Substance Use after Completion of an Intensive Treatment Program with Concurrent Treatment for Posttraumatic Stress Disorder and Substance Use among Veterans: Examining the Role of PTSD Symptoms

Abstract

Objective

Substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) are costly and highly co-occurring diagnoses, particularly among veterans, suggesting a need to understand this comorbidity and effectively treat both disorders among this population.

Methods

The current study aimed to examine substance use outcomes among post-9/11 veterans and service members (N = 48) who completed a two-week intensive outpatient program with concurrent treatment for and PTSD using Prolonged Exposure and substance use. Substance use was assessed at two weeks and three months posttreatment.

Results

The intensive program had high completion rates and demonstrated decreases in substance use at two weeks and three months posttreatment. Additionally, lower PTSD symptoms at treatment completion were related to less substance use posttreatment.

Conclusions

Concurrent intensive treatment of PTSD and SUDs can lead to symptom improvement in a short period of time. Findings support the self-medication model, such that PTSD symptoms at treatment completion were related to substance use at follow-up.

Keywords:

• Posttraumatic stress disorder
• substance use
• cognitive behavioral therapy
• prolonged exposure
• massed treatment
• intensive outpatient programs
• veterans

Acknowledgments

The authors acknowledge, with gratitude, Wounded Warrior Project, which supports the Emory Healthcare Veterans Program and serves as a partner in the Warrior Care Network, dedicated to filling gaps in mental health care for the invisible wounds of war in service members, veterans, and military families.

Disclosure statement

Drs. Watkins and Patton and Ms. Wilcox have no declarations of interest. Dr. Drexler receives compensation for service as Medical Director for the American Academy of Addiction Psychiatry. Dr. Rothbaum has or recently had funding from Wounded Warrior Project, National Science Foundation, Cohen Veteran Bioscience, Bob Woodruff Foundation, The Hidden Heroes Fund (an initiative of the Elizabeth Dole Foundation), Department of Defense Clinical Trial Grant No.W81XWH-10-1-1045, and McCormick Foundation. Dr. Rothbaum receives royalties from Oxford University Press, Guilford, APPI, and Emory University and received advisory board payments from Jazz Pharmaceuticals, Senseye, Nobilis Therapeutics, and Sophren. Dr. Rothbaum owns equity in Virtually Better, Inc. that creates virtual environments. The terms of these arrangements have been reviewed and approved by Emory University in accordance with its conflict of interest policies. Dr. Rauch receives or recently received support from Wounded Warrior Project (WWP), Department of Veterans Affairs (VA), National Science Foundation, National Institute of Health (NIH), Bob Woodruff Foundation, and Department of Defense (DOD). Dr. Rauch receives royalties from Oxford University Press and American Psychological Association Press.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.