HSR&D Home » Research » IIR 04-175 – HSR&D Study
Effectiveness of Screening and Treatment for PTSD in SUD Patients
Jodie A. Trafton, PhD
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: January 2006 - December 2010
Roughly one-third of patients with substance use disorders (SUD) have a co-morbid diagnosis of Posttramatic Stress Disorder (PTSD). SUD patients with PTSD have greater SUD severity and patients with PTSD have higher rates of early relapse to substance use following treatment. Methods to improve the poorer SUD outcomes of this population are needed to foster recovery in patients with these prevalent co-morbidities and improve the effectiveness of VA SUD treatment programs.
To investigate whether the generally poorer substance use outcomes of male veterans with comorbid PTSD and SUD could be improved by offering a specialized treatment track, using Seeking Safety (SS). SS is a manualized, cognitive-behavioral, integrated treatment for these co-morbidities that we hypothesized would ameliorate the negative effect of PTSD on SUD treatment outcomes. Additionally, this study investigated whether this treatment track improved PTSD severity, mental health and social functioning, treatment attendance, and legal problems in SUD patients with PTSD, and explored candidate mediators of treatment effects (e.g. coping skill improvements and reduced PTSD symptoms).
This study is a randomized controlled effectiveness trial in which 96 male veterans with comborbid PTSD-SUD beginning treatment at a VA outpatient substance use disorder clinic were randomly assigned to receive SUD-focused treatment as usual (TAU) or a track for PTSD-SUD patients substituting SS based groups and case management for TAU sessions. Subjects were interviewed at baseline, 3, 6 and 12 months following treatment initiation to monitor treatment outcomes.
Patients randomized to SS showed greater reductions in drug use, but not alcohol use over time than did patients in TAU. Patients overall showed significant improvements in PTSD symptom severity and mental health functioning and reductions in legal problems and avoidance coping over the 6 month period after starting treatment, with no difference in rate of change between TAU and SS. Patients in SS attended significantly more treatment sessions, reported higher levels of treatment satisfaction, and larger increases in approach coping than patients in TAU; however, these factors were not independently associated with drug use outcomes, and thus did not mediate the effects of the SS treatment.
A SS-based track for patients with PTSD in VA outpatient SUD treatment may be useful for improving drug use outcomes, treatment attendance, treatment satisfaction and approach coping in the 6 months following treatment engagement. Because SS uses cognitive behavioral therapy methods familiar to clinicians at the majority of VA SUD treatment programs, adding a SS-based track may provide a readily implementable intervention to improve drug outcomes. A toolkit to facilitate implementation has been developed.
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DRA: Mental, Cognitive and Behavioral Disorders, Substance Use Disorders, Military and Environmental Exposures
DRE: Treatment - Observational, Treatment - Efficacy/Effectiveness Clinical Trial, Diagnosis
Keywords: Drug abuse, PTSD
MeSH Terms: none