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Serotonin Selective Reuptake Inhibitor Treatment of Dual Diagnosis Post-traumatic Stress Disorder and Alcohol Problems (DDx)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02504931
Recruitment Status : Completed
First Posted : July 22, 2015
Results First Posted : February 27, 2018
Last Update Posted : April 10, 2018
Sponsor:
Collaborators:
STRONG STAR Multidisciplinary PTSD Research Consortium
South Texas Veterans Health Care System
U.S. Army Medical Research and Development Command
United States Department of Defense
Information provided by (Responsible Party):
John Roache, The University of Texas Health Science Center at San Antonio

Brief Summary:
The investigators propose to conduct a clinical trial to evaluate sertraline treatment efficacy in a large sample of military veterans with a dual diagnosis of PTSD and Alcohol Use Disorder who are receiving Cognitive and Behavioral Therapy as part of the VA-system's new dual diagnosis program. The study is designed as an efficacy trial of sertraline used as an adjunct to Cognitive Behavioral Therapy (CBT) in the treatment of PTSD/Alcohol dual diagnosis. There are two outcomes of interest, namely PTSD symptom improvement and also decreased alcohol consumption. The investigators are interested to know whether or not sertraline is superior to placebo in improving the symptoms of either one or both of these two disorders. Even though sertraline is a treatment of choice for PTSD, the investigators expect that the comorbid condition of alcohol dependence will complicate the treatment of PTSD and that the clustered subgroups will show differential treatment response with sertraline. The primary objective of the present study is to identify subgroups of alcohol dependent persons with PTSD who will either benefit or not benefit from treatment with SSRI's. The proposed study will enroll veterans with PTSD and dually-diagnosed alcohol dependence in a 12-week treatment providing sertraline vs. placebo medication as an adjunct to manualized CBT and will specifically test the hypothesis that subtypes of alcohol dependence can be used to predict which patients respond well and which subgroup responds poorly to SSRI treatment.

Condition or disease Intervention/treatment Phase
PTSD Alcohol Use Disorder Drug: Sertraline Drug: Placebo Phase 4

Detailed Description:

Experimental Design. The study design is a parallel group, double-blind, placebo-controlled, stratified, randomized medication treatment trial of male and female veterans who experienced "in-theater" trauma and have both a PTSD and Alcohol Use dual diagnosis. All subjects will receive 12 weeks of manualized cognitive & behavioral therapy as a standard of care. Additionally, subjects will be randomized 1:1 to receive double-blind treatment with Sertraline vs. Placebo as an adjunctive treatment. The manualized therapy provides standard cognitive-behavioral therapy (CBT) addressing alcohol use and prolonged exposure (PE) behavioral therapy targeting PTSD. Sertraline is a common treatment for PTSD and psychiatric disturbance but is hypothesized to have differential efficacy in different subtypes of alcohol drinking patients. A stratified randomization scheme will balance placebo and sertraline assignment to two groups, and a post-hoc clustering approach will be used to determine which subgroups of dual diagnosis patients may benefit from sertraline vs. placebo treatment.

Veterans with PTSD who regularly drink more than 5 standard drinks of alcohol in a day (note one 12oz beer = one standard drink) may be eligible for the study if they meet criteria.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 49 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: SSRI Treatment of Dual Diagnosis PTSD and Alcohol Dependence: A Test of the Serotonergic Hypothesis
Actual Study Start Date : April 2011
Actual Primary Completion Date : August 2016
Actual Study Completion Date : December 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Dual Diagnosis

Arm Intervention/treatment
Experimental: Sertraline

Subjects will receive a fixed dose of 150 mg sertraline per day. Sertraline dose will be gradually increased by giving sertraline subjects capsules filled with 50 mg for the first three days and then capsules filled with 100 mg for 4 days before beginning the 150 mg per day in the second week. After completing the study Visit 12, subjects will be given an additional two week supply of medicine to gradually taper down so as to minimize any withdrawal discomfort.

