A novel trauma-focused psychological therapy for co-occurring substance use and PTSD among adolescents

Up to 80% of adolescents have experienced trauma and one in seven suffer from post-traumatic stress disorder (PTSD). In almost 50% of adolescents PTSD cases, recovery is impeded by the presence of a co-occurring substance use disorder, which often develops from repeated self-medication of PTSD symptoms. Once established, both disorders maintain and exacerbate the other leading to chronic illness and significant treatment complications. Despite this, adolescent treatments for this comorbidity remain sparse. This study describes the development of a world-first exposure-based therapy for substance use and PTSD in adolescents (COPE-A), and presents data illustrating the clinical profile of participants recruited in an ongoing RCT.

A description of the development of the COPE-A therapy will be provided. Participants in an RCT examining efficacy of COPE-A (Trial Registration: ACTRN 12618000785292) complete a baseline interview comprising validated assessments for substance use (TLFB), substance use disorder (DISC-V), trauma (PTSD-RI Events), PTSD (CAPS-CA-5) and related comorbidity (e.g., RCADS). RCT recruitment ends June 2022.

COPE-A was adapted from an existing evidence-based adult therapy (Concurrent treatment of PTSD and Substance Use Disorders Using Prolonged Exposure: COPE) and incorporates gold standard treatments for adolescent PTSD and substance use. To date, 45 participants have been recruited in the RCT (69% female; M age 18.5yrs), almost all (98%) meet DSM-V criteria for substance use disorder (cannabis (56%) and alcohol (40%) use most common). All participants have experienced multiple traumas and 87% meet DSM-V criteria for PTSD. High levels of clinical elevated depression and anxiety is present in the sample and close to half (46%) have a history of attempted suicide.

It is imperative to intervene early to address the lifelong burden associated with co-occurring substance use and PTSD. COPE-A is a novel and promising trauma-focused psychological therapy for the many adolescents with this comorbidity who present with complex clinical profiles.