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35th AM (2025) - Poster Session
Breaking the Cycle Pharmacologic Prevention of Alc ...
Breaking the Cycle Pharmacologic Prevention of Alcohol Use Disorder in PTSD
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Pdf Summary
This comprehensive review addresses the significant public health challenge posed by the comorbidity of Post-Traumatic Stress Disorder (PTSD) and Alcohol Use Disorder (AUD), which affects up to 30% of veterans and incurs an annual economic burden of $50–100 billion. PTSD strongly predicts AUD development, especially in high-risk subgroups characterized by prior substance use disorders, family history of AUD, co-occurring mood or anxiety disorders, childhood trauma, severe interpersonal trauma or polyvictimization, PTSD symptom clusters involving externalizing or anxious/dysphoric arousal and sleep disturbances, socioeconomic disadvantages such as low income and homelessness, lack of social support, and male gender.<br /><br />Current interventions largely react to AUD after it manifests, leaving a critical gap in prevention. While psychotherapies like Cognitive Processing Therapy, Prolonged Exposure, and CBT have demonstrated some preventive benefits, pharmacological prevention remains underexplored. This work synthesizes epidemiological, genetic, neurobiological, and clinical trial data to propose a novel framework that views PTSD–AUD comorbidity as a preventable trajectory. By targeting shared neurobiological mechanisms—such as hyperarousal, glutamate dysregulation, and limbic hyperexcitability—with pharmacotherapies during identified high-risk periods (e.g., trauma anniversaries, acute stress), it may be possible to reduce AUD incidence among PTSD patients.<br /><br />Medications such as naltrexone and topiramate have demonstrated efficacy in preventing AUD relapse with established safety profiles in PTSD populations. Other agents like gabapentin and pregabalin show potential for symptom relief but require further study. Importantly, pharmacological prevention should be integrated with behavioral therapies to address both biological and psychological risk factors synergistically.<br /><br />Given the severe human, clinical, and economic impacts of PTSD–AUD comorbidity, early pharmacologic prevention is ethically and clinically justified, particularly for validated high-risk phenotypes. However, rigorous randomized controlled trials focusing on AUD incidence, PTSD symptom stability, and patient adherence are urgently needed to validate these strategies and guide clinical integration. This prevention-minded paradigm aims to shift current reactive practices toward proactive management, ultimately improving outcomes for those affected by this complex dual diagnosis.
Keywords
PTSD
Alcohol Use Disorder
comorbidity
veterans
public health
pharmacological prevention
psychotherapy
naltrexone
topiramate
high-risk subgroups
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