The impact of addiction medications on treatment outcomes for persons with co-occurring PTSD and opioid use disorders

Abstract

Background and objectives: Previous research has been inconclusive about whether adding psychosocial treatment to medication assisted treatment (MAT) improves outcomes for patients with co-occurring psychiatric and opioid use disorders. This study evaluated the impact of MAT and psychosocial therapies on treatment outcomes for patients with co-occurring opioid use disorders and PTSD.

Methods: Patients meeting criteria for PTSD and substance use disorders were randomly assigned to one of three treatment conditions: Standard Care (SC) alone, Integrated Cognitive Behavioral Therapy (ICBT) plus SC, or Individual Addiction Counseling (IAC) plus SC. Substance use and psychiatric symptoms were assessed at baseline and 6 months. Only patients with opioid use disorders were included in the present analyses (n = 126). Two-way ANOVAS and logistic regression analyses were used to examine associations between treatment conditions and MAT, for substance use and psychiatric outcomes.

Results: MAT patients receiving ICBT had significantly decreased odds of a positive urine drug screen, compared to non-MAT patients receiving SC alone (OR = .07, 95% CI = .01, .81, p = .03). For PTSD symptoms, a significant MAT by psychosocial treatment condition interaction demonstrated that MAT patients had comparable declines in PTSD symptoms regardless of psychosocial treatment type (F(2, 88) = 4.74, p = .011). Non-MAT patients in ICBT had significantly larger reductions in PTSD.

Conclusions and scientific significance: For patients with co-occurring opioid use disorders and PTSD, MAT plus ICBT is associated with more significant improvement in substance use. For non-MAT patients, ICBT is most beneficial for PTSD symptoms.

Keywords: co-occurring disorders; integrated treatment; medication-assisted treatment; opioid dependence; posttraumatic stress disorder.

FIG. 1

Predicted probabilities and 95% confidence intervals of positive drug toxicology screen by medication assisted treatment (MAT) prescription status and treatment type. (MAT, medication assisted treatment; ICBT, integrated cognitive behavioral therapy; IAC, individual addiction counseling; SC, standard care.)

FIG. 2

Changes in clinician administered PTSD Scale (CAPS) total scores from baseline to 6 months by medication assisted treatment (MAT) prescription and psychosocial treatment type. (MAT, medication assisted treatment; ICBT, integrated cognitive behavioral therapy; IAC, individual addiction counseling; SC, standard care.)