Six-month treatment outcomes of cocaine-dependent patients with and without PTSD in a multisite national trial.
OBJECTIVE
This study examined 6-month treatment outcomes among 428 cocaine-dependent outpatients with (n = 34) and without (n = 394) posttraumatic stress disorder (PTSD) in a randomized controlled multisite clinical trial of manual-based psychotherapies for substance use disorder (SUD).


METHODS
Assessments were completed at baseline and monthly during the 6-month treatment. With longitudinal mixed-effects models, we compared outcomes between SUD-PTSD and SUD-only patients and also examined rates of within-group change.


RESULTS
Results indicated a highly consistent pattern: the SUD-PTSD patients were more impaired to begin with and remained so across time compared with SUD-only patients (with the exception of substance use and addiction-related legal and employment problems, which did not differ between groups). Also, the SUD-PTSD patients improved less than SUD-only patients in alcohol use and the majority of addiction-related psychosocial problems. However, the two groups did not differ significantly in improvement over time on drug use or global psychological severity.


CONCLUSIONS
The greater impairment and relative lack of improvement of SUD-PTSD patients, compared with those with SUD-only, suggest a need for dual-diagnosis treatments that more directly target their areas of difficulty.
Najavits
Lisa M
LM
National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. lisa_najavits@hms.harvard.edu
Harned
Melanie S
MS
Gallop
Robert J
RJ
Butler
Stephen F
SF
Barber
Jacques P
JP
Thase
Michael E
ME
Crits-Christoph
Paul
P
D000328:Adult; D000436:Alcoholics Anonymous; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D003376:Counseling / Q000379:methods; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D002189:Marijuana Abuse / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D011575:Psychoanalytic Therapy / Q000379:methods; D011613:Psychotherapy / Q000379:methods*; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D014481:United States
D006993:Hypnotics and Sedatives