Subjects in the Sertraline arm also will receive COPE therapy (Concurrent Treatment with Prolonged Exposure)which involves 12 sessions of manualized cognitive and behavioral therapy including exposure therapy for PTSD.

Drug: Sertraline
A Randomized Controlled Trial Design will randomize subjects to one of two arms. Sertraline is the active medication treatment arm.
Other Name: Zoloft

Placebo Comparator: Placebo

Matching placebo capsules will be filled with corn starch only on the same schedule as the Sertraline.

Subjects in the Placebo arm also will receive COPE therapy (Concurrent Treatment with Prolonged Exposure)which involves 12 sessions of manualized cognitive and behavioral therapy including exposure therapy for PTSD.

Drug: Placebo
A Randomized Controlled Trial Design will randomize subjects to one of two arms. Placebo is the control medication treatment arm.
Other Name: Placebo Control




Primary Outcome Measures :
  1. Percent Heavy Drinking Days [ Time Frame: 12 weeks ]
    Number of heavy drinking days in a 12 week period is reported by subjects and the percentage is calculated.


Secondary Outcome Measures :
  1. PTSD (Post Traumatic Stress Disorder) Symptom Score From PCL (Patient Monitoring Checklist) [ Time Frame: 12 weeks of treatment ]

    The PCL is a self-report measure that can be completed by patients in a waiting room prior to a session or by participants as part of a research study.

    The survey has 20 questions scored as:

    0=Not at all

    1. A little bit
    2. Moderately
    3. Quite a bit
    4. Extremely

    Interpretation of the PCL should be made by a clinician. The total symptom severity score is obtained by summing the scores for each of the 20 items to give a total of 1-80 points. The lower the score, the less severe the symptoms of PTSD, the higher the score, the more severe the symptoms.




Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   21 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 21-65 year old Veterans with PTSD who regularly drink more than 5 standard drinks of alcohol in a day
  • who experienced a trauma during deployment and
  • who regularly drink more than 5 standard drinks alcohol and
  • are interested in coming in once per week for 12 weeks of dual diagnosis individual therapy and
  • are willing to participate in a placebo-controlled trial which could include receipt of sertraline (Zoloft).

Exclusion Criteria:

  • if their PTSD Symptoms are adequately controlled by other medication regimens;
  • they require inpatient alcohol detoxification; or currently receive naltrexone, disulfiram, acamprosate, or ondansetron treatment for alcohol dependence; or
  • currently have an unstable medical illness; or
  • have a bipolar or psychotic disorder; or
  • currently are taking and are unwilling to discontinue taking any SSRI, SNRI, MAO inhibitor, tricyclic antidepressant, or anticonvulsant.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02504931


Locations
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United States, Texas
South Texas Veterans Health Care System
San Antonio, Texas, United States, 78229
Sponsors and Collaborators
The University of Texas Health Science Center at San Antonio
STRONG STAR Multidisciplinary PTSD Research Consortium
South Texas Veterans Health Care System
U.S. Army Medical Research and Development Command
United States Department of Defense
Investigators
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Principal Investigator: John D Roache, PhD The University of Texas Health Science Center at San Antonio
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Responsible Party: John Roache, Professor, The University of Texas Health Science Center at San Antonio
ClinicalTrials.gov Identifier: NCT02504931    
Other Study ID Numbers: W81XWH0820117
First Posted: July 22, 2015    Key Record Dates
Results First Posted: February 27, 2018
Last Update Posted: April 10, 2018
Last Verified: April 2017
Keywords provided by John Roache, The University of Texas Health Science Center at San Antonio:
PTSD
Alcohol
Dual Diagnosis
Sertraline
SSRI
Additional relevant MeSH terms:
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Alcoholism
Alcohol-Related Disorders
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders
Sertraline
Antidepressive Agents
Psychotropic Drugs
Serotonin Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Serotonin Agents
Physiological Effects of Drugs