Lisa M Najavits1,2,3, Karen Krinsley1, Molly E Waring4,3, Matthew W Gallagher5, Christopher Skidmore1. 1. a Veterans Affairs Boston Healthcare System , Boston , Massachusetts , USA. 2. b Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA. 3. d Center for Healthcare Organization and Implementation Research , Edith Nourse Rogers Memorial Veterans Hospital , Bedford , Massachusetts , USA. 4. c Departments of Quantitative Health Sciences and Obstetrics & Gynecology , University of Massachusetts Medical School , Worcester , Massachusetts , USA. 5. e Department of Psychology, Texas Institute for Measurement , Evaluation, and Statistics, University of Houston , Houston , Texas , USA.
Abstract
BACKGROUND: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur in military veterans and other populations. OBJECTIVE: To conduct a randomized controlled trial to compare a new past-focused treatment (Creating Change; CC), to a well-established, evidence-based present-focused treatment for PTSD/SUD (Seeking Safety; SS), on symptoms of both disorders. CC guides patients to process the past through exploration of PTSD/SUD life themes and memories whereas SS focuses on coping skills in the present. METHODS:Fifty-two male and female veterans with current PTSD/SUD were randomized (n = 26 per treatment) and assessed at baseline, end-of-treatment and 3-month follow-up. They received 17 individual one-hour sessions. RESULTS: Intent-to-treat analyses indicated that both conditions improved over time, with no difference between conditions, on PTSD, alcohol use, and drug use (our primary outcomes) as well as mental health symptoms, quality of life, self-efficacy, and SUD cognitions. Effect sizes were medium except for alcohol use, which was large. Change over time reflected improvement from baseline to end-of-treatment, with gains sustained at follow-up, although alcohol use showed continued improvement from end-of-treatment to follow-up. Both treatments evidenced a strong safety profile; and attendance, alliance, and treatment satisfaction were also very strong. Conclusions/importance: CC has promise as a PTSD/SUD therapy with strong public health relevance and the potential to fill important gaps in the field. We used minimal exclusionary criteria to obtain a real-world sample, which was severe-predominantly substance-dependent with chronic PTSD and additional psychiatric diagnoses. Future research is warranted, especially on nonveteran samples and treatment mechanisms of action.
RCT Entities:
BACKGROUND:Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur in military veterans and other populations. OBJECTIVE: To conduct a randomized controlled trial to compare a new past-focused treatment (Creating Change; CC), to a well-established, evidence-based present-focused treatment for PTSD/SUD (Seeking Safety; SS), on symptoms of both disorders. CC guides patients to process the past through exploration of PTSD/SUD life themes and memories whereas SS focuses on coping skills in the present. METHODS: Fifty-two male and female veterans with current PTSD/SUD were randomized (n = 26 per treatment) and assessed at baseline, end-of-treatment and 3-month follow-up. They received 17 individual one-hour sessions. RESULTS: Intent-to-treat analyses indicated that both conditions improved over time, with no difference between conditions, on PTSD, alcohol use, and drug use (our primary outcomes) as well as mental health symptoms, quality of life, self-efficacy, and SUD cognitions. Effect sizes were medium except for alcohol use, which was large. Change over time reflected improvement from baseline to end-of-treatment, with gains sustained at follow-up, although alcohol use showed continued improvement from end-of-treatment to follow-up. Both treatments evidenced a strong safety profile; and attendance, alliance, and treatment satisfaction were also very strong. Conclusions/importance: CC has promise as a PTSD/SUD therapy with strong public health relevance and the potential to fill important gaps in the field. We used minimal exclusionary criteria to obtain a real-world sample, which was severe-predominantly substance-dependent with chronic PTSD and additional psychiatric diagnoses. Future research is warranted, especially on nonveteran samples and treatment mechanisms of action.
Authors: Sudie E Back; Therese Killeen; Christal L Badour; Julianne C Flanagan; Nicholas P Allan; Elizabeth Santa Ana; Brian Lozano; Kristina J Korte; Edna B Foa; Kathleen T Brady Journal: Addict Behav Date: 2018-11-27 Impact factor: 3.913
Authors: Lisa M Najavits; H Westley Clark; Carlo C DiClemente; Marc N Potenza; Howard J Shaffer; James L Sorensen; Matthew T Tull; Allen Zweben; Joan E Zweben Journal: Curr Treat Options Psychiatry Date: 2020-09-24
Authors: Tracy L Simpson; Simon B Goldberg; Diana K N Louden; Shannon M Blakey; Sage E Hawn; Aline Lott; Kendall C Browne; Keren Lehavot; Debra Kaysen Journal: J Anxiety Disord Date: 2021-10-26