Lagged effects of substance use on PTSD severity in a randomized controlled trial with modified prolonged exposure and relapse prevention.

There is concern that exposure therapy, an evidence-based cognitive-behavioral treatment for posttraumatic stress disorder (PTSD), may be inappropriate because of risk of relapse for patients with co-occurring substance dependence. To determine whether an integrated treatment for PTSD and substance dependence, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), can achieve greater reductions in PTSD and substance dependence symptom severity compared with usual treatment for substance dependence. Randomized controlled trial enrolling 103 participants who met DSM-IV-TR criteria for both PTSD and substance dependence. Participants were recruited from 2007-2009 in Sydney, Australia; outcomes were assessed at 9 months postbaseline, with interim measures collected at 6 weeks and 3 months postbaseline. Participants were randomized to receive COPE plus usual treatment (n = 55) or usual treatment alone (control) (n = 48). COPE consists of 13 individual 90-minute sessions (ie, 19.5 hours) with a clinical psychologist. Change in PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS; scale range, 0-240) and change in severity of substance dependence as measured by the number of dependence criteria met according to the Composite International Diagnostic Interview version 3.0 (CIDI; range, 0-7), from baseline to 9-month follow-up. A change of 15 points on the CAPS scale and 1 dependence criterion on the CIDI were considered clinically significant. From baseline to 9-month follow-up, significant reductions in PTSD symptom severity were found for both the treatment group (mean difference, -38.24 [95% CI, -47.93 to -28.54]) and the control group (mean difference, -22.14 [95% CI, -30.33 to -13.95]); however, the treatment group demonstrated a significantly greater reduction in PTSD symptom severity (mean difference, -16.09 [95% CI, -29.00 to -3.19]). No significant between-group difference was found in relation to improvement in severity of substance dependence (0.43 vs 0.52; incidence rate ratio, 0.85 [95% CI, 0.60 to 1.21), nor were there any significant between-group differences in relation to changes in substance use, depression, or anxiety. Among patients with PTSD and substance dependence, the combined use of COPE plus usual treatment, compared with usual treatment alone, resulted in improvement in PTSD symptom severity without an increase in severity of substance dependence. isrctn.org Identifier: ISRCTN12908171.

Background: To test whether an integrated prolonged exposure (PE) approach could address posttraumatic stress disorder (PTSD) symptoms effectively in individuals with co-occurring substance use disorders (SUD), we compared concurrent treatment of PTSD and SUD using PE (COPE) to relapse prevention therapy (RPT) for SUD and an active monitoring control group (AMCG). Methods: We conducted a randomized 12-week trial with participants (n = 110; 64% males; 59% African Americans) who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision criteria for full or subthreshold PTSD and SUD. Participants were randomly assigned to COPE (n = 39), RPT (n = 43), or AMCG (n = 28). Results: At the end-of-treatment, COPE and RPT demonstrated greater reduction in PTSD symptom severity relative to AMCG (COPE-AMCG = -34.06, p < 0.001; RPT-AMCG = -22.58, p = 0.002). Although the difference between COPE and RPT was not significant in the complete sample, the subset of participants with full (vs. subthreshold) PTSD demonstrated significantly greater reduction of PTSD severity in COPE relative to RPT. Both treatments were superior to AMCG in reducing the days of primary substance use (COPE-AMCG = -0.97, p = 0.01; RPT-AMCG = -2.07, p < 0.001). Relative to COPE, RPT showed significantly more improvement in SUD outcome at end-of-treatment (RPT-COPE = -1.10, p = 0.047). At 3-month follow-up, COPE and RPT maintained their treatment gains and were not significantly different in PTSD severity or days of primary substance use. Conclusion: COPE and RPT reduced PTSD and SUD severity in participants with PTSD + SUD. Findings suggest that among those with full PTSD, COPE improves PTSD symptoms more than a SUD-only treatment. The use of PE for PTSD was associated with significant decreases in PTSD symptoms without worsening of substance use.

