Development and Initial Testing of a Brief, Integrated Intervention Aimed at Reducing Heavy Alcohol Use and PTSD Among Military Veterans in Primary Care

Public Significance Statement This study found the development of the new, integrated intervention (PC-TIME) for heavy alcohol use and posttraumatic stress disorder (PTSD) for Veterans attending primary care is both an acceptable and promising approach to treating both simultaneously. Most Veterans participating in the open trial reduced drinking and experienced reduced PTSD symptoms, suggesting a larger efficacy trial is warranted. There is a need for integrated treatment approaches that address heavy alcohol use and posttraumatic stress disorder (PTSD) concurrently among Veterans as interactions between heavy drinking and PTSD are frequent. Veteran engagement in specialty mental health services after referral is limited with poorer outcomes following empirically supported, exposure-based PTSD treatments that do not explicitly address alcohol use. The current project aimed to incorporate two evidenced-based interventions: brief motivational intervention with prolonged exposure for primary care for Veterans with heavy drinking and PTSD. Delphi methodology was applied to adapt an intervention protocol using subject matter expert (SME) feedback to guide the refinement of a preliminary treatment manual. The newly developed brief intervention (Primary Care Treatment Integrating Motivation and Exposure [PC-TIME]) was then tested in an open trial (n = 9) to gather Veteran participant feedback to modify the treatment manual. Two rounds of SME feedback resulted in 80% agreement that manual content was "acceptable as-is" across all intervention domains. The resulting protocol is a five-session, integrated intervention with Session 1 primarily focused on alcohol use reduction and Sessions 2-5 consisting of narrative exposure and in vivo exercises for PTSD symptoms with brief alcohol use check-ins. Open trial results indicated high Veteran acceptance of PC-TIME structure and content, and reductions in heavy drinking and PTSD symptoms. Preliminary data suggest PC-TIME to be a promising approach for the treatment of heavy alcohol use and PTSD. A pilot randomized controlled trial (RCT) is necessary to demonstrate the intervention's efficacy with Veterans in a PC setting.