Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA’s Clinical Trials Network
Open accessAbstract
OBJECTIVE: The purpose of the analysis was to examine the temporal course of improvement in symptoms of posttraumatic stress disorder (PTSD) and substance use disorder among women in outpatient substance abuse treatment. METHOD: Participants were 353 women randomly assigned to 12 sessions of either trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and posttreatment at 1 week and after 3, 6, and 12 months. A continuous Markov model was fit on four defined response categories (nonresponse, substance use response, PTSD response, or global response [improvement in both PTSD and substance use]) to investigate the temporal association between improvement in PTSD and substance use symptom severity during the study's treatment phase. A generalized linear model was applied to test this relationship over the follow-up period. RESULTS: Subjects exhibiting nonresponse, substance use response, or global response tended to maintain original classification; subjects exhibiting PTSD response were significantly more likely to transition to global response over time, indicating maintained PTSD improvement was associated with subsequent substance use improvement. Trauma-focused treatment was significantly more effective than health education in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions. CONCLUSIONS: PTSD severity reductions were more likely to be associated with substance use improvement, with minimal evidence of substance use symptom reduction improving PTSD symptoms. Results support the self-medication model of coping with PTSD symptoms and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.
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For those with trauma symptomology, reducing PTSD symptoms is more effective than health education in treating substance use.
“Programs that do treat both have found that for those with trauma symptomology, reducing PTSD symptoms is more effective than health education in treating substance use [63].”
From Health care utilisation changes among Alaska Native adults after participation in an indigenous community programme to address adverse life experiences: a propensity score-matched analysis (2020) · cites this paper as [63]
The Discussion reports that PTSD-targeted treatment was more effective than the comparison treatment at improving substance use, but only among participants with heavy substance use at baseline who achieved significant PTSD reductions. The study involved women with co-occurring PTSD and substance use disorders, so the citing sentence overgeneralizes the finding to people with trauma symptoms broadly. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe observed decrease in cravings after intervention is consistent with research finding that reductions in PTSD symptoms during treatment lead to improvements in SUD symptoms.
“Our observed decrease in cravings after intervention is consistent with research which finds that reductions in PTSD symptoms during treatment lead to improvements in SUD symptoms [48].”
From Written exposure therapy for treatment of perinatal PTSD among women with comorbid PTSD and SUD: A pilot study examining feasibility, acceptability, and preliminary effectiveness (2023) · cites this paper as [48]
Experimental — accuracy not yet measuredThere is recognised need for more trauma-informed approaches to substance use treatment.
“As such, there is recognised need for more trauma-informed approaches to substance use treatment [62–64].”
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“Programs that do treat both have found that for those with trauma symptomology, reducing PTSD symptoms is more effective than health education in treating substance use [63].”
Background
- Authors
- Hien, D. A., Jiang, H., Campbell, A. N. C., Hu, M.-C., Miele, G. M., Cohen, L. R., Brigham, G. S., Capstick, C., Kulaga, A., Robinson, J., Suarez-Morales, L., & Nunes, E. V.
- Affiliations
- City College of New York (US)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2010-01-01
- Volume
- 167
- Issue
- 1
- Pages
- 95-101
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC2806486
- OpenAlex
- W2168836182
- Cited by
- 309
- References
- 22
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 7 · 2023: 12 · 2022: 17 · 2021: 20 · 2020: 14 · 2019: 13 · 2018: 16 · 2017: 33 · 2016: 17 · 2015: 24 · 2014: 31 · 2013: 29 · 2012: 23
- FWCI
- 19.85
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- NSUWorks (Nova Southeastern University) (submittedVersion)
- Funders
- National Institute on Drug Abuse (U10DA013720, U10DA013035, U10-DA-13727, K24DA022412, U10DA013046, U10 DA13035, U10DA013732, U10 DA 13714, U10-DA-13038, U10-DA13732, U10DA013714, U10DA013727, U10DA013038)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- post-traumatic stress disorder, substance use disorders, women, health education, self-medication, integrated treatment, outpatient substance abuse treatment
- MeSH terms
- Adult, Alcoholism, Female, Follow-Up Studies, Humans, Life Change Events, Longitudinal Studies, Markov Chains, Patient Education as Topic, Psychotherapy, Group, Severity of Illness Index, Stress Disorders, Post-Traumatic, United States, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome, Diagnosis, Dual (Psychiatry), Substance-Related Disorders, National Institute on Drug Abuse (U.S.)
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