&lt;p dir="ltr"&gt;Background: Most people experience traumatic events, for instance a natural disaster or the unexpected death of a loved one.&lt;/p&gt;&lt;p dir="ltr"&gt;Some people then develop posttraumatic stress disorder (PTSD), a debilitating disorder characterized by intrusion symptoms, e.g. intense distress and nightmares, avoidance, negative changes in cognitions and mood as well as changes in arousal and reactivity, e.g. startling easily and finding it difficult to concentrate. PTSD is approximately twice as common among women as among men.&lt;/p&gt;&lt;p dir="ltr"&gt;Some people find that alcohol provides short-term relief from their PTSD symptoms, for example by reducing intense distress or being able to sleep and wake without remembering one's nightmares. Over time alcohol use can lead to alcohol use disorder (AUD), which is characterized by problematic alcohol use. There are other trajectories to comorbid PTSD and AUD, but this is the most supported by research to date. PTSD and AUD often occur together.&lt;/p&gt;&lt;p dir="ltr"&gt;PTSD and AUD are associated with negative outcomes, e.g. other mental disorders, suicidality and ill physical health. Similarly, PTSD and alcohol use during pregnancy are associated with adverse outcomes for those pregnant as well as their expected children, including antepartum complications and fetal alcohol spectrum disorders (FASD).&lt;/p&gt;&lt;p dir="ltr"&gt;Comorbid PTSD and AUD tend to be more severe and more impairing than either disorder on its own. For instance, higher rates of comorbid mental disorders, suicidality and homelessness have been found among people with comorbid PTSD and AUD than among individuals with either PTSD or AUD.&lt;/p&gt;&lt;p dir="ltr"&gt;Comorbid PTSD and AUD are regarded as difficult to treat. Traditionally, sequential treatment, where AUD was treated first, then PTSD, was suggested. Patients were typically required to achieve and maintain abstinence before PTSD treatment was initiated, something which potentially is a great barrier to PTSD treatment for those with comorbid PTSD and AUD.&lt;/p&gt;&lt;p dir="ltr"&gt;Great strides have been made in developing treatment of comorbid PTSD and AUD, but the evidence on how to treat comorbid PTSD and AUD is not yet robust. Women are overrepresented among those with comorbid PTSD and AUD, yet, underrepresented in the extant treatment research. Trials of treatment of comorbid PTSD and AUD have included mainly men. Women and men may have different treatment needs and may also respond differently to treatment. So, we need to know more about treatment of comorbid PTSD and AUD in women.&lt;/p&gt;&lt;p dir="ltr"&gt;Objectives: The present thesis sought to estimate the current prevalence of PTSD and alcohol use during pregnancy in Stockholm, Sweden, and to investigate the safety, feasibility, and efficacy of concurrent treatment of comorbid PTSD and AUD, which does not require abstinence, in treatment- seeking women with comorbid PTSD and AUD in Swedish healthcare.&lt;/p&gt;&lt;p dir="ltr"&gt;Methods: Cross-sectional studies were conducted to estimate the current prevalence of PTSD and alcohol use during pregnancy. A pilot study was undertaken to investigate the safety and feasibility of concurrent treatment of PTSD and AUD in treatment-seeking women in Swedish healthcare. A randomized clinical trial was conducted to investigate whether concurrent treatment of PTSD and AUD reduces PTSD symptom severity and alcohol use more than AUD treatment in treatment-seeking women with comorbid PTSD and AUD in Swedish healthcare.&lt;/p&gt;&lt;p dir="ltr"&gt;Results: Approximately 4.1 percent of pregnant people are estimated to have current PTSD and approximately 4.2 percent estimated to use alcohol during pregnancy in Stockholm, Sweden. Concurrent treatment of PTSD and AUD in women was safe and feasible. In the randomized clinical trial, PTSD symptom severity and alcohol use decreased from baseline to 9-month follow-up for both treatments. There was a significantly greater reduction in PTSD symptom severity in the concurrent treatment arm than in the AUD treatment arm. There was no detectable difference in alcohol use between treatments.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions: Further efforts to spread information about alcohol use during pregnancy may be needed, continued screening for alcohol use during pregnancy is warranted as well as treatment of risky alcohol use and AUD, when necessary, to reduce the risk of adverse outcomes for those pregnant as well as their expected children. It may be useful to investigate screening for PTSD in antenatal care further, to evaluate whether systematic screening for PTSD should be introduced in antenatal care. The present findings indicate that concurrent treatment of PTSD and AUD is feasible, safe, and efficacious for treatment-seeking women with comorbid PTSD and AUD in Swedish healthcare, and that abstinence is not required before or during treatment.&lt;/p&gt;&lt;h3&gt;List of scientific papers&lt;/h3&gt;&lt;p dir="ltr"&gt;I. &lt;b&gt;Persson, A;&lt;/b&gt; Lindmark, S; Petersson, K; Gabriel, E; Thorsell, M; Lindström, K; Göransson, M; Cardell, G; Magnusson, Å. Fear of childbirth, potentially traumatic events and posttraumatic stress disorder during pregnancy in Stockholm, Sweden: A cross-sectional study. Sexual &amp; Reproductive Healthcare, 2020, Vol. 25, p. 100516. &lt;a href="https://doi.org/10.1016/j.srhc.2020.100516" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1016/j.srhc.2020.100516&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;II. &lt;b&gt;Persson, A;&lt;/b&gt; Lindmark, S; Petersson, K; Gabriel, E; Thorsell, M; Lindström, K; Göransson, M; Cardell, G; Magnusson, Å. Alcohol and illicit and non-medical prescription drug use before and during pregnancy in Stockholm, Sweden: A cross-sectional study. Sexual &amp; Reproductive Healthcare, 2021, Vol. 29, p. 100622. &lt;a href="https://doi.org/10.1016/j.srhc.2021.100622" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1016/j.srhc.2021.100622&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;III. &lt;b&gt;Persson, A;&lt;/b&gt; Back, S E; Killeen, T K; Brady, K T; Schwandt, M L; Heilig, M; Magnusson, A. Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE): A pilot study in alcohol-dependent women. Journal of Addiction Medicine, 2017, Vol. 11(2), p. 119-125. &lt;a href="https://doi.org/10.1097/ADM.0000000000000286" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1097/ADM.0000000000000286&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;IV. &lt;b&gt;Persson, A;&lt;/b&gt; Axén, Å; Capusan, A J; Magnusson, Å; Heilig, M. Concurrent Treatment of Posttraumatic Stress Disorder and Alcohol Use Disorder in Women: A Randomized Clinical Trial. JAMA Network Open, 2025, Vol. 8(7), p. e2521087. &lt;a href="https://doi.org/10.1001/jamanetworkopen.2025.21087" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1001/jamanetworkopen.2025.21087&lt;/a&gt;&lt;/p&gt;

