Project Harmony: A meta-analysis with individual patient data on behavioral and pharmacologic trials for comorbid posttraumatic stress and alcohol or other drug use disorders
Open accessAbstract
OBJECTIVE: Treatment efficacy for co-occurring posttraumatic stress disorder (PTSD) and substance use disorders is well established, yet direct evidence for comparative effectiveness across treatments is lacking. The present study compared the effectiveness of several behavioral and pharmacological therapies for adults with co-occurring PTSD and alcohol or other drug use disorders. METHODS: A systematic search of PsycINFO, MEDLINE, and ClinicalTrials.gov was conducted through December 2020 for trials targeting PTSD, alcohol or other drug use disorders, or both disorders (36 studies, N=4,046). Primary outcomes were severity scores for PTSD, alcohol use, and drug use, estimated via moderated nonlinear factor analysis. Propensity score weight-adjusted multilevel models were used. Model-predicted effect sizes were estimated for each treatment, and comparative effect sizes for each active arm against treatment as usual, at end of treatment and at 12-month follow-up. RESULTS: Compared with treatment as usual, combining trauma-focused therapy and pharmacotherapy for substance use disorders showed the largest comparative effect sizes for PTSD severity (d=-0.92, 95% CI=-1.57, -0.30) and alcohol use severity (d=-1.10, 95% CI=-1.54, -0.68) at end of treatment. Other treatments with large comparative effect sizes included pharmacotherapies for alcohol or other drug use disorders, trauma-focused integrated therapies, and trauma-focused nonintegrated therapies. Reductions in outcomes for PTSD symptoms and alcohol use were observed for nearly all treatments. CONCLUSIONS: The findings provide support for treating comorbid PTSD and substance use disorders using a variety of approaches, with alcohol-targeted pharmacotherapies and trauma-focused behavioral therapies as a combination of treatments that lead to early and sustained improvements in PTSD and alcohol use severity. Further treatment development is indicated for combining behavioral and pharmacological treatments for synergized impact and understanding the mechanisms of action and conditions under which each treatment type is optimized.
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- Authors
- Hien, D. A., Morgan-López, A. A., Saavedra, L. M., Ruglass, L. M., Ye, A., López-Castro, T., Fitzpatrick, S., Killeen, T. K., Norman, S. B., Ebrahimi, C. T., & Back, S. E.
- Affiliations
- Rutgers, The State University of New Jersey (US)
- Center of Alcohol and Substance Use Studies, Rutgers University–New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina–Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and...
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2023-02-01
- Volume
- 180
- Issue
- 2
- Pages
- 155-166
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC10016363
- OpenAlex
- W4311718142
- Cited by
- 99
- References
- 69
- Citations by year
- 2026: 21 · 2025: 20 · 2024: 19 · 2023: 19 · 2022: 19 · 2021: 1
- FWCI
- 3.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Yale University
- Brown University
- University of Pennsylvania
- University of Minnesota
- University of Connecticut
- Johns Hopkins University
- Dartmouth College
- Georgia State University
- University of South Carolina
- University of Memphis
- University of New South Wales
- Flinders University
- Universiteit van Amsterdam
- Karolinska Institutet
- University of California, San Diego
- Irving Medical Center, Columbia University
- Universitätsklinikum Hamburg-Eppendorf
- National Institute on Alcohol Abuse and Alcoholism (R01AA025853)
- National Institute on Drug Abuse (R25DA035161)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- post-traumatic stress disorder, substance use disorders, alcoholism, trauma-focused psychotherapy, pharmacotherapy, comparative effectiveness, usual care, PTSD symptom severity, alcohol use severity, drug use severity
- MeSH terms
- Adult, Humans, Psychotherapy, Stress Disorders, Post-Traumatic, Comorbidity, Treatment Outcome, Substance-Related Disorders
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