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A Randomized Controlled Trial for Veterans with PTSD and Substance Use Disorder: Creating Change versus Seeking

Lisa M Najavits1,2,3, Karen Krinsley1, Molly E Waring4,3

  • 1a Veterans Affairs Boston Healthcare System , Boston , Massachusetts , USA.

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Summary

A new past-focused therapy (Creating Change) and an existing present-focused therapy (Seeking Safety) both effectively treat posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in veterans, with sustained improvements observed.

Keywords:
PTSDsubstance abusetherapytraumaveterans

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Public Health

Background:

  • Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur in veteran populations.
  • Effective treatments are needed to address both conditions concurrently.

Purpose of the Study:

  • To compare a novel past-focused therapy (Creating Change; CC) against a present-focused therapy (Seeking Safety; SS) for veterans with co-occurring PTSD and SUD.
  • To evaluate the efficacy of CC and SS on symptoms of both disorders, as well as secondary outcomes.

Main Methods:

  • A randomized controlled trial involving 52 veterans with PTSD/SUD.
  • Participants received 17 individual therapy sessions.
  • Assessments were conducted at baseline, end-of-treatment, and 3-month follow-up.

Main Results:

  • Both CC and SS demonstrated significant improvements in PTSD, alcohol use, and drug use symptoms over time, with no significant differences between the two treatments.
  • Medium to large effect sizes were observed for primary outcomes.
  • Improvements were sustained at follow-up, with continued gains in alcohol use.

Conclusions:

  • Creating Change (CC) shows promise as an effective therapy for PTSD/SUD, comparable to Seeking Safety (SS).
  • Both treatments are safe and well-tolerated, with high attendance and satisfaction rates.
  • Findings support the public health relevance of CC for addressing complex mental health needs in real-world samples.