Efficacy and acceptability of interventions for co-occurring PTSD and SUD: A meta-analysis

Simpson, Tracy L.; Goldberg, Simon B.; Louden, Diana; Blakey, Shannon M.; Hawn, Sage E.; Lott, Aline; Browne, Kendall C.; Lehavot, Keren; Kaysen, Debra

doi:10.1016/j.janxdis.2021.102490

Cited by 50 publications

(33 citation statements)

References 97 publications

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“…NeuroGrove, Arvada, Colorado, USA Recent epidemiological research has revealed that around 57% of individuals with chronic posttraumatic stress disorder (PTSD) also struggle with chronic drug and/or alcohol abuse (Simpson et al, 2021). Rates of substance-related overdoses recently hit a record high of 81,000 deaths in the 12 months leading up to May 2020 (Centers for Disease Control and Prevention, 2020).…”

Section: Ashlie Bellmentioning

confidence: 99%

Proceedings of the 2022 ISNR Annual Conference: Keynote and Plenary Presentations

Research¹

2022

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The human brain is a magnificent tapestry of billions of neurons, trillions of synaptic connections with axons woven into a network of nodes and thousands of fiber tracks or edges. Together, these structures constitute the connectome or "the wiring diagram" of the brain. How the "wiring" occurs is dependent upon neuroplasticity, genetic and epigenetic factors: transgenerational experiences, environment

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Section: Ashlie Bellmentioning

confidence: 99%

Proceedings of the 2022 ISNR Annual Conference: Keynote and Plenary Presentations

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2022

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“…Although typically a control condition in PTSD/SUD treatment studies, cognitive-behavioral treatments (CBT) for SUD, such as Relapse Prevention (RP) [12], have demonstrated comparable improvements in both PTSD and substance use outcomes as non-trauma focused integrated treatment [13,14] and have performed as well as trauma-focused treatments on PTSD and substance use outcomes in a priori intent-to-treat models of some [15][16][17][18] but not all trials [19]. Recent meta-analytic work specifically compared manualized CBT-SUD control conditions with both trauma-focused and with non-trauma-focused interventions designed for those with PTSD/SUD in the context of randomized clinical trials [20]. The results indicate that the CBT-SUD conditions did not significantly differ from either trauma-focused or nontrauma-focused treatments on PTSD outcomes at either immediate post-test or longest followup, but were associated with significantly better substance use outcomes [20].…”

Section: Introductionmentioning

confidence: 99%

“…Recent meta-analytic work specifically compared manualized CBT-SUD control conditions with both trauma-focused and with non-trauma-focused interventions designed for those with PTSD/SUD in the context of randomized clinical trials [20]. The results indicate that the CBT-SUD conditions did not significantly differ from either trauma-focused or nontrauma-focused treatments on PTSD outcomes at either immediate post-test or longest followup, but were associated with significantly better substance use outcomes [20]. Additionally, treatment completion for those assigned to individual CBT-SUD control conditions mostly ranged from 55% to 86% [13,[17][18][19]; cf.…”

Section: Introductionmentioning

confidence: 99%

Cognitive Processing Therapy or Relapse Prevention for comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A randomized clinical trial

et al. 2022

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Objective To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. Method Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days. Results At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days. Conclusion Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care. Trial registration The trial is registered at clinicaltrials.gov (NCT01663337).

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“…PTSD symptoms can also acutely motivate drug use (Hawn et al, 2020 ; Weiss et al, 2022 ) and lead to drug cravings (Farrelly et al, 2021 ; Vujanovic et al, 2019 ). In addition, both drug use and PTSD symptoms appear to decrease following integrated trauma-focused therapies (Roberts et al, 2015 ; Simpson et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

A participant-randomized pilot hybrid II trial of group cognitive processing therapy for incarcerated persons with posttraumatic stress and substance use disorder symptoms: study protocol and rationale

et al. 2022

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Background Trauma exposure and drug addiction go hand-in-hand for the 2.17 million people who are incarcerated in US prisons; prevalence of both exceed 80% among this population. This manuscript describes the rationale and methods for a participant-randomized effectiveness-implementation hybrid type II pilot trial designed to: 1) examine the effectiveness of Cognitive Processing Therapy group (CPT), an evidence-based psychotherapy for posttraumatic stress disorder (PTSD), for reducing post-release drug use and PTSD symptoms when adapted for and delivered in prisons; and 2) provide data on implementation outcomes associated with the use of implementation facilitation as a strategy for supporting uptake of CPT in prisons. Method Participants in the effectiveness portion of the trial (N = 120) will be incarcerated men and women who are randomly assigned to one of two group therapies: CPT or a control condition (PTSD coping skills group; PCS). Participants will complete assessment measures three times: pre-treatment, post-treatment, and 3 months following release from incarceration. CPT groups will be led by prison counselors who are receiving implementation facilitation to support their efforts. PCS groups will be led by trained clinicians on the research team. Implementation outcomes will include acceptability, appropriateness, adoption, feasibility, fidelity, and sustainability. After enrollment ends, the research team will monitor CPT sustainment and recidivism outcomes of study participants for one year. Discussion This study will lay the groundwork for a larger study of interventions for co-occurring PTSD and SUD in prisons and, critically, inform the development of strategies (such as implementation facilitation) for supporting their uptake in routine practice. Trial registration NCT04007666, clinicaltrials.gov, 24 June 2019, 02 September 2021.

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Efficacy and acceptability of interventions for co-occurring PTSD and SUD: A meta-analysis

Cited by 50 publications

References 97 publications

Proceedings of the 2022 ISNR Annual Conference: Keynote and Plenary Presentations

Proceedings of the 2022 ISNR Annual Conference: Keynote and Plenary Presentations

Cognitive Processing Therapy or Relapse Prevention for comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A randomized clinical trial

A participant-randomized pilot hybrid II trial of group cognitive processing therapy for incarcerated persons with posttraumatic stress and substance use disorder symptoms: study protocol and rationale

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