title: Study design, interventions, and baseline characteristics for the Substance use and TRauma Intervention for VEterans (STRIVE) trial.
abstract: While comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is common among veterans, there is debate regarding how to best treat individuals suffering from both conditions. Despite data supporting the effectiveness of integrated treatments that simultaneously address both disorders, due to concerns that an early focus on trauma may increase dropout and reduce the likelihood of achieving SUD-related goals, providers continue to prefer a sequential approach, where the addiction is treated first and PTSD treatment is instituted following sustained abstinence or reduced use. This project is designed to directly examine these provider concerns by evaluating the benefits and harms of an integrated versus a sequential approach to treating comorbid PTSD and SUD. This paper reviews the study's methodology, treatment approaches, and baseline participant characteristics. In this randomized clinical trial, one hundred eighty-three veterans with co-occurring PTSD and SUD have been randomized to one of two psychotherapies that include the same treatment components for SUD and PTSD (Motivational Enhancement Therapy and Prolonged Exposure respectively), but differ by whether the components are delivered sequentially or are integrated such that PTSD and SUD symptoms are addressed concurrently. We hypothesize that veterans assigned to integrated treatment will show greater improvement in PTSD and SUD symptoms than veterans assigned to sequential treatment. If this hypothesis is supported, the findings have the potential to change clinicians' beliefs and challenge long-standing practice patterns that require participation in SUD treatment prior to initiating trauma-focused therapies for PTSD.
authors.affiliation: National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA 02130, United States; Minneapolis VA Healthcare System, Minneapolis, MN 55417, United States; Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States. Electronic address: Shannon.Kehle-Forbes@va.gov.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Kehle-Forbes
authors.affiliation: Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, United States; Mental Illness Research, Education, and Clinical Center, at the Corporal Michael J. Crescenz VA Medical Center, and Center of Excellence for Substance Abuse Treatment and Evaluation, Philadelphia, PA 19104, United States.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Drapkin
authors.affiliation: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
authors.affiliation: Minneapolis VA Healthcare System, Minneapolis, MN 55417, United States; Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, United States.
authors.forename: Erin
authors.initials: E
authors.lastname: Koffel
authors.affiliation: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Lynch
authors.affiliation: Minneapolis VA Healthcare System, Minneapolis, MN 55417, United States; Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, United States.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Polusny
authors.affiliation: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
authors.forename: Deborah H A
authors.initials: DH
authors.lastname: Van Horn
authors.affiliation: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Yusko
authors.affiliation: Minneapolis VA Healthcare System, Minneapolis, MN 55417, United States.
authors.forename: Molly
authors.initials: M
authors.lastname: Charlesworth
authors.affiliation: Mental Illness Research, Education, and Clinical Center, at the Corporal Michael J. Crescenz VA Medical Center, and Center of Excellence for Substance Abuse Treatment and Evaluation, Philadelphia, PA 19104, United States.
authors.forename: Molly
authors.initials: M
authors.lastname: Blasco
authors.affiliation: Mental Illness Research, Education, and Clinical Center, at the Corporal Michael J. Crescenz VA Medical Center, and Center of Excellence for Substance Abuse Treatment and Evaluation, Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States.
authors.forename: David W
authors.initials: DW
authors.lastname: Oslin
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D012107:Research Design; D016037:Single-Blind Method; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000628:therapy*; D014728:Veterans
keywords: Motivational Enhancement Therapy; Posttraumatic stress disorder; Prolonged Exposure therapy; Randomized clinical trial; Substance use disorders; Veterans