Written by Will Thurston Class of ‘19
Veterans with posttraumatic stress disorder (PTSD) and those who have experienced combat exposure are at heightened risk for developing alcohol use disorders. Some research has shown that these individuals may also have worse use-related problems and may have a harder time successfully completing treatment than the average civilian (Ouimette, Ahrens, Moos, & Finney, 1997; Ouimette, Finney, & Moos, 1999). However, less research has been done investigating the outcomes of web-based alcohol interventions, which are relatively new and promising treatment options.
This study evaluated the outcomes of a web-based program called VetChange for Operation Enduring Freedom and Operation Iraqi Freedom veterans who met criteria for problematic alcohol use (Brief et al. 2017). VetChange is an online intervention which is designed to help veterans reduce their drinking with the goal of moderation or abstinence. It includes assessments and treatment based on PTSD symptoms, and provides veterans with skills and strategies to control and reduce their drinking.
Before receiving the intervention, the participants were evaluated by several measures and the results are as follows: The average score on a measure of PTSD symptoms indicated that most of the veterans could probably be diagnosed with the disorder. The veterans in the sample were deployed an average of 2 times and experienced an average of about 8 different types of combat exposure. The participants were drinking an average of 6.8 drinks per week, with 32% of drinking days being characterized as heavy. Before the veterans were given the web-based intervention, both PTSD and combat exposure were associated with increased drinking.
The VetChange program resulted in an overall reduction in drinking. Interestingly, individuals with more severe PTSD showed greater reduction of alcohol problem severity than those with lower levels of PTSD symptoms, and veterans with more severe combat exposure showed greater reduction in average weekly drinks than individuals with less combat exposure. The researchers considered these findings and concluded that the presence of PTSD and combat exposure did not prevent or limit the veterans’ ability to successfully respond to a web-based treatment intervention.
There were a few limitations to this study, including the fact that the participants who had to be excluded from the study showed higher average levels of problematic drinking behaviors, which means they may have responded to the intervention differently. The study had a high attrition rate (50%), meaning that half of the veterans did not complete the follow-up element of the study. This is common for web-based follow-ups, and the researchers ran permutation tests to determine if the dropouts were different than those who stayed in based on the existing data, which indicated that attrition did not affect the findings of the study.
The findings of this study are important because they indicate that web-based alcohol treatments can be effective for veterans with PTSD and combat exposure, factors which can make their recovery more difficult. The findings also suggest that individuals with more severe alcohol use problems may receive a greater initial benefit from the VetChange program than those with less severe problems. If this is the case, it is an encouraging trend because it means that veterans who may be in more urgent need of help will be able to quickly improve to a less critical state. As web-based treatments become more popular, they must be tested in other high-risk populations to ensure that they are effective in many scenarios and not just in normative cases.
Brief, D. J., Rubin, A., Enggasser, J. L., Roy, M., & Keane, T. M. (2011). Web-based intervention for returning veterans with symptoms of posttraumatic stress disorder and risky alcohol use. Journal of Contemporary Psychotherapy, 41(4), 237–246. http://doi.org/10.1007/s10879-011-9173-5
Ouimette, P. C., Ahrens, C., Moos, R. H., & Finney, J. W. (1997).
Posttraumatic stress disorder in substance abuse patients: Relationship to 1-year posttreatment outcomes. Psychology of Addictive Behaviors, 11, 34–47. http://dx.doi.org/10.1037/0893-164X.11.1.34
Ouimette, P. C., Finney, J. W., & Moos, R. H. (1999). Two-year posttreatment functioning and coping of substance abuse patients with posttraumatic stress disorder. Psychology of Addictive Behaviors, 13, 105–114. http://dx.doi.org/10.1037/0893-164X.13.2.105