Posttraumatic stress disorder treatment in patients with co- substance use disorders: a randomized clinical trial

Background

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) often co-occur. Reviews and meta-analyses indicate that trauma-focused PTSD treatment is effective in reducing PTSD symptoms in individuals with this comorbidity. However, effect sizes are small and drop-out rates are high. In addition, the effectiveness of several evidence-based treatments for PTSD (e.g. EMDR, Imagery Rescripting) have not yet been examined in patients with co-occurring SUD. Finally, the optimal timing for treating PTSD is unclear. We hypothesized that all trauma-focused treatments would be effective in reducing PTSD symptom severity. In addition, we expected that simultaneous treatment of SUD and PTSD would be superior to sequential treatment of SUD and PTSD in reducing PTSD symptom severity.

Methods

This study is a 6-arm randomized clinical trials in 209 treatment-seeking patients with SUD and PTSD, conducted in two addiction treatment facilities in the Netherlands. Patients were randomly allocated to receive 12 sessions of Prolonged Exposure, EMDR, or Imagery Rescripting for PTSD, simultaneous with or sequential to treatment-as-usual (TAU) for SUD. The primary outcome parameter was PTSD symptoms, as measured with the Clinician Administered PTSD scale for DSM-5 (CAPS-5). Secondary outcome parameters were SUD severity (AUDIT, DUDIT), PTSD treatment completion and SUD treatment completion. 

Results

Main results of the RCT will be presented, demonstrating whether: 1) the addition of 12 sessions of Prolonged Exposure, EMDR, or Imagery Rescripting for PTSD to TAU for SUD is superior to TAU for SUD only; 2) parallel treatment of SUD + PTSD is superior tot sequential treatment of SUD + PTSD; 3) there are differences in effectiveness of Prolonged Exposure, EMDR, and Imagery Rescripting in this patient group.

Conclusions

Based upon the results of this study, conclusions and direct implications for clinical practice will be discussed.