Trauma and post traumatic stress disorder are highly prevalent among people with substance use disorders. There is however, a dearth of literature as to how best to treat this comorbidity. The present study is one of the first randomised controlled trial to examine the efficacy of an integrated therapy for PTSD and substance use disorders.
A/Prof. Sudie Black
(Medical University of South Carolina)
Prof. Kathleen Brady
(Medical University of South Carolina)
(Traumatic Stress Clinic, Westmead Hospital)
A/Prof. Amanda Baker
(University of Newcastle)
- evaluate the efficacy of an integrated intervention for PTSD and substance use disorders by comparing the treatment outcomes of those who receive the intervention with those who receive standard care for their substance use
identify factors that influence the efficacy of the integrated intervention including:
- subject characteristics: demographic, substance use and psychological factors
- treatment characteristics: treatment compliance
- to assess the feasibility of implementing the intervention as measured by treatment retention and client satisfaction
A randomised controlled trial was conducted to address the research aims. One-hundred and three participants were recruited from alcohol and other drug treatment services in greater Sydney and via advertisements. Participants were randomised to one of two groups stratified according to sex: (i) those who receive the intervention (n=55), and (ii) those who receive standard care (n=48).
The intervention was a modified version of Concurrent Treatment of PTSD and Substance Dependence developed in the United States. The intervention consisted of thirteen, 90 minute sessions involving cognitive behavioural therapy with exposure techniques. Attempts were made to follow-up all participants at 6 weeks, 3 months and 9 months post baseline. Baseline and follow-up interviews include validated instruments to measure demographics, substance use and dependence, substance use and PTSD treatment history, criminal involvement, general physical and mental health, trauma exposure and PTSD, depression, anxiety, borderline personality disorder, and health service utilisation.
Across the nine month follow-up period both groups evidenced improvements in their substance use, severity of dependence, PTSD symptoms and depression. Participants randomised to the intervention demonstrated significantly greater improvements in relation to their PTSD symptoms. No other between-group differences were observed in relation to severity of substance dependence, substance use, depression, or anxiety.
The results of this study have been presented in a number of forums including most recently at the APSAD 2011 conference, EABCT 2011 conference, at an invited trauma workshop as part of DANA’s 2011 conference, ASPR 2010 conference and AWS 2010 conference. Concurrent Treatment with Prolonged Exposure (COPE), the treatment employed in this study has also been presented as an all day training workshop at the AACBT 2011 conference.
Mills KL, Teesson M, Back SE, Brady KT, Baker A, Hopwood S, Sannibale C, Barrett E, Merz S, Rosenfeld J, Ewer PL. Integrated Exposure-Based Therapy for Co-occurring Posttraumatic Stress Disorder and Substance Dependence: A Randomized Controlled Trial. JAMA. 2012; 308(7): 690-699.
Mills K, Back S, Brady K, Baker A, Teesson M, Hopwood S, Sannibale C. Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE): A treatment manual. Tech Report No. 322. Sydney: NDARC (2012).
Barrett E, Mills KL, Teesson M. Hurt people who hurt people: Violence among individuals with comorbid substance use disorder and post traumatic stress disorder. Addictive Behaviors. 2011; 36, 721-728.
Farrugia PL, Mills KL, Barrett E, Back SE, Teesson M, Baker A, Sannibale C, Hopwood S, Merz S, Rosenfeld J, Brady KT. Childhood trauma among individuals with co-morbid substance use and post traumatic stress disorder. Mental Health & Substance Use: Dual Diagnosis. 2011; 4, 314-326.
The present study provides evidence in support of integrated treatment for PTSD and substance dependence using prolonged exposure. The COPE treatment was found to be efficacious in reducing PTSD symptom severity. Contrary to popular belief, participants randomised to receive the exposure-based intervention did not demonstrate poorer substance use outcomes relative to those randomised to receive usual treatment only. The complex trauma, substance use, and psychiatric presentations commonly found among individuals with PTSD and substance dependence should not be a deterrent to providing trauma-focused treatment.