OBJECTIVE
  The present study examined predictors and moderators of treatment response among 165 adults meeting Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for comorbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD), who were randomized to 24 weeks of Naltrexone (NAL), NAL and prolonged exposure (PE), pill placebo, or pill placebo and PE. All participants received supportive counseling for alcohol use.
  
  
  METHODS
  Six domains of predictors or moderators (23 variables) were evaluated using measures of PTSD (Posttraumatic Stress Symptom Scale Interview) and AD (days drinking from the timeline follow-back interview) collected every 4 weeks throughout treatment. Multilevel modeling with the Fournier approach was used to evaluate predictors and moderators of rates of symptom improvement and posttreatment outcomes.
  
  
  RESULTS
  Combat trauma, sexual assault trauma, and higher baseline anxiety sensitivity predicted slower improvement and poorer PTSD outcome. Combat trauma, White race, and higher baseline drinking severity predicted poorer drinking outcome. PTSD severity moderated the efficacy of PE on PTSD outcomes, such that the benefit of PE over no-PE was greater for participants with higher baseline PTSD severity. Baseline depressive severity moderated the efficacy of PE on drinking outcomes, whereby the benefit of PE over no-PE was greater for participants with higher depressive symptoms. NAL effects were most beneficial for those with the longest duration of AD.
  
  
  CONCLUSIONS
  These results suggest that concurrent, trauma-focused treatment should be recommended for PTSD-AD patients who present with moderate or severe baseline PTSD and depressive symptoms. Future research should examine the mechanisms underlying poorer outcome among identified subgroups of PTSD-AD patients.
authors.affiliation: Department of Psychiatry, University of Pennsylvania.
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Zandberg
authors.affiliation: Department of Psychology, Southern Methodist University.
authors.forename: David
authors.initials: D
authors.lastname: Rosenfield
authors.affiliation: Department of Psychiatry, University of Pennsylvania.
authors.forename: Carmen P
authors.initials: CP
authors.lastname: McLean
authors.affiliation: Department of Psychology, University of Pennsylvania.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Powers
authors.affiliation: Department of Psychiatry, University of Pennsylvania.
authors.forename: Anu
authors.initials: A
authors.lastname: Asnaani
authors.affiliation: Department of Psychiatry, University of Pennsylvania.
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D010043:Outcome and Process Assessment, Health Care; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*
chemical_list: D009271:Naltrexone