Development of an Integrated Psychosocial Intervention for Alcohol Use Disorder with Comorbid Aggression

PROJECT SUMMARY The relationship between alcohol use (AU) and aggression (AGG) is widely recognized. In fact, epidemiologic data demonstrate that 40% of individuals with Alcohol Use Disorder (AUD) in the community display clinically significant levels of AGG. Moreover, aggression frequency in individuals with AUD+AGG increases as overall alcohol consumption increases, making alcohol- facilitated aggression a major public health threat. While the relationship between AUD and AGG may be bidirectional, our data indicate that more than 90% of those with AUD+AGG report the onset of problematic aggression before the onset of problematic drinking. As such, premorbid AGG represents a risk factor for the development and maintenance of problematic drinking. In addition, experimental studies suggest that alcohol increases aggression primarily in those who are already aggressive. To date, the literature contains little treatment research in those with AUD+AGG. More importantly, AUD treatments, in general, minimally focus on treating AGG in AUD, including considering it an optional element of care. Fortunately, full cognitive behavioral treatments for AGG exist, notably CRCST (Cognitive Restructuring, Relaxation and Coping Skills Training) which we have shown has good efficacy in reducing aggression in those with AGG. In addition, based on our work in aggression, we posit that individuals with AUD+AGG constitute an important subgroup of those with AUD and that this comorbidity (AUD+AGG) represents a target for a personalized medicine approach for AUD. At this time, we have developed a provisional Integrated CBT manual containing the most critical elements for treating AUD and for treating AGG. In this R34 project, we will refine our Integrated CBT-AUD+AGG Treatment Manual in a small study in patients with AUD+AGG and then conduct a pilot RCT comparing this integrated CBT AUD+AGG intervention with CBT-AUD Alone (from Project MATCH). The goal of this study is to obtain acceptability, feasibility, and effect size data, which will be used inform the next steps in this program of research (e.g., a large scale clinical trial).