Linking brain network “profiles” to treatment outcomes among individuals with co-occurring alcohol use and posttraumatic stress disorders

Alcohol use disorders (AUDs) frequently co-occur with posttraumatic stress disorder (PTSD), and this dual diagnosis often results in poorer treatment outcomes than for either disorder alone. An innovative study uses pre-treatment functional neuroimaging to predict treatment responses among individuals with both AUDs and PTSD. These results and others will be shared at the 44^th annual scientific meeting of the Research Society on Alcoholism (RSA), which will be held virtually this year from the 19^th – 23^rd of June 2021 due to the COVID-19 pandemic.

“Numerous studies demonstrate a consistent link between AUDs and PTSD,” said Andrea D. Spadoni, Research Health Science Specialist at the VA San Diego Healthcare System and assistant professor at The University of California, San Diego. “In the general U.S. adult population, individuals with an AUD have a roughly 30 percent greater chance of having PTSD as compared to individuals without an AUD. Among treatment-seeking individuals, an estimated 38 to 58 percent of those seeking treatment for AUD also meet criteria for PTSD.”

The probability that veterans, the subjects of this study, have even higher rates of co-occurrence are greater still. “In a nationally representative sample of U.S. veterans, PTSD was more than four times as prevalent among those with AUDs compared to rates reported among the general U.S. adult population,” said Spadoni. “Rates of co-occurring PTSD and AUD are thought to be higher still in treatment-seeking veterans. In a national sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans using VA care, 62 percent of those with AUDs had a diagnosis of PTSD.”

“Those with both disorders typically present with severe symptom profiles and suffer from poorer treatment outcomes, additional psychiatric problems, higher risk for suicide attempt, and more functional problems than those with just one disorder,” explained Spadoni. “Therefore, there is a great need to better understand how our best interventions may or may not be effective, and for whom they may be most beneficial. The goal of the current study was to predict treatment response within this group from pre-treatment resting state connectivity patterns.” Spadoni will discuss these findings at the virtual RSA meeting on Wednesday, 23 June 2021.

“Our findings indicate that using neuroimaging and data-driven approaches to subtype AUD and PTSD has the potential to identify brain-based biomarkers that are clinically relevant,” explained Spadoni. “Brain connectivity between nodes relevant for integrating cognition and emotion may play an important role in determining whether someone maximally benefits from prolonged exposure therapy — even in individuals with a comorbid AUD. In addition, studies that limit their investigations to singly diagnosed individuals fail to consider the clinical and neural heterogeneity within these disorders, which may in turn limit the generalizability of findings.”

While Spadoni noted that these findings are preliminary and require replication in larger samples, “…our results lend support for the identification of pre-treatment biomarkers that have the potential to improve clinical care,” she said. “By linking brain network ‘profiles’ to treatment outcomes instead of relying on traditional diagnostic status, we can reduce the trial-and-error approach to successful treatment selection. This will reduce the psychological, social, and financial burden that many patients experience when cycling through numerous treatments before finding the one that works.”