Table 2.

Integrated Treatments for Comorbid PTSD and Substance Use Disorders

Treatment	Exposure	Trial Design	Sample	Outcomes	Reference(s)
TREM	None	Quasi- Experimental, Non-Equivalent Group TREM as part of a larger comprehensive treatment model v. TAU at community substance use treatment program; 6 and 12 month follow-up	342 women with a trauma history and SUD, presenting for SUD treatment	Significantly greater reduction in drug use and PTSD symptoms among integrated treatment (including TREM) group compared to TAU	Harris, 1998; Amaro et al., 2007
CBT for PTSD	None	Open Pilot Trial Post-treatment and 3 month follow-up	11 patients in community addictions treatment	Significant impact on PTSD symptoms and substance use; demonstrated feasibility of delivery in community addictions treatment facility	McGovern et al., 2009
Transcend	None	Open Pilot Trial 6 and 12 month follow-up	46 male Vietnam Veterans with PTSD and SUDs, presenting in partial hospitalization program	Significant improvements in PTSD symptoms across all follow- ups; Decreased substance use at follow-up	Donovan et al., 2001
Seeking Safety	None	Uncontrolled Trial 3 month follow-up	27 females with trauma history and SUD, recruited from the community	Among completers (n=17), significant improvements in substance use, trauma-related symptoms, suicide risk, depression, social adjustment, problem solving, family functioning, and cognitions about substance use.	Najavits, 1998
		Uncontrolled Trial 3 month follow-up	17 females with PTSD and SUD, incarcerated sample	Significant improvement in PTSD symptoms (53% no longer met criteria at post- treatment); Improvement in PTSD maintained at follow-up; Significant reductions in SUD symptoms, with only 35% reporting use within 3 months of prison release.	Zlotnick et al., 2003
		Uncontrolled Trial Pre and Post only	25 male and female Veterans with PTSD and SUD, presenting in outpatient Veterans Administration clinic	Significant improvements in self-reported PTSD symptoms, quality of life, communication, problem solving skills and abstinence at post- treatment	Cook et al., 2006
		RCT SS and standard community care v. Relapse prevention and standard community care; 6 and 9 month follow- up	107 females with PTSD or sub- threshold PTSD and SUD, presenting in community clinic	Significant reductions in SUDs and PTSD for both groups; PTSD symptoms still in moderate severity range; No group differences at follow-up	Hien et al., 2004
		Uncontrolled Pilot SS plus Prolonged Exposure	5 men with comorbid PTSD and substance dependence presenting at outpatient clinic	Significant improvements in drug use, trauma symptoms, psychosocial functioning, anxiety, & feelings/thoughts related to safety	Najavits et al., 2005
		RCT SS and standard community care v. standard community care; 3 month follow-up	33 adolescent girls with PTSD and SUD, recruited from community and community clinics	Significantly improved outcomes among SS group regarding attitudes toward substance use, some trauma- related symptoms, and associated pathology	Najavits et al., 2006
		Quasi- Experimental SS v. wait list control	107 females with PTSD or sub- threshold PTSD and SUD, low- income sample	Significant reductions in PTSD symptoms and alcohol use among SS v. wait list control; trend toward significant decrease in drug use for SS group	Cohen et al., 2006
		Quasi- Experimental SS group v. TAU	313 women with trauma history, substance use disorder and comorbid Axis I or Axis II disorder	SS group showed greater treatment retention over 3 months and greater improvement in PTSD symptoms and coping skills than TAU	Gatz et al., 2007
		RCT SS and TAU v. TAU	49 females with PTSD or sub- threshold PTSD and SUD, incarcerated sample	No significant differences between groups on all key domains; Both conditions showed significant improvements in PTSD and SUD symptoms across time	Zlotnick et al., 2009
		RCT SS v. Women’s Health Education; 6, 9, and 12 month follow-up	353 females with PTSD or sub- threshold PTSD and SUD, from national, multi-site community sample	Significant reduction in PTSD for both groups; No group differences on PTSD outcomes; No significant impact on abstinence at follow-up	Hien et al., 2009
		Uncontrolled Pilot	14 male OEF/OIF Veterans	Preliminary findings show significant reductions in PTSD symptoms and alcohol use	Norman et al., 2010
		Controlled Trial SS v. wait list control	114 incarcerated women reporting trauma history, history of SUD, and at least moderate PTSD symptoms	SS group demonstrated decreased depression, improved interpersonal functioning, and decreased maladaptive coping compared to control	Lynch et al., 2012
		RCT SS v. TAU; 3 month follow-up	98 male Veterans with PTSD and SUD (treatment as usual did not have to meet criteria for PTSD), presenting in outpatient Veterans Administration clinic	Significantly better drug use outcomes among SS than TAU; No differences between groups in alcohol use or PTSD symptom improvement	Boden et al., 2012
		RCT SDPT v. 12 Step Facilitation; 1 month follow-up	19 men and women with PTSD or sub- threshold PTSD and SUD, presenting in Methadone clinic	Significant improvement in SUD and PTSD severity for both groups; No differences between groups	Triffleman et al., 2000
SDPT	In vivo	Open Pilot Trial 6 month follow-up	39 men and women with PTSD and cocaine dependence, presenting for SUD treatment	Significant improvement in PTSD and cocaine dependence symptoms for completers; Improvements maintained at follow-up	Back et al., 2001; Brady et al., 2001
COPE	In vivo & Imaginal	RCT COPE plus TAU v. TAU; 3 and 9 month follow-up	103 men and women with PTSD and drug dependence, presenting for SUD treatment in Australia	Significant improvement in SUD and PTSD severity for both groups; Greater reduction in PTSD among treatment group	Mills et al., in press
		Case Study 3 and 6 month follow-up	OEF/OIF male Veteran with PTSD and alcohol dependence	Preliminary findings show significant improvement in SUD and PTSD at end of treatment and both follow-up time points	Back et al., 2012

Note. TAU = Treatment as usual. Table does not represent an exhaustive review of all published trials of integrated treatment models.