Many people who have posttraumatic stress disorder (PTSD) also struggle with problematic alcohol or drug use (i.e., 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 for 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 Veterans Affairs healthcare facilities. We will also test whether some participants did better than others, so we can learn how to individualize treatment recommendations to patients. This study will help patients and providers jointly make decisions about how to treat symptoms of PTSD when the patient is also struggling with substance use.
This will lead to more patients experiencing meaningful improvement in their symptoms of PTSD and being satisfied with their care. 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 the patient’s 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 six months after they finish PTSD treatment. At the end of the study we will compare which treatment approach, TFT versus NTFT, 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). Our patient partner panel will help us reduce stigma regarding participation in PTSD and SUD treatment to make sure as many patients as possible feel comfortable participating in the study, and our stakeholders will help us communicate study findings to patients. A clinician partner panel will provide feedback on the study and convey how to make the findings as useful as possible to those who treat patients with both PTSD and SUD.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.