Concurrent Treatment with Prolonged Exposure for Co-Occurring Full or Subthreshold Posttraumatic Stress Disorder and Substance Use Disorders: A Randomized Clinical Trial

Abstract

Background: To test whether an integrated prolonged exposure (PE) approach could address posttraumatic stress disorder (PTSD) symptoms effectively in individuals with co-occurring substance use disorders (SUD), we compared concurrent treatment of PTSD and SUD using PE (COPE) to relapse prevention therapy (RPT) for SUD and an active monitoring control group (AMCG). Methods: We conducted a randomized 12-week trial with participants (n = 110; 64% males; 59% African Americans) who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision criteria for full or subthreshold PTSD and SUD. Participants were randomly assigned to COPE (n = 39), RPT (n = 43), or AMCG (n = 28). Results: At the end-of-treatment, COPE and RPT demonstrated greater reduction in PTSD symptom severity relative to AMCG (COPE-AMCG = -34.06, p < 0.001; RPT-AMCG = -22.58, p = 0.002). Although the difference between COPE and RPT was not significant in the complete sample, the subset of participants with full (vs. subthreshold) PTSD demonstrated significantly greater reduction of PTSD severity in COPE relative to RPT. Both treatments were superior to AMCG in reducing the days of primary substance use (COPE-AMCG = -0.97, p = 0.01; RPT-AMCG = -2.07, p < 0.001). Relative to COPE, RPT showed significantly more improvement in SUD outcome at end-of-treatment (RPT-COPE = -1.10, p = 0.047). At 3-month follow-up, COPE and RPT maintained their treatment gains and were not significantly different in PTSD severity or days of primary substance use. Conclusion: COPE and RPT reduced PTSD and SUD severity in participants with PTSD + SUD. Findings suggest that among those with full PTSD, COPE improves PTSD symptoms more than a SUD-only treatment. The use of PE for PTSD was associated with significant decreases in PTSD symptoms without worsening of substance use.

Emotion dysregulation moderates the effect of cognitive behavior therapy with prolonged exposure for co-occurring PTSD and substance use disorders

“…Furthermore, the current study provides indications for treatment matching by degree of emotion regulation difficulties. Without taking baseline level of ED into consideration, Ruglass et al (2017) showed that those who received either COPE or RPT demonstrated statistically significant improvements in both PTSD and SUD outcomes when compared to the control group. The present study’s examination of baseline level of ED as a moderator revealed indications for differential treatment selection.…”

“…The institutional review board of the City College of New York approved all procedures. Detailed descriptions of all study procedures including randomization, the interventions and fidelity, and data collection are described in Ruglass et al (2017).…”

“…In a recently completed RCT for individuals with PTSD+SUD, Ruglass et al (2017) compared an integrated, exposure-based treatment (Concurrent Treatment with Prolonged Exposure [COPE]; Back et al, 2014) to cognitive behavior therapy for substance dependence alone (Relapse Prevention Therapy [RPT]; Carroll, 1996). Both treatments were associated with significant benefits in PTSD and SUD domains.…”

“…Both treatments were superior to AMCG in reducing use of primary substance in the past seven days (COPE-AMCG = −0.97, p = .01; RPT-AMCG = −2.07, p <.001). The present study was a secondary analysis of the aforementioned (clinicaltrials.gov #NCT01365247, Ruglass et al, 2017). We specifically examined ED as a moderator of treatment and compared impact on PTSD and SUD outcomes by treatment type.…”

A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders

“…To address this research gap, our study compares Seeking Safety plus treatment as usual (TAU) to Relapse Prevention Training (RPT) plus TAU and to a TAU control. RPT, a standard SUD treatment, was chosen as an active control condition because it has been shown to be effective for reducing symptoms of PTSD and substance use in individuals with co-occurring PTSD and SUD (Hien, Cohen, Miele, Litt, & Capstick, 2004;Ruglass et al, 2017). The primary hypothesis was that Seeking Safety plus TAU would outperform TAU alone on PTSD reduction, but not differ from RPT plus TAU.…”