Lagged effects of substance use on PTSD severity in a randomized controlled trial with modified prolonged exposure and relapse prevention.

Abstract

Objective: To advance understanding the effectiveness of evidence-based treatments for comorbid posttraumatic stress and substance use disorders (PTSD and SUD), research must provide a more nuanced picture of how substance use affects change in PTSD symptoms over the course of treatments, and whether prolonged exposure techniques can be efficacious during active substance use. A dataset that included patients with PTSD/subthreshold PTSD and SUD treated with an exposure-based intervention provided an opportunity to conduct a secondary analysis to test how patients’ substance use impacted PTSD change over treatment. Method: We applied growth models to week-to-week PTSD symptom and substance use changes during treatment and follow-up of a randomized controlled trial of two cognitive behavioral treatments for PTSD and SUD: Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE) and Relapse Prevention Therapy (RPT). Cross-lagged analyses were used to determine whether prior week substance use impacted subsequent PTSD symptom severity. Results: Both treatments evidenced significant reductions in PTSD symptom severity. In the context of continued substance use, results suggest that individuals still benefit from exposure-based treatment. Conclusion: Results provide evidence that RPT and COPE both led to significant reductions in PTSD, providing further support that exposure-based techniques tailored for SUD can be conducted without jeopardizing PTSD or SUD outcomes. Implications for clinical decision-making around treatment selection are discussed.

The Effects of Prolonged Exposure on Substance Use in Patients With Posttraumatic Stress Disorder and Substance Use Disorders

“…The lack of an association between PTSD severity and subsequent substance use is consistent with studies documenting similar rates and severity of substance use in SUD samples with and without PTSD (Dworkin, Kaysen, Bedard-Gilligan, Rhew, & Lee, 2017;Peirce, Brooner, Kolodner, Schacht, & Kidorf, 2013;Peirce et al, 2016), but contrary to what has been reported in some prospective studies (e.g., Black, Cooney, Sartor, Arias, & Rosen, 2018;Dworkin et al, 2017;Hien et al, 2010). In contrast, self-reported substance use in the present study was moderately associated with more severe PTSD symptoms, which has also been documented in recent studies of exposure-based therapy (Hien et al 2018;Jarnecke et al, 2019). Helping patients reduce or eliminate substance use might have more benefit on their PTSD symptoms than has previously been understood.…”

“…In contrast, self‐reported substance use in the present study was moderately associated with more severe PTSD symptoms, which has also been documented in recent studies of exposure‐based therapy (Hien et al. 2018; Jarnecke et al., 2019). Helping patients reduce or eliminate substance use might have more benefit on their PTSD symptoms than has previously been understood.…”

“…In addition, other studies have shown that improvements in PTSD symptoms precede improvement in SUD symptoms (Back, Brady, Jaanimägi, & Jackson, 2006; Hien et al., 2010); thus, there could be a significant improvement in abstinence or treatment retention if patients receive effective treatment for their PTSD. Fewer tests of the effect of SUD improvement on PTSD improvement have been conducted, although the results of one study suggest that patients who reduce their substance use may also show improvement in their PTSD symptoms (Hien et al., 2018).…”

Safety and Efficacy of Exposure-Based Risk Reduction Through Family Therapy for Co-occurring Substance Use Problems and Posttraumatic Stress Disorder Symptoms Among Adolescents

“…These results complement recent treatment research supporting the safety and utility of exposure-based treatments for adults with cooccurring SUP and PTSD. [11][12][13][14][15]20 Together findings from this and prior research demonstrate that it is safe to provide exposurebased treatment to this population when combined with substance use treatment, and this approach also may lead to the best long-term SUP and PTSD symptom outcomes.…”

“…However, no existing interventions address co-occurring SUP and PTSD symptoms among adolescents in an integrated fashion, perhaps owing to the highly compartmentalized nature of the mental health and addiction fields, the well-recognized challenges in the treatment of co-occurring SUP and PTSD symptoms across the life span, 15 and the long-standing but unsupported clinical lore asserting that engaging youth with SUP and PTSD symptoms in exposure-based treatment (criterion standard treatment for PTSD symptoms) is unsafe owing to concerns that exposure-induced distress might exacerbate SUPs. 20 Risk reduction through family therapy (RRFT) 21 was developed to address the need for an efficacious intervention for cooccurring SUP and PTSD symptoms among adolescents. An open trial 22 and a pilot randomized clinical trial (RCT) 23 supported the feasibility and preliminary efficacy of RRFT.…”