Currently, there are two e-health programs which have been developed to target co-occurring AOD use and PTSD among veterans. Thinking Forward is a self-directed online CBT program, comprising 12 interactive modules, developed for people with PTSD engaging in hazardous alcohol use. Findings to date have been mixed with one RCT reporting an association between Thinking Forward and reductions in heavy drinking but not PTSD symptoms, and another finding reductions in PTSD symptoms but not alcohol use [1365, 1366]. Similarly, VetChange, a CBT and MI-based online program for veterans with clinical levels of PTSD and at-risk alcohol use, has demonstrated significant post-treatment reductions in alcohol use and PTSD symptoms relative to baseline [1367–1369]. These reductions were more pronounced for VetChange participants compared to those randomised to a waitlist control [1367]. VetChange has also been adapted into a mobile app (https://mobile.va.gov/app/vetchange), which is yet to be evaluated.
Although there are few internet programs targeting co-occurring PTSD and AOD use, many evidence-based interventions exist for PTSD as a single disorder. Two meta-analyses support the benefit of e-health interventions, finding that they lead to greater improvements in PTSD symptoms compared to usual care, waitlist, and active controls [1370, 1371]. Improvements were observed regardless of whether individualised feedback was provided alongside the e-health intervention [1370]. Programs shown to have moderate treatment effects often incorporated CBT techniques, in the form of psychoeducation, exposure (e.g., writing about one’s trauma experience), anxiety management, and cognitive restructuring [1350].
Two promising internet programs – PTSD Online and The PTSD Course – have been developed in Australia and provide psychoeducational resources about AOD use [1195, 1372]. PTSD Online is a 10-week therapist-assisted program incorporating psychoeducation and CBT-based components. Several uncontrolled studies have found promising results, including high levels of treatment satisfaction and significant post-treatment improvements in PTSD symptoms, psychological distress, and quality of life relative to baseline [1195, 1196, 1373, 1374]. Similarly, The PTSD Course (formerly PTSD Program) is an online intervention including seven lessons based on elements of psychoeducation, CBT, and exposure therapy. People accessing the program are able to discuss relevant issues in forums moderated by therapists and message clinicians. One small RCT found significantly greater reductions in PTSD symptom severity among people randomised to receive PTSD Course compared to a waitlist control [1372]. People who accessed PTSD Course also reported high levels of satisfaction with the treatment.
There are several smartphone apps designed to treat PTSD as a single disorder. PTSD Coach, developed by the US Department of Veterans Affairs, is based on CBT and incorporates psychoeducation, self-assessment, treatment and referral resources, and social support tools, which can together be used as a stand-alone or supportive app during therapy [1375]. An online version of the app is also available (http://www.ptsd.va.gov/apps/PTSDCoachOnline). When compared to a waitlist control, Kuhn and colleagues [1376] found people accessing PTSD Coach reported greater reductions in PTSD symptoms [1376]. Miner and colleagues [1377], on the other hand, found no difference in post-treatment PTSD symptom scores [1377]. PTSD Coach has also been adapted into PTSD Coach Australia for Australian veterans [1378]. Qualitative feedback from participants provided promising support for this adaptation [1379].