Evaluating treatments for posttraumatic stress disorder, alcohol and other drug use disorders using meta-analysis of individual patient data: Design and methodology of a virtual clinical trial

Saavedra, Lissette M.; Morgan‐López, Antonio A.; Hien, Denise A.; López‐Castro, Teresa; Ruglass, Lesia M.; Back, Sudie E.; Fitzpatrick, Skye; Norman, Sonya B.; Killeen, Therese K.; Ebrahimi, Chantel T.; Hamblen, Jessica L.

doi:10.1016/j.cct.2021.106479

Cited by 16 publications

(4 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The studies included in this review mostly continued to exclude on the basis of cognitive impairment, current suicide risk, and severe mental illness, and our findings should not be generalized to individuals with these types of presentation. Going forward, initiatives such as Project Harmony (Saavedra et al, 2021 ), which plan to undertake meta-analysis of individual patient data, are likely to greatly improve our understanding of key patient outcome predictors.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder

Roberts

Lotzin

Schäfer

2022

European Journal of Psychotraumatology

View full text Add to dashboard Cite

Background The psychological treatment of comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) is clinically challenging, and outcomes are often poor. Objective This paper describes a systematic review and meta-analysis which sought to establish the current efficacy for a number of established psychological approaches for adults and adolescents, in comparison to interventions for SUD alone, or other active approaches, following a pre-registered protocol. Method This review followed PRISMA and Cochrane Collaboration guidelines. Data extraction and risk of bias judgements using Cochrane criteria were undertaken by all authors. Primary outcomes were PTSD severity and substance use post-treatment. The quality of findings was assessed using GRADE. Following a comprehensive search, conducted to 13 September 2021, 27 studies were included. Results We found a relatively high level of dropout across studies. In our main comparisons, we found no benefits for present-focused treatment approaches aimed at improving coping skills beyond those for SUD-only interventions. We found modest benefits for trauma-focused intervention plus SUD intervention post-treatment for PTSD (standardized mean difference (SMD) = −0.36, 95% confidence interval (CI) −0.64, −0.08), and at 6–13 months for PTSD (SMD = −0.48, 95% CI −0.81, −0.15) and alcohol use (SMD = −0.23, 95% CI −0.44, −0.02). There were no benefits for cognitive restructuring interventions as a group, but we found a modest effect for integrated cognitive behavioural therapy (ICBT) for PTSD post-treatment (SMD = −0.33, 95% CI −0.62, −0.04). There was evidence of some benefit for trauma-focused intervention over present-focused intervention for PTSD from a single study and for reduction in dropout for incentivized attendance for trauma-focused intervention from another single study. Most findings were of very low quality. Conclusion There is evidence that trauma-focused therapy and ICBT can improve PTSD for some individuals, but many patients do not fully engage with treatment and average treatment effects are modest. HIGHLIGHTS For PTSD, evidence was strongest for trauma-focused CBT-based approaches, but effects were modest. There was little evidence of any added benefit on substance use, beyond that of standard addiction treatments, for any included intervention. Dropout from treatment was high

show abstract

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder

Roberts

Lotzin

Schäfer

2022

European Journal of Psychotraumatology

View full text Add to dashboard Cite

show abstract

“…These limitations suggest the potential to consider conducting meta-analysis with individual patient data (MIPD), which could have significant advantages over conventional meta-analysis and NMA, especially when a smaller number of studies are available. The practical implications for PTSD + AOD treatment can be seen with the potential findings of an MIPD, as contrasted against a conventional meta-analysis or NMA, with MIPD being a more nuanced examination of variation in treatment efficacy across patient types (e.g., Saavedra et al, 2021). And, a future program of research syntheses could also capitalize upon a number of other new methods and generated findings, including second-order meta-analyses of previous meta-analytic studies (“metas of metas”), meta-syntheses of qualitative studies, and meta-analyses of quantitative single-case studies in order to cast a broad net on this public mental health problem.…”

Section: Discussionmentioning

confidence: 99%

Project harmony: A systematic review and network meta-analysis of psychotherapy and pharmacologic trials for comorbid posttraumatic stress, alcohol, and other drug use disorders.

Hien,

Papini,

Saavedra

et al. 2024

Psychological Bulletin

Self Cite

View full text Add to dashboard Cite

We conducted a systematic review and network meta-analyses (NMA) of psychotherapy and pharmacologic treatments for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol or other drug use disorder (AOD). A comprehensive search spanning 1995-2019 yielded a pool of 39 studies for systematic review, including 24 randomized controlled trials for the NMA. Study interventions were grouped by target of treatment (PTSD + AOD, PTSD-only, and AOD-only) and approach (psychotherapy or medication). Standardized mean differences (SMD) from the NMA yielded evidence that at the end of treatment, integrated, trauma-focused therapy for PTSD + AOD was more effective at reducing PTSD symptoms than integrated, non-trauma-focused therapy (SMD = −0.30), AOD-focused psychotherapy (SMD = −0.29), and other control psychotherapies (SMD = −0.43). End-of-treatment alcohol use severity was less for AOD medication compared to placebo medication (SMD = −0.36) and trauma-focused therapy for PTSD + placebo medication (SMD = −0.67), and less for trauma-focused psychotherapy + AOD medication compared to PTSD medication (SMD = −0.53), placebo medication (SMD = −0.50), and trauma-focused psychotherapy + placebo medication (SMD = −0.81). Key limitations include the small number of studies in the NMA for pharmacologic treatments and the lack of demographic diversity apparent in the existing literature. Findings suggest room for new studies that can address limitations in study sample composition, sample sizes, retention, and apply new techniques for conducting comparative effectiveness in PTSD + AOD treatment. Public Significance StatementRoughly half of individuals with posttraumatic stress disorder (PTSD) also meet the criteria for an alcohol and other drug use disorder (AOD) with numerous and costly public health consequences. A systematic review and network meta-analysis characterized the evidence base of psychotherapy and pharmacological interventions for PTSD and AOD. Integrated, trauma-focused interventions targeting both PTSD and AOD were more effective at reducing PTSD symptoms than integrated non-traumafocused, AOD-focused psychotherapy, and other control psychotherapies. AOD medications with and without trauma-focused therapies were more effective in reducing alcohol use severity than placebo controls. Few treatment studies reported adverse events for any intervention outcomes.

show abstract

“…Unfortunately, addiction science large-scale collaboration is rare. A notable exception that we are aware of is Project Harmony, which is a executed by a collaborative team of alcohol use researchers (mostly working in psychiatry departments) and which aims to integrate and analyze data from over 30 treatment trials for AUD (Saavedra et al, 2021).…”

Section: Lack Of Large-scale Collaborationmentioning

confidence: 99%

Accelerating addiction research via Open Science and Team Science

Dora

Piccirillo

Foster

et al. 2023

Psychology of Learning and Motivation

View full text Add to dashboard Cite

Evaluating treatments for posttraumatic stress disorder, alcohol and other drug use disorders using meta-analysis of individual patient data: Design and methodology of a virtual clinical trial

Cited by 16 publications

References 70 publications

A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder

A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder

Project harmony: A systematic review and network meta-analysis of psychotherapy and pharmacologic trials for comorbid posttraumatic stress, alcohol, and other drug use disorders.

Accelerating addiction research via Open Science and Team Science

Contact Info

Product

Resources

About