Publication:
Integrated Exposure-Based Therapy for Co-occurring Posttraumatic Stress Disorder and Substance Dependence: A Randomized Controlled Trial

dc.contributor.author Mills, Katherine en_US
dc.contributor.author Teesson, Maree en_US
dc.contributor.author Back, Sudie en_US
dc.contributor.author Brady, Kathleen en_US
dc.contributor.author Baker, Amanda en_US
dc.contributor.author Hopwood, Sally en_US
dc.contributor.author Sannibale, Claudia en_US
dc.contributor.author Barrett, Emma en_US
dc.contributor.author Merz, Sabine en_US
dc.contributor.author Rosenfeld, Julia en_US
dc.contributor.author Ewer, Philippa en_US
dc.date.accessioned 2021-11-25T12:27:51Z
dc.date.available 2021-11-25T12:27:51Z
dc.date.issued 2012 en_US
dc.description.abstract Context: There is concern that exposure therapy, an evidence-based cognitive-behavioral treatment for posttraumatic stress disorder (PTSD), may be inappropriate for patients with co-occurring substance dependence (SD). Objective: To determine whether an integrated treatment for PTSD and SD, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), can achieve greater reductions in PTSD and SD symptom severity compared to treatment as usual (TAU) for SD. Design, Setting, and Patients: A randomized controlled trial of 103 participants who met DSM-IV-TR criteria for both PTSD and SD. Participants were recruited from 2007-2009 in Sydney, Australia, and randomized to one of two conditions. The treatment group received COPE plus TAU (COPE+TAU; n=55) and the control group received TAU alone (n=48). Outcomes were assessed at 9-months post-baseline, and interim measures collected at 6-weeks and 3-months post-baseline. Interventions: COPE consists of 13 individual 90-minute sessions (i.e., 19.5 hours) with a clinical psychologist. It represents an integration of existing evidence based manualized cognitive behavioral treatments for PTSD and SD, comprising psychoeducation, motivational enhancement, and cognitive behavioral therapy for PTSD and SD, including imaginal and in vivo exposure. Main outcome measures: Change in PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS; scale range 0-240), and change in severity of SD as measured by the number of dependence criteria met according to the Composite International Diagnostic Interview version 3.0 (CIDI; range 0-7), from baseline to 9-month follow-up. A change of 15 points on the CAPS scale and 1 dependence criteria on the CIDI were considered to be clinically significant. Results: From baseline to 9-month follow-up, significant reductions in PTSD symptom severity were found for both the treatment (mean difference -38.24, 95%CI: -47.93 - -28.54) and control group (mean difference -22.14, 95%CI: -30.33 - -13.95), however, the treatment group demonstrated a significantly greater reduction in PTSD symptom severity compared to the control group (mean difference -16.09, 95%CI: -29.00 to -3.19). No significant between group difference was found in relation to improvement in severity of SD (0.43 v 0.52; IRR 0.85, 95%CI: 0.60 - 1.21), nor were there any significant between group differences in relation to changes in substance use, depression or anxiety. Conclusions: Among patients with PTSD and SD, the combined use of COPE+TAU, compared with TAU alone, resulted in improvement in PTSD symptom severity without an increase in severity of SD. Trial registration: Registration number ISRCTN12908171; URL: http://www.controlled-trials.com/ISRCTN12908171/mills en_US
dc.identifier.issn 0098-7484 en_US
dc.identifier.uri http://hdl.handle.net/1959.4/53176
dc.language English
dc.language.iso EN en_US
dc.rights CC BY-NC-ND 3.0 en_US
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/3.0/au/ en_US
dc.source Legacy MARC en_US
dc.title Integrated Exposure-Based Therapy for Co-occurring Posttraumatic Stress Disorder and Substance Dependence: A Randomized Controlled Trial en_US
dc.type Journal Article en
dcterms.accessRights metadata only access
dspace.entity.type Publication en_US
unsw.accessRights.uri http://purl.org/coar/access_right/c_14cb
unsw.identifier.doiPublisher http://dx.doi.org/10.1001/jama.2012.9071 en_US
unsw.relation.FunderRefNo 455209 en_US
unsw.relation.FunderRefNoURL http://purl.org/au-research/grants/nhmrc/455209 en_US
unsw.relation.faculty Medicine & Health
unsw.relation.faculty Science
unsw.relation.fundingScheme NHMRC Project en_US
unsw.relation.ispartofissue 7 en_US
unsw.relation.ispartofjournal JAMA en_US
unsw.relation.ispartofpagefrompageto 690-699 en_US
unsw.relation.ispartofvolume 308 en_US
unsw.relation.originalPublicationAffiliation Mills, Katherine, National Drug & Alcohol Research Centre, Faculty of Medicine, UNSW en_US
unsw.relation.originalPublicationAffiliation Teesson, Maree, National Drug & Alcohol Research Centre, Faculty of Medicine, UNSW en_US
unsw.relation.originalPublicationAffiliation Back, Sudie, Medical University of South Carolina en_US
unsw.relation.originalPublicationAffiliation Brady, Kathleen, Medical University of South Carolina en_US
unsw.relation.originalPublicationAffiliation Baker, Amanda, University of Newcastle en_US
unsw.relation.originalPublicationAffiliation Hopwood, Sally, Psychology, Faculty of Science, UNSW en_US
unsw.relation.originalPublicationAffiliation Sannibale, Claudia, National Drug & Alcohol Research Centre, Faculty of Medicine, UNSW en_US
unsw.relation.originalPublicationAffiliation Barrett, Emma, National Drug & Alcohol Research Centre, Faculty of Medicine, UNSW en_US
unsw.relation.originalPublicationAffiliation Merz, Sabine, National Drug & Alcohol Research Centre, Faculty of Medicine, UNSW en_US
unsw.relation.originalPublicationAffiliation Rosenfeld, Julia, National Drug & Alcohol Research Centre, Faculty of Medicine, UNSW en_US
unsw.relation.originalPublicationAffiliation Ewer, Philippa, National Drug & Alcohol Research Centre, Faculty of Medicine, UNSW en_US
unsw.relation.school NDARC *
unsw.relation.school School of Psychology *
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