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No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder.
Alcohol Clin Exp Res. 2017 04; 41(4):681-702.AC

Abstract

Prior reviews of behavioral treatments for individuals with comorbid alcohol and drug use disorders (substance use disorder SUD) and posttraumatic stress disorder (PTSD) have not systematically considered whether comparison conditions are matched to target treatments on time and attention. A systematic literature search using PubMed MESH terms for alcohol and substance use disorders, PTSD, and treatment identified relevant behavioral randomized clinical trials (RCTs) that evaluated PTSD-oriented exposure-based treatments, addiction-focused treatments, and coping-based treatments that do not involve exposure to trauma memories. Information pertaining to within-subject changes over time and between-subject differences, quality of control condition, recruitment efficiency, and assessment and treatment retention was synthesized. Alcohol and drug outcomes were described separately when possible. Twenty-four behavioral RCTs were identified: 7 exposure based, 6 addiction focused, and 11 coping based. Seven studies included SUD intervention comparison conditions matched to the target intervention on time and attention. Most of the 24 studies found that participants in both the experimental and control conditions improved significantly over time on SUD and PTSD outcomes. No study found significant between-group differences in both SUD and PTSD outcomes favoring the experimental treatment. Despite greater treatment dropout, there was greater improvement in some PTSD outcomes for exposure-based interventions than the control conditions, including when the control conditions were matched for time and attention. Addiction-focused and coping-based interventions did not generally show an advantage over comparably robust controls, although some coping-based interventions yielded better drug use outcomes than control conditions. When available, interventions that integrate exposure-based PTSD treatment and behavioral SUD treatment are recommended as they are associated with better PTSD outcomes than SUD care matched for time and attention. However, the results of this critical review also suggest that people with SUD/PTSD can benefit from a variety of treatment options, including standard SUD care.

Authors+Show Affiliations

Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care, Seattle, Washington. Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington.Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington. Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care, Seattle, Washington. Department of Health Services, University of Washington, Seattle, Washington.Mental Illness Research, Education and Clinical Centers (MIRECC) VA Connecticut Health Care System, West Haven, Connecticut. Department of Psychiatry, Yale University, New Haven, Connecticut.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28055143

Citation

Simpson, Tracy L., et al. "No Wrong Doors: Findings From a Critical Review of Behavioral Randomized Clinical Trials for Individuals With Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder." Alcoholism, Clinical and Experimental Research, vol. 41, no. 4, 2017, pp. 681-702.
Simpson TL, Lehavot K, Petrakis IL. No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder. Alcohol Clin Exp Res. 2017;41(4):681-702.
Simpson, T. L., Lehavot, K., & Petrakis, I. L. (2017). No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder. Alcoholism, Clinical and Experimental Research, 41(4), 681-702. https://doi.org/10.1111/acer.13325
Simpson TL, Lehavot K, Petrakis IL. No Wrong Doors: Findings From a Critical Review of Behavioral Randomized Clinical Trials for Individuals With Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder. Alcohol Clin Exp Res. 2017;41(4):681-702. PubMed PMID: 28055143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder. AU - Simpson,Tracy L, AU - Lehavot,Keren, AU - Petrakis,Ismene L, Y1 - 2017/02/10/ PY - 2016/08/11/received PY - 2017/01/03/accepted PY - 2017/1/6/pubmed PY - 2017/12/19/medline PY - 2017/1/6/entrez KW - Behavioral Intervention KW - Critical Review KW - Posttraumatic Stress Disorder KW - Psychotherapy KW - Substance Use Disorders SP - 681 EP - 702 JF - Alcoholism, clinical and experimental research JO - Alcohol Clin Exp Res VL - 41 IS - 4 N2 - Prior reviews of behavioral treatments for individuals with comorbid alcohol and drug use disorders (substance use disorder SUD) and posttraumatic stress disorder (PTSD) have not systematically considered whether comparison conditions are matched to target treatments on time and attention. A systematic literature search using PubMed MESH terms for alcohol and substance use disorders, PTSD, and treatment identified relevant behavioral randomized clinical trials (RCTs) that evaluated PTSD-oriented exposure-based treatments, addiction-focused treatments, and coping-based treatments that do not involve exposure to trauma memories. Information pertaining to within-subject changes over time and between-subject differences, quality of control condition, recruitment efficiency, and assessment and treatment retention was synthesized. Alcohol and drug outcomes were described separately when possible. Twenty-four behavioral RCTs were identified: 7 exposure based, 6 addiction focused, and 11 coping based. Seven studies included SUD intervention comparison conditions matched to the target intervention on time and attention. Most of the 24 studies found that participants in both the experimental and control conditions improved significantly over time on SUD and PTSD outcomes. No study found significant between-group differences in both SUD and PTSD outcomes favoring the experimental treatment. Despite greater treatment dropout, there was greater improvement in some PTSD outcomes for exposure-based interventions than the control conditions, including when the control conditions were matched for time and attention. Addiction-focused and coping-based interventions did not generally show an advantage over comparably robust controls, although some coping-based interventions yielded better drug use outcomes than control conditions. When available, interventions that integrate exposure-based PTSD treatment and behavioral SUD treatment are recommended as they are associated with better PTSD outcomes than SUD care matched for time and attention. However, the results of this critical review also suggest that people with SUD/PTSD can benefit from a variety of treatment options, including standard SUD care. SN - 1530-0277 UR - https://www.unboundmedicine.com/medline/citation/28055143/No_Wrong_Doors:_Findings_from_a_Critical_Review_of_Behavioral_Randomized_Clinical_Trials_for_Individuals_with_Co_Occurring_Alcohol/Drug_Problems_and_Posttraumatic_Stress_Disorder_ L2 - https://doi.org/10.1111/acer.13325 DB - PRIME DP - Unbound Medicine ER -