Background: Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur in youth. Integrated, trauma-focused treatments are recommended, but evidence in youth is limited and the dynamics of symptom change are poorly understood. Objectives: We investigated within-treatment changes in PTSD and substance use, and their temporal sequencing, in a randomised controlled trial (RCT) comparing integrated treatment with supportive counselling among youth aged 13–25 years. Method: Participants (n = 55) were randomised to an integrated, exposure-based treatment, Concurrent Treatment of PTSD and SUD Using Prolonged Exposure – Adolescent version (COPE-A); or supportive counselling, Person-Centred Therapy (PCT). PTSD and substance use symptoms were assessed at each session. Generalised estimating equations were used to analyse symptom change over time, and Spearman’s correlations were used to examine associations between early (sessions 1-5) and later (sessions 5-11) change. Results: COPE-A showed significantly greater reductions in total PTSD symptom severity during treatment (β = −17.00, 95% CI −29.50 to −4.46); with no between-group differences in substance use quantity or frequency. PTSD symptom clusters improved concurrently, but no temporal relationships were observed. Temporal relationships for substance use change were limited, and changes in PTSD symptoms were not associated with concurrent or subsequent changes in substance use. Conclusion: Integrated, trauma-focused treatment reduced PTSD symptoms, reinforcing the safety and tolerability of exposure-based therapy in this youth sample with comorbid PTSD-SUD. PTSD improvement was not associated with either concurrent or subsequent reductions in substance use. Understanding temporal patterns of change may help refine models of PTSD-SUD comorbidity and optimise intervention delivery.

