Summary of findings 4. Non‐trauma‐focused psychological intervention for PTSD and SUD or PTSD only compared to active psychological intervention for SUD only.
| Non‐trauma‐focused psychological therapy for PTSD and SUD or PTSD only compared to active psychological therapy for SUD only | ||||||
| Patient or population: Individuals with post‐traumatic stress disorder and comorbid substance use disorder Settings: Community substance abuse treatment programs Intervention: Individual‐based combined non‐trauma‐focused psychological therapy Comparison: Active psychological therapy for SUD only | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Active psychological therapyfor SUD only | Individual‐based combined non‐trauma‐focused psychological therapy | |||||
|
PTSD severity following treatment completion As assessed by the CAPS. High scores indicate greater symptom severity |
‐ | The mean PTSD severity following treatment completion in the intervention groups was 0.26 standard deviations lower (1.29 lower to 0.77 higher) | ‐ | 128 (2 studies) | ⊕⊝⊝⊝ very low1,2,3 | SMD ‐0.26 (‐1.29 to 0.77) Not significant |
|
Drug or alcohol use, or both following treatment completion As assessed by the SUI or ASI. High scores indicate greater symptom severity |
‐ | The mean drug/alcohol use following treatment completion in the intervention groups was 0.22 standard deviations higher (0.13 lower to 0.57 higher) | ‐ | 128 (2 studies) | ⊕⊕⊝⊝ low1,3 | SMD 0.22 (‐0.13 to 0.57) Not significant |
| Treatment completers | Study population | RR 0.91 (0.68 to 1.20) | 128 (2 studies) | ⊕⊝⊝⊝ very low1,3 | Not significant | |
| 618 per 1000 | 563 per 1000 (420 to 742) | |||||
| Moderate | ||||||
| 591 per 1000 | 538 per 1000 (402 to 709) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ASI: Addiction Severity Index; CAPS: Clinician Administered PTSD Scale; CI: confidence interval; PTSD: post‐traumatic stress disorder; RR: risk ratio; SMD: standardised mean difference; SUD: substance use disorder; SUI: Substance Use Inventory | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Quality of evidence downgraded by one point because the risk of bias in most trials was high or unclear in several domains. 2Quality of evidence downgraded by two points because of a high level of unexplained statistical heterogeneity. 3Quality of evidence downgraded by one point because findings were based on outcomes from two studies with small sample sizes.
Both studies in this comparison involved access to adjunctive SUD‐based therapy.