Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders

Abstract

The authors compared the effectiveness of the Seeking Safety group, cognitive-behavioral treatment for substance use disorder and posttraumatic stress disorder (PTSD), to an active comparison health education group (Women's Health Education [WHE]) within the National Institute on Drug Abuse's Clinical Trials Network. The authors randomized 353 women to receive 12 sessions of Seeking Safety (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment 1 week and 3, 6, and 12 months posttreatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS), the PTSD Symptom Scale-Self Report (PSS-SR), and a substance use inventory (self-reported abstinence and percentage of days of use over 7 days). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively) but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline. Study results do not favor Seeking Safety over WHE as an adjunct to substance use disorder treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions.

Trial registration: ClinicalTrials.gov NCT00078156.

Figure 1

CONSORT diagram of participant flow through the protocol.

Figure 2

Mean (with 95% CI) Post-Traumatic Stress Scale Self-report severity at baseline, 1-week post-treatment, 3-, 6- and 12-month follow-up for the intention-to-treat sample (N=353). Study phase refers to in-treatment (baseline to 1-week post-treatment) versus over the follow-up period (3-, 6- and 12-months post-treatment). There is a significant study phase by treatment by time interaction effect (χ²(1)=4.18, p-value = .04). PSS-SR=Post-traumatic Stress Scale Self-report (Foa et al., 1993).