Abstract

Background: Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are associated with a more severe course and worse outcome than either disorder alone. In Europe, few treatments have been evaluated for PTSD and SUD. Seeking Safety, a manualized, integrated, cognitive-behavioural treatment, has been shown to be effective in studies in the USA.

Objective: To test the efficacy of Seeking Safety plus treatment as usual (TAU) in female outpatients with PTSD and SUD compared to Relapse Prevention Training (RPT) plus TAU and TAU alone.

Method: In five German study centres a total of N = 343 women were randomized into one of the three study conditions. PTSD severity (primary outcome), substance use, depression and emotion dysregulation (secondary outcomes) were assessed at baseline, post-treatment, as well as at three months and six months post-treatment.

Results: Treatment participants attended M = 6.6 sessions (Seeking Safety) and M = 6.1 sessions (RPT). In an intent-to-treat analysis, Seeking Safety plus TAU, RPT plus TAU and TAU alone showed comparable decreases in PTSD severity over the course of the study. Seeking Safety plus TAU showed superior efficacy to TAU alone on depression and emotion regulation and RPT plus TAU was more effective than TAU alone on number of substance-free days and alcohol severity. Minimum-dose analyses suggest additional effects of both programmes among participants who attended at least eight group sessions.

Conclusions: With respect to PTSD symptoms, a brief dose of Seeking Safety and RPT in addition to TAU was not superior to TAU alone in women with PTSD and SUD. However, Seeking Safety and RPT showed greater reductions than TAU alone in other domains of psychopathology and substance use outcomes respectively. Future studies should investigate further variables, such as what aspects of each treatment appeal to particular patients and how best to disseminate them.

Details

Title
A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders
Author
Schäfer, Ingo 1 ; Lotzin, Annett 1 ; Hiller, Philipp 1 ; Sehner, Susanne 2 ; Driessen, Martin 3 ; Hillemacher, Thomas 4 ; Schäfer, Martin 5 ; Scherbaum, Norbert 6 ; Schneider, Barbara 7 ; Grundmann, Johanna 1 

 Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 
 Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 
 Department of Psychiatry and Psychotherapy Bethel, Ev. Klinikum Bielefeld, Bielefeld, Germany 
 Department of Psychiatry and Psychotherapy, Paracelsus University Nuremberg, Nürnberg, Germany; Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany 
 Department of Psychiatry, Psychotherapy and Addiction Medicine, Lehrkrankenhaus der Universität Duisburg-Essen, Essen, Germany 
 Department of Psychiatry and Psychotherapy, LVR-Klinik Essen, University Duisburg-Essen, Essen, Germany 
 Department of Addictive Disorders and Psychiatry, LVR-Klinik Cologne, Cologne, Germany 
Publication year
2019
Publication date
2019
Publisher
Taylor & Francis Ltd.
e-ISSN
20008066
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2351042118
Copyright
© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This work is licensed under the Creative Commons  Attribution – Non-Commercial License http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.