Study Targets Treating Comorbid Substance Use Disorder and PTSD
Post-traumatic stress disorder interacts directly with substance use disorders (SUDs) to worsen SUD symptoms and make recovery less likely. VA runs the largest substance use disorder treatment program in the world, and the high prevalence of PTSD and substance use disorders in returning OEF/OIF Veterans has made developing effective treatment options for these comorbidities a priority. This randomized controlled effectiveness trial sought to determine whether male Veterans with an SUD and co-occurring PTSD symptoms in a VA outpatient SUD clinic would benefit from a specialized treatment program for these comorbid disorders. Investigators randomly assigned Veterans to receive treatment as usual (TAU, n=49) or Seeking Safety (SS, n=49) treatment. Seeking Safety is a manualized integrated treatment for PTSD and SUD that focuses on safe coping skills addressed through cognitive, behavioral, interpersonal, and case management domains. Primary outcome measures were drug and alcohol use severity, as well as PTSD symptom severity. All outcomes were measured at baseline, three months (end of treatment), and six months (3 months post-treatment).
Findings show that Seeking Safety, the manualized treatment approach for substance use disorder, was well received and associated with better drug use outcomes than TAU in male Veterans with PTSD. Compared to TAU, Seeking Safety also was associated with increased treatment attendance, client satisfaction, and active coping through treatment. Although these factors may be beneficial for promoting recovery more broadly, neither they – nor reduction in PTSD severity that occurred during treatment – accounted for reductions in drug use among Veterans during the study.
The authors suggest that Seeking Safety simultaneously addresses PTSD early within SUD treatment and uses techniques familiar to the majority of addiction treatment professionals, which may facilitate clinical implementation.
Boden M, Kimerling R, Jacobs-Lentz J, Bowman D, Weaver C, Carney D, Walser R, and Trafton J. Seeking Safety treatment for male Veterans with a substance use disorder and PTSD symptomatology. Addiction September 16, 2001;E-pub ahead of print.
This study was funded by HSR&D (IIR 04-175). Drs. Boden, Kimerling, and Trafton are part of HSR&D’s Center for Health Care Evaluation in Palo Alto, CA.