Combined treatment for PTSD and Problematic Alcohol Use in middle-aged and older patients - a pilot study

Problematic alcohol use (PAU) among older adults is an increasing public health
concern which leads to rising health care costs; especially given the fact that
the proportion of elderly people is increasing, as well as life expectancy
(Immonen et al., 2011; Wetterling et al., 2003). Problematic alcohol use
frequently co-occurs with Posttraumatic stress disorder (PTSD). PTSD is
associated with non-effective coping, more abuse of alcohol and drugs, and a
greater chance for future traumatic experiences (Mueser et al., 2002). It has
been suggested that after experiencing a trauma, some people supress their
trauma symptoms by excessive alcohol use. In turn, excessive alcohol use
hampers a healthy processing of a traumatic event. This leads to a
self-perpetuating vicious cycle of PTSD symptoms and problematic alcohol use.
Integrated treatment for both PTSD and problematic alcohol use seems the
appropriate approach.

The aim of this study is to investigate the feasibility and efficacy of a
combined treatment for PTSD and problematic alcohol use (PAU) in a Dutch sample
of older patients with PTSD and PAU. Expertise from Brijder addiction care will
be shared with Parnassia therapists, and this exchange may have a better
collaboration in the treatment of older patients (which is a rapidly growing
group in The Netherlands) as a positive side effect. Our longer-term aim is to
conduct a multicenter Randomized Controlled Trial (RCT) with cost-effectiveness
analysis (CEA) to compare different methods of treating patients with a dual
diagnosis of PTSD and PAU.

For this open-label pilot study a pretest-posttest design will be used, with a
follow-up 3 months after treatment.

Patients will first receive the standard treatment for SUD, a CBT-based
*lifestyle training* (De Wildt, 2000). As soon as patient and therapist observe
that the patient has a certain degree of control over their alcohol use, EMDR
treatment is initiated focusing on the PTSD symptoms, while the SUD treatment
continues

There are no documented cases of harmful effects of EMDR. For some people, the
eye movement procedure may cause mild eye discomfort or dizziness. If this
happens, the therapist will use other techniques, such as gently tapping on
client*s hands or using binaural sounds.
It is common for people to experience strong emotions during and after EMDR
sessions, so the therapist will give accurate information about what can be
expected after the sessions.
The benefits of this study are twofold: we expect that the trauma-related
symptoms and complaints will decrease, as well as the symptoms of problematic
alcohol use, e.g. amount of alcoholic drinks. In addition, as aforementioned
symptoms are positively associated with depression and anxiety, we expect these
symptoms to decrease as well.