{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T10:48:38Z","timestamp":1787827718773,"version":"build-2784847793"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000005","name":"United States Department of Defense","doi-asserted-by":"publisher","award":["W81XWH-13-2-0065"],"award-info":[{"award-number":["W81XWH-13-2-0065"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"United States Department of Veterans Affairs","doi-asserted-by":"publisher","award":["I01CX001136-01"],"award-info":[{"award-number":["I01CX001136-01"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004925","name":"Texas Health and Human Services Commission","doi-asserted-by":"publisher","award":["HT9425-24-1-1021"],"award-info":[{"award-number":["HT9425-24-1-1021"]}],"id":[{"id":"10.13039\/100004925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Individuals with post-traumatic stress disorder (PTSD) are at increased risk for hazardous drinking, which often complicates treatment and affects trauma-focused psychotherapy outcomes. The present study is an exploratory, secondary analysis investigating differential effects of prolonged exposure (PE) among those with and without hazardous drinking and whether treatment outcomes varied across these groups as a function of PE format. Data used were from a randomized controlled trial that examined two daily, compressed formats of PE treatment for PTSD (massed and intensive outpatient program) in military personnel and veterans (N = 234). Individuals without hazardous drinking had greater PTSD symptom reductions compared to those with hazardous drinking (d = 0.42, p = 0.001). However, the hazardous drinking group also demonstrated significant reductions in PTSD (d = 1.46, p &lt; 0.001) following treatment, as well as in the number of drinks per week (d = 0.63, p = 0.025) at the 6-month follow-up. There was no significant difference in treatment engagement based on drinking classification and outcomes did not vary based on PE format. The findings suggest that PE is an appropriate treatment for individuals with PTSD and hazardous drinking. However, group differences in PTSD symptom reductions indicate concurrent hazardous drinking reduces treatment benefits of PE.<\/jats:p>","DOI":"10.3390\/bs15070954","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T13:00:51Z","timestamp":1752757251000},"page":"954","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Differential Effects of Hazardous Drinking on Post-Traumatic Stress Disorder Outcomes Across Two Prolonged Exposure Treatment Formats"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8875-1906","authenticated-orcid":false,"given":"Casey L.","family":"Straud","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"},{"name":"Department of Psychology, University of Texas at San Antonio, San Antonio, TX 78249, USA"},{"name":"Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiara H.","family":"Buccellato","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"},{"name":"Department of Psychology, University of Texas at San Antonio, San Antonio, TX 78249, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edna B.","family":"Foa","sequence":"additional","affiliation":[{"name":"Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily A.","family":"Brown","sequence":"additional","affiliation":[{"name":"Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4322-9318","authenticated-orcid":false,"given":"Carmen P.","family":"McLean","sequence":"additional","affiliation":[{"name":"Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA"},{"name":"Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5227-313X","authenticated-orcid":false,"given":"Tabatha H.","family":"Blount","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard P.","family":"Schobitz","sequence":"additional","affiliation":[{"name":"Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA"},{"name":"U.S. Public Health Service Commissioned Corps Headquarters, Rockville, MD 20852, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryann B.","family":"DeBeer","sequence":"additional","affiliation":[{"name":"Rocky Mountain MIRECC for Suicide Prevention, U.S. Department of Veterans Affairs, Aurora, CO 80045, USA"},{"name":"Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8618-2607","authenticated-orcid":false,"given":"Joseph","family":"Mignogna","sequence":"additional","affiliation":[{"name":"Rocky Mountain MIRECC for Suicide Prevention, U.S. Department of Veterans Affairs, Aurora, CO 80045, USA"},{"name":"Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke A.","family":"Fina","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5888-836X","authenticated-orcid":false,"given":"Brittany N.","family":"Hall-Clark","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian C.","family":"Schrader","sequence":"additional","affiliation":[{"name":"Department of Behavioral Health, Carl R. 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Darnall Army Medical Center, Fort Hood, TX 76544, USA"},{"name":"School of Social Work, Tulane University, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa M.","family":"Jacoby","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wyatt R.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"},{"name":"VA North Texas Health Care System, Dallas, TX 75216, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett T.","family":"Litz","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA 02130, USA"},{"name":"Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric C.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Counseling and Behavioral Health, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara L.","family":"Niles","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA"},{"name":"Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3327-5233","authenticated-orcid":false,"given":"Stacey","family":"Young-McCaughan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"},{"name":"Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0482-3149","authenticated-orcid":false,"given":"Terence M.","family":"Keane","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA"},{"name":"Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2947-2936","authenticated-orcid":false,"given":"Alan L.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"},{"name":"Department of Psychology, University of Texas at San Antonio, San Antonio, TX 78249, USA"},{"name":"Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association [APA] (2013). 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