Substance use disorders (SUD) and post traumatic stress disorder (PTSD) are chronic, debilitating disorders that frequently co-occur (SUD+PTSD). For many individuals with SUD+PTSD, the onset of these disorders occurs during adolescence, yet the majority do not receive treatment until much later in life, if at all. There is a critical need to intervene early in the trajectory to prevent the long-term psychological and physical health problems associated with this comorbidity. However there are currently no empirically validated treatments for adolescents with SUD+PTSD. We seek to address this gap by conducting a Phase I pilot study of an innovative, exposure-based treatment for substance use and traumatic stress among adolescents: Concurrent treatment of PTSD and substance use using Prolonged Exposure - Adolescents (COPE-A).
Dr Vanessa Cobham
School of Psychology, University of Queensland
North Shore Child and Adolescent Mental Health, Northern Sydney Local Health District
Professor Sudie Black
Department of Psychiatry and Behavioural Science, Medical University of South Carolina
Up to two-thirds of clients entering SUD treatment in Australia meet criteria for PTSD, a debilitating anxiety disorder that has been associated with poorer treatment outcomes. Comorbid SUD+PTSD typically has its onset during the critical developmental period of adolescence. Substance use and traumatic stress during adolescence has been associated with significant structural and functional brain abnormalities, leading to extensive social, educational, physical and psychological impairments; and unsurprisingly, a more chronic course of illness. There is an urgent need to intervene early to prevent the long-term problems associated with this comorbidity. However, there are currently no empirically validated treatments for adolescents with SUD+PTSD. Our previous research has demonstrated the COPE intervention to be one of the only efficacious treatments for adults with comorbid SUD+PTSD. Using our collective research and clinical expertise, we have adapted COPE for use among adolescents (COPE-A).
To conduct a Phase I pilot study examining the feasibility and acceptability of COPE-A as a treatment for substance use and traumatic stress among adolescents.
Ten adolescents (aged 12-17 yrs) with comorbid substance use and traumatic stress will be recruited and offered the intervention. Adolescents and their caregivers will undergo interviews at baseline and post-treatment. Measures of therapeutic compliance, treatment acceptability and feasibility, and treatment outcome will be analysed.
Using our collective research and clinical expertise, we adapted the adult COPE treatment for use among adolescents (COPE-A) and piloted the implementation with a female adolescent aged 17yrs. At baseline she met criteria for a DSM-5 diagnosis of PTSD and reported severe symptom levels based on Child PTSD Reaction Index (PTSD RI). She reported alcohol and cannabis as her drugs of concern, and screened positive for a SUD diagnosis based on the CRAFFT. The participant completed 5 sessions of COPE-A treatment and the preliminary data are promising. By session 5, she had achieved an 11% reduction in PTSD symptom severity (PTSD-RI score 64 v 57) and had not used alcohol or cannabis for one week.
This research study has led to strong working collaborations with adolescent clinical practitioners at the Children’s Hospital, Westmead and at NSW Juvenile Justice. It has also led to the development and submission of a National Health and Medical Research Council (NHMRC) Project Grant to carry out a large randomised controlled trial to examine the efficacy of the COPE-A treatment. This research grant represents a collaboration of multidisciplinary researchers from the University of NSW, the University of Queensland, Macquarie University, the Medical University of South Carolina (US) and Lund University (Sweden); and clinical practitioners in private practice, from North Shore Child and Adolescent Mental Health, the Westmead Children’s Hospital, and NSW Juvenile Justice.
Presentations to promote the research:
1. Barrett EL and Kelly E. The COPE-A pilot study: Treating traumatic stress and substance use among adolescents. Presentation to The Children’s Hospital at Westmead. Sydney, Australia (Feb, 2015).
2. Barrett EL and Kelly E. The COPE-A pilot study: Treating traumatic stress and substance use among adolescents. Invited presentation at the Redfern Waterloo CDAT Drug Education Forum. Sydney, Australia (Nov, 2014).
3. Barrett EL and Kelly E. The COPE-A pilot study: Treating traumatic stress and substance use among adolescents. Presentation to Ted Noffs Foundation. Sydney, Australia (Oct, 2014).
4. Mills KL and Barrett EL. Treating comorbid PTSD and substance abuse. Invited seminar presentation for the Anxiety Practitioners Network. Sydney, Australia (Aug 2014).
Upcoming presentation and paper in preparation:
1. Barrett EL, Mills KL, Cobham V, Wignall A, Ross J, Teesson M, Back S, Slade T. An innovative approach to treating trauma and substance use in young people. Invited presentation at The Mental Health Services (TheMHS) Conference. Canberra, Australia (Aug, 2015).
2. Kelly, E, Cobham V, Barrett E, Mills K, Integrated CBT for the treatment of co-occurring PTSD and substance use: An adolescent case study. Clinical Case Studies (paper in preparation).
Clinicians providing adolescent substance use and mental health services face a significant challenge when presented with these commonly co-occurring conditions. Currently, there are no evidence-based treatment options for this comorbidity. As the first trial of its kind, this pilot study provides crucial information regarding the treatment of this comorbidity among adolescents. Using our collective research and clinical expertise, this pilot study has enabled us to develop the existing adult COPE treatment for use among adolescents (COPE-A) and preliminary findings from the implementation of the treatment are promising. The lessons learned from this pilot study are particularly useful for the development of a larger RCT which will more rigorously examine the efficacy of COPE-A. The findings from this research will be of utmost interest not only to scientific and clinical communities in Australia, but also internationally.