PTSD and Alcohol Couples Treatment for Veterans

Co-occurring PTSD-AUD is a complex and urgent public health crisis. COPE is a highly efficacious integrated intervention that has strong positive effects on reducing PTSD symptoms, but has substantial room for improvement regarding AUD outcomes. Adapting a brief dyadic intervention designed to target AUD to be delivered alongside COPE (COPE + B-FIT) is a promising way to bolster AUD outcomes and increase relationship functioning to promote recovery for Veteran and their families. The present study will test a modified version of B-FIT that is specifically designed to be delivered to Veterans with PTSD-AUD and their romantic partners. The goals of B-FIT are to: 1. increase reinforcement for AUD treatment engagement, 2. increase positive rewards from drinking reductions, and 3. decrease drinking cues by decreasing negative communication and increasing positive communication. This trial will recruit Veterans and their romantic partners (N=40 couples/80 individuals). This Stage 1a/1b trial will look at primary outcomes of feasibility and acceptability of the adapted B-FIT intervention, and secondary outcomes of PTSD symptoms, AUD symptoms, and psychosocial functioning.

Inclusion criteria

Inclusion criteria

for Veterans and Significant Others:

• Any gender or sexual identity; any race or ethnicity
• Married, cohabiting for at least 6 months, or in a committed relationship for at least 6 months and both partners are willing to participate.
• The Veteran meets current or past-year DSM-5 diagnostic status for both PTSD (assessed via CAPS-5) and AUD (assessed via the Quick Structured Clinical Interview for DSM-5)

• Concurrent substance use disorders are acceptable provided that alcohol is the Veteran's primary substance of choice
• Must demonstrate cognitive functioning sufficient to provide informed consent and participate accurately (=>26 on the Mini-Mental State Exam [MMSE])
• Participants taking psychotropic medications will be required to be maintained on a stable dose for at least 4 weeks before study initiation
• Not currently enrolled in couple therapy

Additional inclusion criteria for the Veteran patient:

• U.S. military Veteran
• Enrolled, or is willing to become enrolled, in VA healthcare
• Not attending trauma-focused therapy during the intervention period

Exclusion criteria

• History of moderate, severe, or unilateral violence in the relationship in the past year as measured by the CTS-2
• Either partner demonstrates a need for a higher level of care as assessed by the Quick Structured Clinical Interview for DSM-5 Disorders (QuickSCID)

• i.e., history of or current psychotic or bipolar disorders, current severe drug use disorder, or concerns about alcohol withdrawal as demonstrated by a score >8 on the CIWA-Ar)
• Either partner reports current suicidal or homicidal ideation and intent or prior intent or attempt in the past 6 months as assessed by the CSSRS and PHQ-9 item 9
• The Veteran's SO cannot have substance use problems as indicated by a score < 8 on the AUDIT and QuickSCID