The role of alcohol misuse in PTSD outcomes for women in community treatment: A secondary analysis of NIDA’s Women and Trauma study.

Individuals with comorbid substance use and posttraumatic stress disorder may differentially benefit from integrated trauma-focused interventions based on specific presenting characteristics such as substance use type and PTSD severity. This study is a secondary analysis of a National Drug Abuse Treatment Clinical Trials Network study (protocol CTN-0015) exploring the effectiveness of two interventions for women with comorbid PTSD and substance use disorders. Using generalized estimating equations, the association of baseline alcohol misuse with PTSD outcome measures over time was examined for all randomized participants. The results showed that women entering treatment with baseline alcohol misuse had higher Post Traumatic Stress Disorder Symptom Scale (PSS-SR) total scores, cluster C (avoidance/numbing) scores, and cluster D (hyper-arousal) scores. For women with alcohol misuse, after treatment week 1, PSS-SR scores were significantly lower in the Seeking Safety intervention group during treatment and follow-up compared to those in the health education intervention. Alcohol misusers in the Seeking Safety group who had higher baseline hyper-arousal severity improved more quickly than those with lower baseline hyper-arousal severity during treatment.

In conclusion, these findings suggest that the type of substance abuse at treatment entry may inform treatment selection, predict treatment response among those with co-occurring PTSD and substance use disorders, and indicate a more severe clinical picture. In particular, this study suggests that an integrated trauma model, such as Seeking Safety, may be a sound, first-line, clinical approach to managing PTSD among women with active alcohol misuse.

Related protocols: CTN-0015