Alcohol dependence and posttraumatic stress disorder: differences in clinical presentation and response to cognitive-behavioral therapy by order of onset.

Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) frequently co-occur. However, little systematic study has examined the importance of their temporal order of onset. In this study, differences in clinical presentation and response to cognitive-behavioral substance-use therapy by order of onset were examined among 94 (51 men and 43 women) individuals with AD and PTSD. The findings revealed that women with primary AD and men with primary PTSD presented as more distressed and/or depressed than their counterparts at treatment entry. A relationship between increased alcohol intake and higher PTSD symptom levels was observed during treatment. In general, the primary PTSD group derived greater overall benefit (e.g., in physical health, alcohol use, social functioning) as compared with the primary AD group. Finally, women with primary AD appeared particularly vulnerable to continued psychiatric distress and depression at the end of treatment. These findings increase awareness of the importance of considering the order of onset and may ultimately lead to treatment improvements for this population.