While comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is common among veterans, there is debate regarding how to best treat individuals suffering from both conditions. Despite data supporting the effectiveness of integrated treatments that simultaneously address both disorders, due to concerns that an early focus on trauma may increase dropout and reduce the likelihood of achieving SUD-related goals, providers continue to prefer a sequential approach, where the addiction is treated first and PTSD treatment is instituted following sustained abstinence or reduced use. This project is designed to directly examine these provider concerns by evaluating the benefits and harms of an integrated versus a sequential approach to treating comorbid PTSD and SUD. This paper reviews the study's methodology, treatment approaches, and baseline participant characteristics. In this randomized clinical trial, one hundred eighty-three veterans with co-occurring PTSD and SUD have been randomized to one of two psychotherapies that include the same treatment components for SUD and PTSD (Motivational Enhancement Therapy and Prolonged Exposure respectively), but differ by whether the components are delivered sequentially or are integrated such that PTSD and SUD symptoms are addressed concurrently. We hypothesize that veterans assigned to integrated treatment will show greater improvement in PTSD and SUD symptoms than veterans assigned to sequential treatment. If this hypothesis is supported, the findings have the potential to change clinicians’ beliefs and challenge long-standing practice patterns that require participation in SUD treatment prior to initiating trauma-focused therapies for PTSD.
Bibliographical noteFunding Information:
None of the authors declare conflicts of interest. 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). Support was also provided by the Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center (CMCVAMC) and Center of Excellence for Substance Abuse Treatment and Evaluation at the CMCVAMC. ClinicalTrials.gov Identifier: NCT01211106 . 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.
Copyright 2017 Elsevier B.V., All rights reserved.
- Motivational Enhancement Therapy
- Posttraumatic stress disorder
- Prolonged Exposure therapy
- Randomized clinical trial
- Substance use disorders