Psychotherapy for PTSD Among Veterans Also Receiving Drug or Alcohol Treatment

Completed · Not applicable

Conditions studied: Stress Disorders, Post-Traumatic, Substance Use Disorders

In brief

Many people who have posttraumatic stress disorder (PTSD) also struggle with problematic alcohol or drug use (substance use disorders \[SUD\]). Patients with both conditions prefer PTSD be treated alongside SUD. However, clinicians don't know if treatments that have been found to help those with PTSD work as well for people who also have SUD. This often leads to delaying PTSD treatment or using psychotherapies without research support. Trauma-focused psychotherapy (TFT) is the type of psychotherapy for PTSD that has been studied most often among people with both PTSD and SUD. It reduces symptoms of PTSD and substance use, although it might not work as well in those who have SUD as those who do not. Further, many patients with both PTSD and SUD do not complete TFT. Another strategy for treating PTSD is non-trauma-focused psychotherapy (NTFT). One NTFT, Present Centered Therapy, has been found to reduce symptoms of PTSD and more patients are able to complete NTFT than are able to finish TFT. However, no one has studied how well Present Centered Therapy works among patients who also have SUD. We will test which approach (TFT of NTFT) is better for reducing symptoms of PTSD and which is more likely to be completed by patients with both PTSD and SUD at VA healthcare facilities. We will also test to see whether some participants did better than others, so we can learn how to individualize treatment recommendations to patients. Participants will be assigned by chance to either TFT of NTFT. Patients assigned to TFT will receive either Prolonged Exposure or Cognitive Processing Therapy; both are weekly psychotherapies focused on addressing thoughts and/or memories related to their trauma. Those assigned to NTFT will receive Present Centered Therapy, a weekly psychotherapy in which patients learn about how PTSD relates to their current difficulties and problem solve current life difficulties. All participants will also receive SUD treatment. Participants will answer questions about their symptoms and experience with treatment before, right after they finish, and three and six months after they finish PTSD treatment. At the end of the study we will compare which treatment approach worked better to decrease PTSD symptom severity and which treatment patients were better able to complete. We will also track other outcomes that are important to patients (e.g., how they are doing in their relationships).

Key facts

Study ID

NCT04581434

Run by

Center for Veterans Research and Education

People needed

426

Starts

2020-12-08

Expected to finish

2024-04-26

Last updated by the study team

2024-06-25

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Initiate an episode of outpatient SUD treatment at an enrolled facility.
• meet DSM-5 criteria for a current SUD (Tobacco Use Disorder alone is not sufficient for inclusion).
• Report substance use in the past 30 days (or in the 30 days prior to entering a controlled environment if exiting said controlled environment at time of enrollment)
• meet DSM-5 criteria for PTSD
• provide informed consent and be willing to be randomized to PTSD treatment condition
• agree to not receive non-study, active psychotherapy for PTSD during study treatment

You may not qualify if…

• Severe cognitive impairment
• Current suicidal or homicidal intent with a specific plan
• Unstable psychotic or manic symptoms not attributable to SUD
• More than 30 days between index outpatient SUD intake/treatment planning appointment \& consent or more than 90 days between the index outpatient SUD visit and the first PTSD psychotherapy session

Where it is running

• San Diego VA Healthcare System — San Diego, California, United States
• Tampa VA Medical Center — Tampa, Florida, United States
• Atlanta VA Medical Center — Atlanta, Georgia, United States
• Edward Hines, Jr. VA Hospital — Hines, Illinois, United States
• Southeast Louisiana Veterans Health Care System — New Orleans, Louisiana, United States
• Minneapolis VA Medical Center — Minneapolis, Minnesota, United States
• Syracuse VA Medical Center — Syracuse, New York, United States
• Durham VA Medical Center — Durham, North Carolina, United States
• Cincinnati VA Healthcare System — Cincinnati, Ohio, United States
• Louis Stokes Cleveland VA Medical Center — Cleveland, Ohio, United States
• Philadelphia VA Medical Center — Philadelphia, Pennsylvania, United States
• Salt Lake City VA Healthcare System — Salt Lake City, Utah, United States
• Puget Sound VA Healthcare System — Seattle, Washington, United States
• Madison VA Medical Center — Madison, Wisconsin, United States

Full record on ClinicalTrials.gov

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