Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans

Abstract

Objective-A substantial amount of individuals with substance use disorders (SUD) also meet criteria for posttraumatic stress disorder (PTSD). Prolonged exposure (PE) is an effective, evidenced-based treatment for PTSD, but there is limited data on its use among individuals with current alcohol or drug use disorders. This study evaluated the efficacy of an integrated treatment that incorporates PE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure or COPE) among veterans. Method-Military veterans (N = 81, 90.1% male) with current SUD and PTSD were randomized to 12 sessions of COPE or Relapse Prevention (RP). Primary outcomes included the Clinician-Administered PTSD Scale (CAPS), PTSD Checklist-Military version (PCL-M), and the Timeline Follow-back (TLFB). Results-On average, participants attended 8 out of 12 sessions and there were no group differences in retention. Intent-to-treat analyses revealed that COPE, in comparison to RP, resulted in significantly greater reductions in CAPS (d = 1.4, p <. 001) and PCL-M scores (d = 1.3, p =. 01), as well as higher rates of PTSD diagnostic remission (OR = 5.3, p < .01). Both groups evidenced significant and comparable reductions in SUD severity during treatment. At 6-months

Does trauma-focused exposure therapy exacerbate symptoms among patients with comorbid PTSD and substance use disorders?

“…Participants completed a large assessment battery. 4 Measures relevant to the present study included the Mini International Neuropsyhiatric Interview (baseline), the Clinician Administered PTSD Scale (baseline and last session), the PTSD Symptom Checklist (baseline 1 For a full report of the overall outcomes from this randomized clinical trial, see additional publications (Back et al, 2019;Jarnecke et al, 2019). The 2:1 randomization ratio was used due to ethical concerns.…”

“…One emerging exposure-based treatment for comorbid PTSD and SUD is called Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE; Back et al, 2014a). Overall outcome data suggest that COPE can improve symptoms of both SUD and PTSD among civilian and military individuals with both diagnoses (Back et al, 2019;Hien et al, 2016;Mills et al, 2012Mills et al, , 2016Persson et al, 2017;Ruglass et al, 2017). Only one of these studies (Mills et al, 2016) has evaluated symptom exacerbation based on reliable change analyses.…”

“…For a full description of all measures completed by participants in the study, see additional publication(Back et al, 2019).…”

Brain and Cognition for Addiction Medicine: From Prevention to Recovery Neural Substrates for Treatment of Psychostimulant-Induced Cognitive Deficits

“…Interestingly, there is significant overlap in pathways that mediate extinction of fear-associated memories and extinction of drug-associated memories (93). In fact, currently, behavioral therapies are being used to concurrently treat both substance abuse and post-traumatic stress disorder (96). Thus, in this review where direct evidence is lacking, we suggest neural substrates that play a role in extinction of fear-associated memories as possible targets for promoting extinction of drug-associated memories.…”

Veterans with PTSD and comorbid substance use disorders: Does single versus poly-substance use disorder affect treatment outcomes?

“…Participants were U.S. military Veterans enrolled in a larger randomized controlled trial (Back et al, 2019) examining the efficacy of a novel 12-week, exposure-based integrated treatment for comorbid PTSD and SUD (i.e., Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure, or COPE; Back et al, 2014) versus Relapse Prevention cognitive behavioral therapy (CBT; Carroll, 1998). This larger study lends evidence to the efficacy of COPE, demonstrating that COPE resulted in significantly greater reductions in PTSD than RP, as well as comparable reductions in SUD during treatment and greater reductions during follow up (Back et al, 2019). All participants met Diagnostic and Statistical Manual of Mental Disorders IV Text Revision (DSM-IV-TR; Amerian Psychiatric Association, 2000) criteria for current SUD and PTSD.…”