Trauma-focused treatments are effective for posttraumatic stress disorder (PTSD) but are rarely offered to patients with comorbid substance use disorder. Research suggests gender-based differences in prevalence and treatment needs for these patients, but treatment trials have mainly included men. To evaluate whether integrated trauma-focused psychological treatment (ie, integrated treatment) leads to greater reduction in PTSD symptom severity and weekly alcohol use than usual treatment (ie, relapse prevention) for alcohol use disorder (AUD) in women. This randomized clinical trial was conducted at 3 outpatient addiction services in Sweden. Data were collected from 2016 to 2021, and participants were followed up for 9 months after treatment initiation. Data were analyzed from October 2024 to April 2025. Participants were women older than 18 years with current PTSD and moderate-to-severe AUD diagnoses meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Participants were randomly assigned to either the integrated treatment or relapse prevention arm. Intention-to-treat analyses were carried out using linear mixed models. Twelve sessions, typically weekly, of integrated treatment (ie, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure [COPE]) or relapse prevention were delivered by trained and experienced staff (including registered nurses, licensed psychologists, and social workers). Prespecified co-primary outcomes were PTSD symptom severity (assessed by blinded raters using Clinician-Administered PTSD Scale for DSM-5 [CAPS-5]) and weekly alcohol use (self-assessed using Timeline Followback) from baseline to the 9-month follow-up. Secondary outcomes included self-reported PTSD symptom severity, clinician-rated PTSD remission, and an objective biomarker of alcohol use (phosphatidylethanol level). Ninety women (mean [SD] age, 44.7 [12.5] years) were included and randomly assigned to integrated treatment (n = 45) or relapse prevention (n = 45). In both arms, PTSD symptom severity decreased from baseline to 9-month follow-up (mean CAPS-5 score for integrated treatment: 37.40 [95% CI, 33.84-40.96] to 13.18 [95% CI, 8.95-17.41]; relapse prevention: 39.09 [95% CI, 35.53-42.65] to 23.68 [95% CI, 19.47-27.88]), with a significantly greater decrease in the integrated treatment arm than the relapse prevention arm (treatment-by-time interaction: F4,155 = 3.0; P = .02). Self-reported alcohol use decreased significantly over time (F14,581 = 3.0; P < .001) in both arms (integrated treatment: 144.41 [95% CI, 104.66-184.15] g/week to 92.65 [95% CI, 48.81-136.48] g/week; relapse prevention: 133.45 [95% CI, 93.71-173.19] g/week to 77.80 [95% CI, 31.65-123.95] g/week), but there was no detectable difference between treatments. In this trial of integrated treatment vs relapse prevention, integrated treatment led to a greater reduction in PTSD symptom severity and no detectable difference in alcohol use decrease compared with relapse prevention. These results support that integrated treatment can safely and effectively treat PTSD in women with AUD and ongoing alcohol use. ISRCTN.org Identifier: ISRCTN61391164.

A dynamical systems analysis of change in PTSD symptoms, depression symptoms, and suicidal ideation among military personnel during treatment for PTSD

Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) is an integrated, evidence-based treatment that results in significant reductions in posttraumatic stress disorder (PTSD) and substance use disorder (SUD) severity. Emotional processing theory suggests that successful prolonged exposure-based treatments should result in more cohesive trauma narratives due to better integration and organization of trauma memory into cognitive conceptualizations of fear. Therefore, we hypothesized that language used by patients would become more cohesive over time and increased language cohesion would be related to larger reductions in PTSD and SUD outcomes. Broadly, language cohesion refers to several linguistic devices that help establish and cohere meaning throughout spoken and written discourse (e.g., increased use of transition words like "and," "then," and "but"). This was the first known study to examine changes in language related to both PTSD and SUD severity during COPE treatment. The sample included 28 military veterans with current comorbid PTSD/SUD enrolled in a larger COPE study. A text analysis program, Coh-Metrix, was used to analyze language cohesiveness. No language cohesion variables significantly changed over time. Narrativity levels significantly moderated change in PTSD outcomes, =0.11. Adversative connectives significantly moderated change in SUD outcomes, = 0.26. The findings illuminate potential processes underlying successful COPE treatment. Less use of language conveying a narrative and more use of contrast-indicative words (e.g., but, whereas) was associated with larger reductions in PTSD and SUD outcomes during treatment. These results contribute to the extant literature on associations between trauma exposure, language, and emotional processing.

