New Research on PTSD and Alcohol Use Disorder Brings Hope: An Interview with Dr. Steven L. Batki

There’s a well-known and long-recognized co-occurrence of PTSD and substance use disorders, particularly alcohol use disorder. Research shows that people with PTSD are 2-4 times more likely to develop a substance use disorder (SUD) in their lifetime, which can create emotional and behavioral conditions that complicate treatment and increase relapse risk. As such, there is now rising interest in integrated, dual diagnosis treatment that seeks to address these disorders concurrently in order to facilitate sustainable recovery from both. Dr. Batki is one of the researchers leading the way as the medical community investigates new pharmacological treatment methods that target PTSD and alcohol use disorder simultaneously.

“In my position as the chief of addiction recovery treatment services at the San Francisco VA, I’ve been doing clinical work and conducting research with veterans with SUDs—in particular, alcohol use disorder [and PTSD],” Dr. Batki says. “We’ve conducted several studies, the first of which was published in the journal Alcoholism: Clinical and Experimental Research in 2014. That paper described our first study using the anticonvulsant medication Topiramate in the treatment of both symptoms of PTSD and alcohol use disorder amongst veterans who had both conditions.”

Dr. Batki and his research team found that 12 weeks of brief weekly health-based motivational counseling led to a greater reduction of alcohol use and PTSD symptoms in subjects who also received Topiramate as part of their treatment than in those who received the placebo. Although the sample size was small—comprised of just 30 veterans—the results were promising enough to secure funding for a larger study from the Department of Defense. The studies add to a small but growing body of research suggesting that Topiramate may be a viable treatment for both alcohol use disorder and PTSD.

So why does Topiramate work for both conditions? “There’s a very major overlap in the parts of the brain that are affected by alcohol use disorder and PTSD,” Dr. Batki says.

Both disorders involve deep, older, central parts of the brain that control the regulation of emotion and our response to stress. In individuals who have traumatic stress experiences, re-experiencing stress has been shown to be a trigger, or cue, for increasing craving for alcohol and other substance use. Topiramate may reduce that link between stress response and craving for alcohol.

This is important because, as Dr. Batki points out, there are currently few pharmacological therapies that address PTSD. “The fact is that medication for PTSD is still in a very early stage of development and the currently approved medications, such as SSRIs [selective serotonin reuptake inhibitors] and other antidepressants, aren’t very effective,” he explains.

Pharmacotherapy that not only treats PTSD but also addresses alcohol use disorder could open up a new, more effective path to healing for people struggling with these co-occurring disorders, both by providing effective treatment and by reducing barriers to therapeutic engagement. “It is well-recognized that re-experiencing stressors is something that has to be addressed in order to facilitate treatment engagement and retention,” Dr. Batki explains.

I think it’s a reasonable assumption to make that reducing the day-to-day stresses, which can be triggered by therapeutic interactions, may play a role in increasing the accessibility of psychotherapeutic involvement. Hopefully, it also reduces the impact of both internal and external stressors faced by patients and reduces the potency of those stressors to serve as triggers for cravings or returning to drug and alcohol use, as well as the anxiety that can sometimes emerge from abstinence from substances.

In other words, the use of Topiramate may both reduce symptoms on its own while also nurturing greater psychotherapeutic engagement by minimizing the stress that can prevent you from fully participating in psychotherapeutic and peer support-based treatment.

While Dr. Batki’s work may change the way PTSD and alcohol use disorder are treated on a wide scale in the future, it is already benefitting patients at Alta Mira. “The research very much influences treatment for alcohol use disorder and PTSD at Alta Mira,” he says.

It increases our already high level of sensitivity for the need for the use of medications in both alcohol use disorder and PTSD if the PTSD symptoms are severe enough. That’s an important point because, very often, medications are underutilized in many addiction treatment settings. There’s a great deal of evidence in the medical literature showing the results of surveys and examination of patient records that shows that among individuals with alcohol use disorder in the United States, probably fewer than 20% of them are ever offered medications for relapse prevention.

For PTSD, there’s a higher rate of medications being offered as part of treatment in addition to psychotherapy. However, in PTSD, it is well-known that the medications we have exhibited very limited effectiveness. Being aware of current research that shows the potential for benefits of certain medications both for the treatment of traumatic stress symptom reduction and to reduce the chances of relapse to alcohol use is really important.

Indeed, Alta Mira’s sophisticated capacity to assess and treat co-occurring disorders using cutting-edge research by virtue of its close relationship with the UCSF School of Medicine and the addiction psychiatry fellowship program is unusual. Thanks to its connections, Alta Mira is able to apply the findings from current and ongoing research in an integrative way to improve treatment outcomes for its clients.