Abstract
BackgroundPosttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment.MethodsIn this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger.DiscussionThis study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide.Trial registrationNetherlands Trial Register (NTR), Identifier: NL7885. Registered 22 July 2019.
Highlights
Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity
Current study This paper describes the study design of the Treatment Of PTSD and Addiction (TOPA) study, a Dutch randomized controlled trial (RCT) in patients with co-occurring PTSD and SUD who will receive PTSD treatment as an add-on to regular SUD treatment
Design This study is a single blind 6-arm randomized controlled trial, consisting of 3 arms for simultaneous SUD/PTSD treatment with the PTSD treatments consisting of Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR), and Imagery Rescripting (ImRs), and 3 arms for sequential SUD/PTSD treatment with the PTSD treatments consisting of PE, EMDR, and ImRs
Summary
Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. It is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment. PTSD and SUD comorbidity Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) often co-occur, with an estimated prevalence of SUD amongst individuals with PTSD of 46% in an epidemiologic study in the United States [1]. The onset or maintenance of both SUD and PTSD could be related to a shared underlying factor such as genetic vulnerability [6, 7]
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