A Randomized Controlled Trial Comparing Integrated Cognitive Behavioral Therapy Versus Individual Addiction Counseling for Co-occurring Substance Use and Posttraumatic Stress Disorders

Abstract

Objective: Co-occurring posttraumatic stress (PTSD) and substance use disorders provide clinical challenges to addiction treatment providers. Interventions are needed that are effective, well-tolerated by patients, and capable of being delivered by typical clinicians in community settings. This is a randomized controlled trial of integrated cognitive behavioral therapy for co-occurring PTSD and substance use disorders. Methods: Fifty-three participants sampled from seven community addiction treatment programs were randomized to integrated cognitive behavioral therapy plus standard care or individual addiction counseling plus standard care. Fourteen community therapists employed by these programs delivered both manual-guided therapies. Primary outcomes were PTSD symptoms, substance use symptoms, and therapy retention. Participants were assessed at baseline, 3- and 6-month follow-up. Results: Integrated cognitive behavioral therapy was more effective than individual addiction counseling in reducing PTSD re-experiencing symptoms and PTSD diagnosis. Individual addiction counseling was comparably effective to integrated cognitive behavioral therapy in substance use outcomes and on other measures of psychiatric symptom severity. Participants assigned to individual addiction counseling with severe PTSD were less likely to initiate and engage in the therapy than those assigned to integrated cognitive behavioral therapy. In general, participants with severe PTSD were more likely to benefit from integrated cognitive behavioral therapy. Conclusions: The findings support the promise of efficacy of integrated cognitive behavioral therapy in improving outcomes for persons in addiction treatment with PTSD. Community counselors delivered both interventions with satisfactory adherence and competence. Despite several limitations to this research, a larger randomized controlled trial of integrated cognitive behavioral therapy appears to be warranted.

Keywords:

• co-occurring disorders
• posttraumatic stress disorder
• substance use
• integrated treatment
• cognitive behavioral therapy

ACKNOWLEDGMENTS

This research was supported by K23DA16574, R01DA27650 and R01DA30102 (McGovern). The authors wish to acknowledge the patients and staff at Dartmouth-Hitchcock Medical Center Addiction Treatment Program (Lebanon, New Hampshire), Farnum Recovery Center (Manchester, New Hampshire), the Hartford Dispensary (Hartford and New Britain, Connecticut), Brattleboro Retreat (Brattleboro, Vermont), Clara Martin Center (Wilder, Vermont), and WestBridge Inc. (Manchester, New Hampshire). Kim Mueser, Stanley Rosenberg, Stephanie Acquilano, Beth Dickinson, and Whitney Kling of the Dartmouth Psychiatric Research Center were key to the execution of this research.