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Posttraumatic stress disorder and alcohol dependence: Does order of onset make a difference?

Mclean, Carmen P. ; Su, Yi-Jen ; Foa, Edna B.

Journal of Anxiety Disorders, December 2014, Vol.28(8), pp.894-901 [Peer Reviewed Journal]

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  • Title:
    Posttraumatic stress disorder and alcohol dependence: Does order of onset make a difference?
  • Author/Creator: Mclean, Carmen P. ; Su, Yi-Jen ; Foa, Edna B.
  • Language: English
  • Subjects: Posttraumatic Stress ; Alcohol Dependence ; Onset ; Prolonged Exposure ; Naltrexone
  • Is Part Of: Journal of Anxiety Disorders, December 2014, Vol.28(8), pp.894-901
  • Description: •Compared patients with PTSD and AD based on which disorder developed first.•Tested differences in clinical characteristics and response to combined treatment.•AD-first patients were more likely to be lower income.•AD-first patients were more likely to have cluster B comorbidity.•Order of onset of PTSD and AD was unrelated to response to a combined treatment. 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.
  • Identifier: ISSN: 0887-6185 ; DOI: 10.1016/j.janxdis.2014.09.023