BACKGROUND/RATIONALE:
Studies indicate that treatment for posttraumatic stress disorder (PTSD) may be the single most important factor in preventing relapse among dually diagnosed veterans in substance use disorder (SUD) treatment settings. One third of veterans in SUD treatment suffer from PTSD-SUD comorbidity. These patients also have more severe SUD symptoms and higher rates of relapse to substance use when compared to SUD-only patients. Thus, systematic detection and treatment of PTSD in SUD settings is critical to effective SUD treatment for many VA patients. Unfortunately, PTSD is under-detected in SUD treatment settings, and behavioral interventions that address symptoms of PTSD are not yet a part of standard VA SUD treatments. As a result, VA treatment outcomes for PTSD-SUD patients are poor compared to those of SUD-only patients.
OBJECTIVE(S):
This study proposes a prospective program of research that will identify feasible and inexpensive methods to detect and treat comorbid PTSD among VA SUD patients, thereby improving substance abuse treatment outcomes. Our objectives are to test the effectiveness of substituting 2 hours/week of Seeking Safety-based groups for standard substance use focused groups for male patients attending outpatient substance use disorder treatment who meet clinical criteria for PTSD. We hypothesize that enhanced SUD treatment that incorporates “Seeking Safety” will improve SUD treatment outcomes for PTSD-SUD patients as compared to outcomes for PTSD-SUD patients receiving treatment as usual. Additionally, we examine two hypothesized models via which “Seeking Safety” may effect substance use outcomes. We examine whether 1) reductions in PTSD symptomatology and 2) improvements in coping strategies used in response to PTSD symptoms (reductions in using to cope and other avoidance coping strategies) partially mediate the effect of treatment on substance use outcomes.
METHODS:
A randomized clinical trial of 210 male veterans with PTSD and substance use disorders attending outpatient substance use disorder treatment at the VA Oakland mental health center. Patients will be randomized to 3 months of outpatient substance abuse treatment including either 2 hours/week of “Seeking Safety” or standard addiction focused group therapy. Data will be collected in patient interviews at treatment entry and at 3, 6 and 12 months after treatment initiation and by medical record review. Substance use, PTSD symptomatology, mental health, social functioning, legal problems, use of coping techniques, and treatment satisfaction outcomes will be assessed. Primary and secondary treatment outcomes of patients in “Seeking Safety” versus treatment as usual will be compared by repeated measures ANCOVA. We will test the mediational hypotheses using the 4-step method described by Baron and Kenny (1986).
FINDINGS/RESULTS:
Seeking Safety was piloted tested with male veterans in the clinic methadone program and found to be well accepted and feasible in male veteran patients. This study recruited and completed treatment entry interviews with 62 potential trial subjects: Nineteen potential subjects did not qualify for the study and 43 subjects were randomized into treatment groups.
IMPACT:
The proposed study builds on previous VA research by this team in a) detection and assessment of PTSD; and b) SUD treatment outcomes research. Our results will indicate the utility of dissemination of Seeking Safety treatment as a strategy to improve substance abuse treatment outcomes for the approximately 33,000 addiction treatment-seeking veterans with comorbid PTSD.
PUBLICATIONS: Weaver, Trafton, Walser, & Kimerling. (2007). Pilot Test of Seeking Safety Treatment With Male Veterans. Psychiatry Services, 58, 1012-1013
PUBLICATIONS:
Journal Articles
- Weaver CM, Trafton JA, Walser RD, Kimerling RE. Pilot test of seeking safety treatment with male veterans. Psychiatric Services. 2007; 58(7): 1012-3.
