As a result of sustained operations in Afghanistan and Iraq, there are an increasing number of U.S. military personnel and Veterans at risk of developing both substance use disorders (SUDs) and Post Traumatic Stress Disorder (PTSD). If left untreated, individuals with SUDs and/or PTSD are at risk for other mental health problems (e.g., depression), suicidal ideation and attempts, physical health problems, reduced resiliency, lost productivity, and family/relationship impairment. While mental health services are in place for U.S. military personnel, substantial gaps in the treatment of co-occurring SUDs and PTSD exist and there is little scientific evidence available to guide the provision of care. The proposed study directly addresses this knowledge gap by testing the feasibility and preliminary efficacy of an integrative behavioral intervention for the treatment of co-occurring SUDs and PTSD modified for use among U.S. military personnel (including National Guard and Reservists) who have served in Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). The intervention, called """"""""Concurrent Treatment with Prolonged Exposure"""""""" or """"""""COPE,"""""""" represents a novel treatment that integrates cognitive-behavioral therapy for SUDs with prolonged exposure therapy for PTSD. In earlier studies with civilians, COPE has demonstrated efficacy in reducing alcohol and drug use severity, PTSD symptoms, and associated mental health problems (e.g., depression, anxiety). In this hybrid Stage Ib/Stage II study, we will (1) use a manualized, well-tolerated behavioral treatment for SUDs and PTSD (COPE);(2) employ a two-arm randomized between-groups experimental design (COPE versus a modified treatment-as- usual (TAU);and (3) examine standardized, repeated dependent measures of clinical outcomes and process variables at 5 time points (pre-, mid-, and post-treatment;3 and 6 month follow-up). The proposed project is directly responsive to the mission of the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in that it seeks to enhance and accelerate research on the prevention and treatment of alcohol and drug use disorders (including illicit and prescription drugs) and comorbid conditions (e.g., PTSD, depression, sleep disturbances, HIV risk behaviors). The findings of this study will provide empirical evidence to inform policies and programs to better serve the needs of U.S. military personnel, Veterans, and their families.

Public Health Relevance

Substance use disorders and Post Traumatic Stress Disorder (PTSD) are debilitating and chronic disorders that frequently co-occur and affect a substantial proportion of OEF/OIF Veterans and their families. The current services offered do not adequately address co-occurring substance use disorders and PTSD, and there is an immediate need for the development of theory-grounded, evidence-based treatments. The proposed study has the potential to significantly improve the standard of patient care, advance the comorbidity science in this area, decrease public health expenditures, and improve the military readiness and overall health of our U.S. military families.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZDA1-NXR-B (10))
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Kahana, Shoshana Y
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Medical University of South Carolina
Schools of Medicine
United States
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Szafranski, Derek D; Gros, Daniel F; Acierno, Ron et al. (2018) Heterogeneity of treatment dropout: PTSD, depression, and alcohol use disorder reductions in PTSD and AUD/SUD treatment noncompleters. Clin Psychol Psychother :
Jarnecke, Amber M; Allan, Nicholas P; Badour, Christal L et al. (2018) Substance use disorders and PTSD: Examining substance use, PTSD symptoms, and dropout following imaginal exposure. Addict Behav 90:35-39
Bountress, Kaitlin E; Badour, Christal; Flanagan, Julianne et al. (2018) Treatment of co-occurring posttraumatic stress disorder and substance use: Does order of onset influence outcomes? Psychol Trauma 10:662-665
Flanagan, Julianne C; Fischer, Melanie S; Badour, Christal L et al. (2017) The Role of Relationship Adjustment in an Integrated Individual Treatment for PTSD and Substance Use Disorders Among Veterans: An Exploratory Study. J Dual Diagn 13:213-218
Mills, Adam C; Badour, Christal L; Korte, Kristina J et al. (2017) Integrated Treatment of PTSD and Substance Use Disorders: Examination of Imaginal Exposure Length. J Trauma Stress 30:166-172
Gros, Daniel F; Lancaster, Cynthia L; Horner, Michael David et al. (2017) The influence of traumatic brain injury on treatment outcomes of Concurrent Treatment for PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) in veterans. Compr Psychiatry 78:48-53
Szafranski, Derek D; Snead, Alexandra; Allan, Nicholas P et al. (2017) Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout. Addict Behav 73:30-35
Badour, Christal L; Flanagan, Julianne C; Gros, Daniel F et al. (2017) Habituation of distress and craving during treatment as predictors of change in PTSD symptoms and substance use severity. J Consult Clin Psychol 85:274-281
Gros, Daniel F; Flanagan, Julianne C; Korte, Kristina J et al. (2016) Relations among social support, PTSD symptoms, and substance use in veterans. Psychol Addict Behav 30:764-770
Adams, Zachary W; McCauley, Jenna L; Back, Sudie E et al. (2016) Clinician Perspectives on Treating Adolescents with Co-occurring Post-Traumatic Stress Disorder, Substance Use, and Other Problems. J Child Adolesc Subst Abuse 25:575-583

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