Adapting a Brief Dyadic Intervention for Co-occurring Post-Traumatic Stress Disorder and Alcohol Use Disorder

About This Grant

The proposed CDA-2 will support Dr. Giff’s pursuit of a VA research career focused on improving the psychosocial functioning of Veterans with co-occurring post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD). Significance to VA: PTSD and AUD are highly comorbid, which presents a unique set of challenges for Veterans and their loved ones. Experiencing PTSD-AUD exponentially increases Veterans’ risk for debilitating mental health sequelae, poor physical health, and deleterious social and occupational outcomes. COPE is a robustly evidence-based treatment for PTSD-AUD that is widely used in VA clinics. While COPE outcomes related to PTSD symptom reduction are consistently outstanding, there is room to improve both AUD outcomes and rates of retention. COPE shows moderate effects on Veterans’ drinking reductions, indicating a critical need for research examining novel ways to bolster drinking outcomes. Innovation and Impact: Results from separate literatures indicate that integrating a family member or significant other (SO) is a promising method to improve AUD recovery and AUD and PTSD treatment retention. Veterans with AUD and PTSD often report conflictual relationships, which can interfere with AUD recovery, and including SOs is likely to foster more effective dyadic support and communication. The brief inclusion of SOs in Veterans’ treatment of PTSD-AUD is yet to be studied, despite strong potential for this model to improve treatment effectiveness, retention, and dyadic functioning. Pairing COPE with Brief Family-Involved Treatment for Alcohol Use Disorder (B-FIT) is one promising method to bridge this persistent gap in treatment programming for Veterans. B-FIT is a 3-session dyadic intervention designed to be delivered alongside evidence-based individual AUD treatments. Distilled from the original 12-session Alcohol Behavioral Couple Therapy, B-FIT focuses on enhancing family support for alcohol behavior change efforts and improving communication skills. A recent pilot of B-FIT demonstrated large effects for reductions in risky drinking. The objective of the proposed study is to examine the preliminary feasibility and acceptability of combining B-FIT with COPE among Veterans with co-occurring PTSD and AUD. Specific Aims: 1. Adapt the B-FIT manual to be delivered as an adjunct intervention to COPE; 2. Examine the feasibility and acceptability of BFIT + COPE through a one-armed open-label pilot trial as assessed by (a) rates of enrollment and treatment completion; and (b) participants’ quantitative ratings and qualitative perceptions of the intervention; and 3) Explore the effects of BFIT + COPE from pre- to posttreatment and at 3-month follow-up on (a) AUD outcomes, (b) psychosocial and relationship functioning, and (c) PTSD outcomes. Methodology: Aim 1 will include qualitative interviews with 10 Veteran-SO dyads and 10 VHA mental health clinicians to inform an adaptation of the B-FIT manual to be relevant for Veterans with PTSD-AUD. Once completed, the adapted manual will be piloted through a single-arm, open feasibility trial of 40 Veteran-SO dyads with primary outcomes of feasibility and acceptability. Secondary outcomes of AUD (AUDIT & TLFB); psychosocial functioning (B-IPF, Q-LES-Q-SF, DAS-7); and PTSD (PCL-5 & CAPS) will be explored. Path to Translation/Implementation: This project will provide critical pilot data on feasibility and implementation to support a subsequent Merit award testing the effectiveness and implementation of this intervention in VA clinics. The following training aims will ensure that the candidate is poised to continue this work: (1) Veteran-centered intervention development/adaptation and clinical trials management; (2) Knowledge of AUD; (3) Advanced statistical analysis; (4) Preliminary education in dissemination and implementation; and (5) Scholarly productivity and professional development. The candidate will accomplish these aims through devoted mentorship, didactic opportunities, and by leading the proposed project. She will conduct this work with support from the scientific community at the Ralph H. Johnson VAHCS and MUSC. The research and training proposed can address urgent needs within VHA and will prepare the candidate to be an expert in family-supported interventions to improve the lives of Veterans.