Integrated Treatment of OEF/OIF Veterans With PTSD & Substance Use Disorders
Condition: Posttraumatic Stress Disorders; Combat Disorders; Alcohol Dependence; Drug Dependence
MeSH terms: Substance-Related Disorders; Alcoholism; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic; Combat Disorders
Study type: Interventional

Summary: 
      In comparison to the general population, U.S. military and Veterans are at an increased risk
      for developing both substance use disorders (SUD) and Post Traumatic Stress Disorder (PTSD).
      Current research has shown that there is a high comorbidity of SUD and PTSD, and although
      there are a number of treatments for SUD and PTSD independently, there are very few effective
      methods to simultaneously treat both disorders. Because of this substantial gap in the
      treatment of both SUDs and PTSD, it has become essential to develop a combined treatment that
      would address and treat both disorders. Individuals, specifically U.S. military and Veterans,
      with SUD/PTSD have unique needs that require a specialized treatment approach. This designed
      approach would employ cognitive-behavioral therapy (CBT) to treat the SUD, in conjunction
      with Prolonged Exposure therapy to treat the PTSD. Prolonged Exposure (PE) is an empirically
      supported and evidence-based treatment that is currently regarded as the "gold standard"
      psychosocial treatment for PTSD. In combination with CBT, this treatment would address both
      disorders in hopes of reducing substance use and PTSD symptomatology.
    

Detailed description: 
      As a result of sustained operations in Afghanistan and Iraq, there are an increasing number
      of U.S. military personnel and Veterans at risk of developing both substance use disorders
      (SUDs) and Post Traumatic Stress Disorder (PTSD). If left untreated, individuals with SUDs
      and/or PTSD are at risk for other mental health problems (e.g., depression), suicidal
      ideation and attempts, physical health problems, reduced resiliency, lost productivity, and
      family/relationship impairment. While mental health services are in place for U.S. military
      personnel, substantial gaps in the treatment of co-occurring SUDs and PTSD exist and there is
      little scientific evidence available to guide the provision of care. The proposed study
      directly addresses this knowledge gap by testing the feasibility and preliminary efficacy of
      an integrative behavioral intervention for the treatment of co-occurring SUDs and PTSD
      modified for use among U.S. military personnel (including National Guard and Reservists) who
      have served in Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). The
      intervention, called "Concurrent Treatment with Prolonged exposure" or "COPE," represents a
      novel treatment that integrates cognitive-behavioral therapy for SUDs with prolonged exposure
      therapy for PTSD. In earlier studies with civilians, COPE has demonstrated efficacy in
      reducing alcohol and drug use severity, PTSD symptoms, and associated mental health problems
      (e.g., depression, anxiety). In this hybrid Stage Ib/Stage II study, we will (1) use a
      manualized, well-tolerated behavioral treatment for SUDs and PTSD (COPE); (2) employ a
      two-arm randomized between-groups experimental design (COPE versus a modified treatment-as
      usual (TAU); and (3) examine standardized, repeated dependent measures of clinical outcomes
      and process variables at 5 time points (pre-, mid-, and post-treatment; 3 and 6 month
      follow-up). The proposed project is directly responsive to the mission of the National
      Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism
      (NIAAA) in that it seeks to enhance and accelerate research on the prevention and treatment
      of alcohol and drug use disorders (including illicit and prescription drugs) and comorbid
      conditions (e.g., PTSD, depression, sleep disturbances, HIV risk behaviors). The findings of
      this study will provide empirical evidence to inform policies and programs to better serve
      the needs of U.S. military personnel, Veterans, and their families.
    

Intervention name(s): Concurrent Treatment with Prolonged Exposure (COPE)
Intervention type(s): Behavioral
Intervention description(s): 12 weeks of concurrent prolonged exposure treatment for PTSD combined with cognitive behavioral therapy for substance use disorders (alcohol or drugs).
Other intervention name(s): Prolonged Exposure
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Military; Posttraumatic Stress Disorder; PTSD; PostTraumatic Stress Disorders; Combat; Psychological Treatment; Psychotherapy; Trauma; Posttraumatic Stress; Prolonged Exposure; Exposure therapy; Behavior Therapy; Cognitive Behavior Therapy; Stress Disorders; Drug Abuse; Drug Dependence; Alcohol Abuse; Alcohol Dependence; Substance Use Disorders; Alcoholism