• Shannon M Kehle-Forbes, Shirley Chen, Melissa A Polusny, Kevin G Lynch, Erin Koffel, Erin Ingram, Edna B Foa, Deborah H A Van Horn, Michelle L Drapkin, David A Yusko, and David W Oslin.
• National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130, United States; Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, United States; University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States. Electronic address: Shannon.Kehle-Forbes@va.gov.
• Drug Alcohol Depend. 2019 Dec 1; 205: 107647.

ObjectiveRecent clinical practice guidelines recommend the delivery of evidence-based psychotherapies for both substance use disorder (SUD) and posttraumatic stress disorder (PTSD) within the same treatment episode for patients with SUD/PTSD comorbidity. This randomized clinical trial evaluated the comparative effectiveness of integrating versus phasing evidence-based psychotherapies for SUD and PTSD among veterans with co-occurring SUD/ PTSD.Method183 veterans with DSM-IV PTSD and SUD at two VA Medical Centers were randomized to one of two psychotherapies during which Motivational Enhancement Therapy [MET] for SUD and Prolonged Exposure [PE] for PTSD were either phased or integrated throughout treatment. Primary outcomes as evaluated by blinded assessors were percent days with drug use or heavy drinking and PTSD symptomology. We hypothesized integrated MET/PE (n = 95) would yield better SUD and PTSD-related outcomes at posttreatment than phased MET/PE (n = 88).ResultsIn intent-to-treat analyses (n=183), both treatment groups achieved clinically (d=0.46 - 1.06) and statistically significant reductions in SUD (p < 0.01) and PTSD (p < 0.01) symptomology; the time by treatment interactions were not significant. Post-hoc analyses could not confirm statistical non-inferiority; between-group effect sizes suggest a lack of clinically-meaningful differences between the two treatment approaches (d=0.08 - 0.27).ConclusionsOur hypothesis that integrated MET/PE would result in better outcomes than phased MET/PE across a range of PTSD and SUD measures was not supported; both strategies for combining two single-disorder treatments for co-occurring SUD/PTSD yielded significant symptom reduction.Published by Elsevier B.V.

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