Temporal dynamics of symptom change among veterans receiving an integrated treatment for posttraumatic stress disorder and substance use disorders

Abstract

The present study examined temporal patterns of symptom change during treatment for comorbid posttraumatic stress disorders (PTSD) and substance use disorders (SUDs). We hypothesized that PTSD symptom severity would predict subsequent-session substance use and that this association would be particularly strong among patients who received an integrated treatment versus SUDonly treatment. Participants were 81 United States military veterans with current PTSD and an SUD who were enrolled in a 12-week, randomized controlled trial examining the efficacy of an integrated treatment called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) compared with cognitive behavioral relapse prevention therapy (RP). Lagged multilevel models indicated that PTSD symptom improvement did not significantly predict the likelihood of next-session substance use (likelihood of use: B = 0.03, SE = 0.02, p = .141; percentage of days using B = -0.02, SE = 0.01, p = .172. Neither substance use, B = 1.53, SE = 1.79, p = .391, nor frequency of use, B = 0.26, SE = 0.50, p = .612, predicted next-session PTSD symptom severity in either treatment condition. Stronger associations between PTSD symptoms and next-session substance use were expected given the self-medication hypothesis. Additional research is needed to better understand the temporal dynamics of symptom change as well as the specific mediators and mechanisms underlying symptom change.

The impact of substance use on posttraumatic stress disorder symptoms and treatment discontinuation

“…Psychotherapy interventions for comorbid SUD and PTSD have been the subject of an increasing number of studies over the past two decades (e.g., Bedard-Gilligan et al, 2018;Brady et al, 2004). Research on treatment models has largely focused on two interconnected issues: (a) the effectiveness of integrated treatments for co-occurring PTSD and SUD and (b) the potential harms of engaging in trauma-focused treatment when a co-occurring SUD is active (e.g., Badour et al, 2021;Kehle-Forbes et al, 2019;Tripp et al, 2020). Recent meta-analyses have demonstrated that integrated PTSD and SUD treatments, particularly those that involve a specific trauma focus, are effective at reducing PTSD and SUD symptoms (Roberts et al, 2015(Roberts et al, , 2022Simpson et al, 2021).…”

“…One treatment-focused study found that alcohol use during integrated treatment predicted an exacerbation of PTSD symptoms two sessions later (Tripp et al, 2020). However, in another treatmentfocused study, Badour et al (2021) noted that neither substance use (i.e., alcohol, cocaine, marijuana, benzodiazepines, opioids, amphetamines) nor the frequency of use were significant predictors of PTSD symptoms in the next session. The authors also found that opioid use, alone or with other substances, did not predict next-day PTSD symptoms in a nontreatment study of daily monitoring of use and symptoms (Badour et al, 2023).…”

“…The authors also found that opioid use, alone or with other substances, did not predict next‐day PTSD symptoms in a nontreatment study of daily monitoring of use and symptoms (Badour et al., 2023). Overall, some studies have shown a positive concurrent association between alcohol use and PTSD symptoms (Black et al., 2018; Possemato et al., 2015), one study found a prospective increase in PTSD symptoms (Tripp et al., 2020), and another found no association (Badour et al., 2021). Studies on other substance use and PTSD symptoms have found no association (Badour et al., 2021, 2023).…”

“…Overall, some studies have shown a positive concurrent association between alcohol use and PTSD symptoms (Black et al., 2018; Possemato et al., 2015), one study found a prospective increase in PTSD symptoms (Tripp et al., 2020), and another found no association (Badour et al., 2021). Studies on other substance use and PTSD symptoms have found no association (Badour et al., 2021, 2023). These results suggest that other substance use may not interfere with PTSD symptom response to treatment, but alcohol use possibly would, though the results are not consistent for alcohol.…”