Friday, April 4, 2025
4/4/2025
Hybrid Effectiveness-Implementation Trial of Massed PTSD Treatment in a Community Substance Use Program - Project Summary/Abstract Over 20 studies have shown that prolonged Exposure (PE) is a highly efficacious and effective treatment for posttraumatic stress disorder (PTSD). While PE has been disseminated across many types of treatment settings, it is still rarely available to substance using populations. This is unfortunate because co-occurrence of PTSD and substance use disorder (SUD) is extremely common, research points to the importance of treating both disorders concurrently with effective treatments, and numerous studies have shown PE to be safe and effective for PTSD comorbid with SUD. One reason for poor dissemination may be that when PE is available to SUD patients, treatment dropout is high and effect sizes are smaller for PTSD/SUD studies than for primary PTSD. Higher PE attendance is associated with greater benefit over other treatment. A possible way to enhance effectiveness is to offer PE in a massed format (M-PE; i.e., multiple sessions per week instead of once weekly). For PTSD, M-PE has been shown to be effective and reduce drop out compared to weekly PE. Although most studies of PTSD/SUD treatment have been in outpatient settings, there is indication that M-PE initiated in intensive outpatient (IOP) SUD treatment can improve attendance and outcomes. Taken together, the research suggests that initiating PE in a massed format in IOP SUD treatment is an extremely promising strategy to improve PTSD/SUD outcomes. A critical next step is a pragmatic Hybrid Type I randomized clinical trial of M-PE initiated in IOP SUD treatment. We propose to compare M-PE with treatment as usual (TAU) to SUD treatment as usual only (SUD care including a weekly trauma skills group) at the Gateway Community Services, Inc., a nationally recognized leader in community SUD treatment. Participants will be 168 male and female GCS patients with PTSD/SUD. Our central hypotheses are that M-PE will result in greater reductions in PTSD symptoms and substance use as compared to TAU. Our primary aim is to compare the effectiveness of M-PE to TAU in IOP SUD treatment in impacting PTSD symptoms and substance use. We hypothesize that M- PE will show greater improvements in PTSD symptom severity at study treatment completion and 1-, 3-, and 6- months follow-up and less substance use at study treatment completion, 1-, 3-, and 6-months follow-up. We will also explore differences in treatment arms on patient-centered outcomes, including days of (non-primary) substance use, depressive symptoms, functioning, quality of life, suicidal ideation, and participant satisfaction. We will examine gender as a moderator and changes in trauma related cognitions, cravings, and their temporal association as mediators of change in PTSD and substance use. Finally, we will conduct a mixed-method process evaluation to understand patients’, providers’ and stakeholders’ experiences with M-PE, explore barriers to integrating M-PE into IOP SUD treatment, and identify strategies for widespread implementation.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).