Trauma-focused treatment for posttraumatic stress disorder combined with CBT for severe substance use disorder: a randomized controlled trial

Debora Van Dam,Paul Mg Emmelkamp,Ellen Vedel,Thomas Ehring

doi:10.1186/1471-244x-13-172

Abstract

BackgroundThis randomized controlled trial (RCT) investigated the effectiveness of a combined treatment for co-morbid Posttraumatic Stress Disorder (PTSD) and severe Substance Use Disorder (SUD).MethodsStructured Writing Therapy for PTSD (SWT), an evidence-based traumafocused intervention, was added on to Treatment As Usual (TAU), consisting of an intensive cognitive behavioral inpatient or day group treatment for SUD. The outcomes of the combined treatment (TAU + SWT) were compared to TAU alone in a sample of 34 patients.ResultsResults showed a general reduction of SUD symptoms for both TAU + SWT and TAU. Treatment superiority of TAU + SWT was neither confirmed by interaction effects (time x condition) for SUD or PTSD symptoms, nor by a group difference for SUD diagnostic status at post-treatment. However, planned contrasts revealed that improvements for PTSD severity over time were only significant within the TAU + SWT group. In addition, within the TAU + SWT group the remission of PTSD diagnoses after treatment was significant, which was not the case for TAU. Finally, at post-treatment a trend was noticed for between group differences for the number of PTSD diagnoses favoring TAU + SWT above TAU.ConclusionsIn sum, the current study provides preliminary evidence that adding a trauma-focused treatment on to standard SUD treatment may be beneficial.

Highlights

This randomized controlled trial (RCT) investigated the effectiveness of a combined treatment for comorbid Posttraumatic Stress Disorder (PTSD) and severe Substance Use Disorder (SUD)
In line with this theory, research investigating the chronology of PTSD and SUD has shown that SUD is preceded by PTSD more often than vice versa [10,11], that the exacerbation of PTSD symptoms is the most important factor in predicting van Dam et al BMC Psychiatry 2013, 13:172 http://www.biomedcentral.com/1471-244X/13/172 relapse following SUD treatment [12], and that improvements in PTSD symptoms are associated with subsequent improvements in substance dependence [13,14]
PTSD symptom severity General Linear Model (GLM) repeated measures analyses on the imputed dataset revealed a main effect for time, F(3, 34) = 6.37, p = .001, partial η2 = 0.166, and no main effect for condition F(1, 34) = 0.01, p = .921, partial η2 = 0

Summary

Introduction

This randomized controlled trial (RCT) investigated the effectiveness of a combined treatment for comorbid Posttraumatic Stress Disorder (PTSD) and severe Substance Use Disorder (SUD). The detection and treatment of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients have increasingly been studied [1,2,3]. Most evidence is available for the self-medication theory [9], which suggests that substances are used to alleviate or suppress PTSD symptoms In line with this theory, research investigating the chronology of PTSD and SUD has shown that SUD is preceded by PTSD more often than vice versa [10,11], that the exacerbation of PTSD symptoms is the most important factor in predicting van Dam et al BMC Psychiatry 2013, 13:172 http://www.biomedcentral.com/1471-244X/13/172 relapse following SUD treatment [12], and that improvements in PTSD symptoms are associated with subsequent improvements in substance dependence [13,14]. Experimental research suggests that traumarelated cues can trigger a craving response [15]

Methods

Results

Conclusion