Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE): A Pilot Study in Alcohol-dependent Women

Abstract

Objectives: Posttraumatic stress disorder (PTSD) and substance use disorders are highly comorbid. Effective treatments are largely lacking. This pilot study evaluated the safety and feasibility of a novel intervention, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), in preparation for a randomized controlled trial.

Methods: Twenty-two treatment-seeking women with current DSM-IV-TR PTSD and alcohol dependence (AD) were recruited. Participants received COPE. Safety and feasibility were evaluated, as were efficacy-related outcomes: PTSD and depression symptom severity, alcohol use, craving, and dependence severity.

Results: No adverse events occurred. COPE was implemented in routine clinical practice. Among the assessed women, 95.8% were eligible to participate. Treatment attendance and completion were higher than in previous studies. Post treatment, all efficacy-related outcomes, including PTSD and depression symptom severity, alcohol use, craving, and dependence severity, were significantly reduced.

Conclusions: COPE was safe and feasible to use. Concerns that trauma-focused, exposure-based therapy might promote relapse in this population appear unwarranted. Our findings provide initial evidence suggestive of COPE efficacy for comorbid PTSD and AD in women. These results provide a strong rationale for investigating the efficacy of COPE for comorbid PTSD and AD in women in a randomized controlled trial.

Conflict of interest statement

Conflicts of interest: Professors Back, Killeen, and Brady are authors of the manual describing the intervention used in this study, and may receive royalties from its further sales. For the remaining authors none were declared.

Figures

FIGURE 1.

Study flow.

FIGURE 2.

Group means and 95% confidence intervals for (A) clinician-rated PTSD symptom severity (CAPS-DX) and (B) participant self-rated PTSD symptom severity (PCL-C) (n=22).

FIGURE 3.

Group means and 95% confidence intervals for (A) grams of alcohol consumed per week (TLFB), (B) percent heavy drinking days, (C) alcohol craving (PACS), and (D) alcohol dependence severity (AUDIT) (n=22).