Does a history of violent offending impact treatment response for comorbid PTSD and substance use disorders? A secondary analysis of a randomized controlled trial

Comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is common, and both are associated with cognitive dysfunction. However, few studies examine the impact of cognitive deficits on treatment outcomes. Here, we leverage data from a randomized clinical trial of integrated versus phased psychotherapy for SUD and PTSD to examine the relation of cognitive functioning to treatment response. One-hundred and thirteen veterans with co-occurring PTSD and SUD completed Penn Computerized Neurocognitive Battery tests assessing attention, executive control, memory, and spatial processing. Linear mixed-effects models examined interactions between cognitive functioning and time in predicting primary PTSD and SUD outcomes across both treatments. Significant verbal immediate memory by time interactions were found for both PTSD symptoms (p = .01, f 2 = 0.020) and percent heavy drinking or drug use days (p = .004, f 2 = 0.020). There was a significant working memory by time interaction for percent heavy drinking or drug use days (p = .007, f 2 = 0.016). Participants with better verbal memory had greater reductions across time in PTSD symptoms and drinking/drug use, while those with better working memory had lesser reductions in their drinking/drug use across time. Individuals with lower verbal memory functioning had less robust PTSD and SUD symptom reductions in PTSD/SUD psychotherapy, with differences that were generally small in magnitude. Those with better working memory functioning had worse SUD outcomes. Together with prior literature, findings suggest that neurocognitive functioning may impact the effectiveness of PTSD and SUD treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are highly co-occurring and evidence for the optimal ways of treating PTSD in SUD patients is mixed. Our aim was to compare three different PTSD treatments, each added simultaneously to SUD treatment, with SUD treatment alone in patients with co-occurring SUD-PTSD. These PTSD treatments were: Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs). A single-blind 4-arm randomized controlled trial with follow-up at 3months. Two addiction treatment centers in the Netherlands, providing intra- and extramural care. 209 patients with SUD and co-morbid PTSD were included [mean age 37.5 (standard deviation, SD = 11.99), female sex = 46.4%, mean Clinically Administered PTSD Scale (CAPS) score = 37.35 (SD = 9.28)]. Participants were randomized to either simultaneous SUD + PE (n = 53), SUD + EMDR (n = 50), SUD + ImRs (n = 55) or to SUD treatment only (n = 51), with the active PTSD treatments consisting of 12 sessions each within 3months. Standard protocols were used. The primary outcome was clinician-administered PTSD symptom severity as measured by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (CAPS-5) at 3month follow-up. Secondary outcomes included loss of PTSD diagnosis, full remission of PSTD and SUD-severity, also recorded at 3months. Compared with SUD only, the mean differences in CAPS-5 score were B = -5.41 [95% confidence interval (CI) = 10.88, 0.05, P = 0.052] for SUD + PE, B = -7.97 (95% CI = -13.57, -2.37, P = 0.006) for SUD + EMDR and B = -10.03 (95% CI = -15.29, -4.77, P < 0.001) for SUD + ImRs. When adjusted for baseline covariates, mean differences were B = -5.81 (95% CI = -11.48, -0.15, P = 0.044) for SUD + PE, B = -8.85 (95% CI = -14.60, -3.10, P = 0.003) for SUD + EMDR and B = -10.75 (95% CI = -15.94, -5.56, P = <0.001) for SUD + ImRs. No between-group differences in SUD outcomes were found. Among people with co-occurring substance use disorder (SUD) and post-traumatic stress disorder (PTSD), trauma-focused PTSD treatment as add-on to SUD treatment appears to be effective in decreasing PTSD severity compared with manualized SUD only treatment and does not appear to increase SUD severity.

The present study examined temporal patterns of symptom change during treatment for comorbid posttraumatic stress disorders (PTSD) and substance use disorders (SUDs). We hypothesized that PTSD symptom severity would predict subsequent-session substance use and that this association would be particularly strong among patients who received an integrated treatment versus SUD-only treatment. Participants were 81 United States military veterans with current PTSD and an SUD who were enrolled in a 12-week, randomized controlled trial examining the efficacy of an integrated treatment called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) compared with cognitive behavioral relapse prevention therapy (RP). Lagged multilevel models indicated that PTSD symptom improvement did not significantly predict the likelihood of next-session substance use (likelihood of use: B = 0.03, SE = 0.02, p = .141; percentage of days using B = -0.02, SE = 0.01, p = .172. Neither substance use, B = 1.53, SE = 1.79, p = .391, nor frequency of use, B = 0.26, SE = 0.50, p = .612, predicted next-session PTSD symptom severity in either treatment condition. Stronger associations between PTSD symptoms and next-session substance use were expected given the self-medication hypothesis. Additional research is needed to better understand the temporal dynamics of symptom change as well as the specific mediators and mechanisms underlying symptom change.

