A randomized controlled trial evaluating integrated versus phased application of evidence-based psychotherapies for military veterans with comorbid PTSD and substance use disorders

Shannon M. Kehle-Forbes, Shirley Chen, Melissa A. Polusny, Kevin G. Lynch, Erin Koffel, Erin Ingram, Edna B. Foa, Deborah H.A. Van Horn, Michelle L. Drapkin, David A. Yusko, David W. Oslin

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

OBJECTIVE: Recent clinical practice guidelines recommend the delivery of evidence-based psychotherapies for both substance use disorder (SUD) and posttraumatic stress disorder (PTSD) within the same treatment episode for patients with SUD/PTSD comorbidity. This randomized clinical trial evaluated the comparative effectiveness of integrating versus phasing evidence-based psychotherapies for SUD and PTSD among veterans with co-occurring SUD/ PTSD.

METHOD: 183 veterans with DSM-IV PTSD and SUD at two VA Medical Centers were randomized to one of two psychotherapies during which Motivational Enhancement Therapy [MET] for SUD and Prolonged Exposure [PE] for PTSD were either phased or integrated throughout treatment. Primary outcomes as evaluated by blinded assessors were percent days with drug use or heavy drinking and PTSD symptomology. We hypothesized integrated MET/PE (n = 95) would yield better SUD and PTSD-related outcomes at posttreatment than phased MET/PE (n = 88).

RESULTS: In intent-to-treat analyses (n=183), both treatment groups achieved clinically (d=0.46 - 1.06) and statistically significant reductions in SUD (p < 0.01) and PTSD (p < 0.01) symptomology; the time by treatment interactions were not significant. Post-hoc analyses could not confirm statistical non-inferiority; between-group effect sizes suggest a lack of clinically-meaningful differences between the two treatment approaches (d=0.08 - 0.27).

CONCLUSIONS: Our hypothesis that integrated MET/PE would result in better outcomes than phased MET/PE across a range of PTSD and SUD measures was not supported; both strategies for combining two single-disorder treatments for co-occurring SUD/PTSD yielded significant symptom reduction.

Original languageEnglish (US)
Article number107647
JournalDrug and alcohol dependence
Volume205
DOIs
StatePublished - Dec 1 2019

Bibliographical note

Funding Information:
This material is based upon work supported by Merit Review Award # ZDA1-03-W10 from the United States (U.S.) Department of Veterans Affairs , Clinical Science Research & Development . Dr. Kehle-Forbes was supported by a Health Services Research & Development Career Development Award (09-020). This material is the result of work supported with resources and the use of facilities at the Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center (CMCVAMC) and the Minneapolis VA Healthcare System. The funder had no involvement in the study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit this article for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Funding Information:
This material is based upon work supported by Merit Review Award # ZDA1-03-W10 from the United States (U.S.) Department of Veterans Affairs, Clinical Science Research & Development. Dr. Kehle-Forbes was supported by a Health Services Research & Development Career Development Award (09-020). This material is the result of work supported with resources and the use of facilities at the Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center (CMCVAMC) and the Minneapolis VA Healthcare System. The funder had no involvement in the study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit this article for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Publisher Copyright:
© 2019

Keywords

  • Posttraumatic stress disorder
  • Psychotherapy
  • Substance use disorders
  • Veterans

PubMed: MeSH publication types

  • Journal Article

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