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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA030143-03
Application #
8263981
Study Section
Special Emphasis Panel (ZDA1-NXR-B (10))
Program Officer
Chambers, Jessica Campbell
Project Start
2010-08-01
Project End
2015-05-31
Budget Start
2012-06-01
Budget End
2013-05-31
Support Year
3
Fiscal Year
2012
Total Cost
$326,231
Indirect Cost
$95,803
Name
Medical University of South Carolina
Department
Psychiatry
Type
Schools of Medicine
DUNS #
183710748
City
Charleston
State
SC
Country
United States
Zip Code
29425
Flanagan, Julianne C; Teer, Andrew; Beylotte, Francis M et al. (2014) Correlates of Recent and Lifetime Aggression among Veterans with Co-Occurring PTSD and Substance Use Disorders. Ment Health Subst Use 7:315-328
Back, Sudie E; Killeen, Therese K; Teer, Andrew P et al. (2014) Substance use disorders and PTSD: an exploratory study of treatment preferences among military veterans. Addict Behav 39:369-73
Price, Matthew; Gros, Daniel F; Strachan, Martha et al. (2013) Combat experiences, pre-deployment training, and outcome of exposure therapy for post-traumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom veterans. Clin Psychol Psychother 20:277-85
Price, Matthew; Gros, Daniel F; Strachan, Martha et al. (2013) The Role of Social Support in Exposure Therapy for Operation Iraqi Freedom/Operation Enduring Freedom Veterans: A Preliminary Investigation. Psychol Trauma 5:93-100
Farrugia, Philippa L; Mills, Katherine L; Barrett, Emma et al. (2011) Childhood trauma among individuals with co-morbid substance use and post traumatic stress disorder. Ment Health Subst Use 4:314-326