This study examined the impact of ongoing substance use during posttraumatic stress disorder (PTSD) and substance use disorder (SUD) treatment on PTSD symptoms and treatment discontinuation. The study represents a secondary analysis of U.S. military veterans (N = 183) who participated in a randomized clinical trial for the treatment of both PTSD and SUD. Veterans mostly identified as Black (53.8%) or White (41.9%) and male (92.4%). Substance use, PTSD symptoms, and treatment discontinuation were measured at 4-week intervals throughout treatment. Predictors were the percentage of days with alcohol, cannabis, and other substance use (primarily cocaine and opioids) and the average number of alcoholic drinks per drinking day. Outcomes were PTSD symptoms and treatment discontinuation at concurrent and prospective assessments. Multilevel models accounted for the nested structure of the longitudinal data. Alcohol, cannabis, and other substance use did not predict PTSD symptoms or treatment discontinuation prospectively. Concurrently, we observed that as a participant's percentage of drinking days increased by 34.7% (i.e., 1 standard deviation), PTSD symptoms during the same period were 0.07 standard deviations higher (i.e., 1 point on the PCL), B = 0.03, p = .033. No other substances were related to PTSD symptoms concurrently. The findings demonstrate that PTSD symptoms improved regardless of substance use during exposure-based PTSD and SUD treatment, and treatment discontinuation was not associated with substance use. This study suggests that substance use during treatment cannot directly explain the poorer treatment outcomes observed in the literature on comorbid PTSD/SUD compared to PTSD-only populations.

Toxic stress in adolescence: A person-centered approach

This paper examines factors associated with change in PTSD symptom severity among individuals randomised to receive an integrated exposure-based psychotherapy for PTSD and substance dependence–Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE). Outcomes examined include change in PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS), and the reliability and clinical significance of change in PTSD symptom severity. Factors examined include patient baseline characteristics, treatment characteristics, and events over follow-up. The mean difference in CAPS score was 38.24 (SE 4.81). Approximately half (49.1%) demonstrated a reliable and clinically significant improvement in PTSD symptom severity. No one was classified as having demonstrated clinically significant worsening of symptoms. Three independent predictors of reductions in PTSD symptom severity were identified: baseline PTSD symptom severity (β 0.77, SE 0.23, p = 0.001), number of traumas experienced prior to baseline (β −0.30, SE 0.15, p = 0.049), and number of sessions attended (β 2.05, SE 0.87, p = 0.024). The present study provides further evidence regarding the safety of the COPE treatment and factors associated with improvement in PTSD symptom severity. The identification of only a small number of predictors of the outcome points to the broad applicability of the COPE treatment to PTSD and substance use disorder (SUD) patients.

This study examined the prevalence of lifetime traumatic events and current symptoms of posttraumatic stress disorder (PTSD) among treatment-seeking cocaine-dependent outpatients and compared patients with and without PTSD on current substance use, psychopathology, and sociodemographic characteristics. The subjects were 122 adult cocaine-dependent outpatients participating in a treatment outcome study of psychosocial therapy. In addition to standard self-report and interview measures of psychopathology and substance use, the subjects completed the Trauma History Questionnaire and the PTSD Checklist before entering treatment. These patients experienced a large number of lifetime traumatic events (mean = 5.7); men experienced more general disasters and crime-related traumas than women, and women experienced more physical and sexual abuse than men. According to self-report measures, 20.5% of the subjects currently met the DSM-III-R criteria for PTSD; the rate of PTSD was 30.2% among women and 15.2% among men. Patients with PTSD had significantly higher rates of co-occurring axis I and axis II disorders, interpersonal problems, medical problems, resistance to treatment, and psychopathology symptoms than patients without PTSD. Psychopathology symptoms represented the most consistent difference between the two groups and provided the best prediction of PTSD status in a logistic regression. However, the groups did not differ significantly in current substance use or sociodemographic characteristics. These findings underscore the value of screening substance abusers for PTSD, because it can identify a small but substantial number who might require additional treatment. Further studies of the relationship between PTSD and substance abuse appear warranted.