Combining seeking safety with sertraline for PTSD and alcohol use disorders: A randomized controlled trial.

Abstract

Objective The current study marks the first randomized controlled trial to test the benefit of combining Seeking Safety (SS), a present-focused cognitive behavioral therapy for co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), with sertraline, a front-line medication for PTSD shown to also impact drinking outcomes. Method Sixty-nine participants (81% female; 59% African American) with primarily childhood sexual (46%) and physical (39%) trauma exposure, and drug dependence in addition to AUD were randomized to receive a partial-dose (12 sessions) of SS with either sertraline (n = 32; M = 7 sessions) or placebo (n = 37; M = 6 sessions). Assessments conducted at baseline, end-of-treatment, 6- and 12-months posttreatment measured PTSD and AUD symptom severity. Results Both groups demonstrated significant improvement in PTSD symptoms. The SS plus sertraline group exhibited a significantly greater reduction in PTSD symptoms than the SS plus placebo group at end-of-treatment (M difference = −16.15, p = .04, d = 0.83), which was sustained at 6- and 12-month follow-up (M difference = −13.81, p = .04, d = 0.71, and M difference = −12.72, p = .05, d = 0.65, respectively). Both SS groups improved significantly on AUD severity at all posttreatment time points with no significant differences between SS plus sertraline and SS plus placebo. Conclusion Results support the combining of a cognitive behavioral therapy and sertraline for PTSD/AUD. Clinically significant reductions in both PTSD and AUD severity were achieved and sustained through 12-months follow-up, Moreover, greater mean improvement in PTSD symptoms was observed across all follow-up assessments in the SS plus sertraline group.

Targeting the SAVA (Substance Abuse, Violence, and AIDS) Syndemic Among Women and Girls

“…With the exception of Healing our Women ( HOW ), few of these interventions are culturally congruent. 57,58,63 Additionally, few studies have examined the efficacy of combined pharmacotherapy and behavioral interventions for the syndemic, 67,68 however, those studies suggest that combined interventions are clinically warranted. Evidence generally supports the use of selective serotonin reuptake inhibitors for PTSD and other trauma-related conditions, such as depression and anxiety.…”

The impact of treatment condition and the lagged effects of PTSD symptom severity and alcohol use on changes in alcohol craving

“…For example, Hien et al (2004) found that both SS and relapse prevention therapy resulted in significant reductions in substance use compared to standard community treatment. Additionally, Hien et al (2015) reported that SS, combined with either sertraline or placebo, showed significant reductions in alcohol symptoms at the end of treatment, which was sustained through 12-months follow-up. Furthermore, TREM has been shown to significantly reduce alcohol and drug abuse severity but not PTSD symptoms compared to TAU (Fallot, McHugo, Harris, & Xie, 2011).…”

“…In general, these treatments show positive outcomes in improving patients’ PTSD symptoms and/or other symptom areas. Specifically, treatments such as ICBT, TREM, and COPE showed greater improvements in PTSD symptoms compared to control conditions (Hien et al, 2015; Najavits & Hien, 2013). The results of the efficacy of SS are mixed with one study finding no differences between SS and an active comparison health education group in terms of PTSD symptom reductions or substance use outcomes (Hien et al, 2009).…”

Indigenous Healing and Seeking Safety: A Blended Implementation Project for Intergenerational Trauma and Substance Use Disorders

“…In a recent randomized controlled trial, Hien et al (2015) tested the benefits of combining Seeking Safety with sertraline, a frontline medication for PTSD shown also to affect drinking outcomes. Both groups demonstrated significant improvements in PTSD symptoms (Hein et al, 2015).…”