Present- Versus Past-focused Therapy for PTSD and Substance Use Disorder

Pilot Study of an Integrated Exposure-Based Model for Posttraumatic Stress Disorder and Substance Use Disorder

This study compares Creating Change, a new past-focused behavioral therapy for posttraumatic stress disorder (PTSD)/substance use disorder (SUD), to Seeking Safety, an evidence-based present-focused behavioral therapy for PTSD/SUD.

This study evaluates a new behavioral therapy model, Creating Change (CC) for PTSD/SUD. CC helps clients explore the past as a step in their recovery process. It has major public health relevance in that it is a low-cost, flexible model designed for all trauma and substance abuse types, both genders, and all clinical settings. It has particular relevance for VA in that many veterans suffer from PTSD and SUD. The new model demonstrated positive results in two pilot studies.

Inclusion Criteria:

• Meet Diagnostic and Statistical Manual (DSM-IV) criteria for current PTSD and current substance use disorder
• Have used a substance in the 60 days prior to intake
• Outpatient
• Plan to stay in Boston for the next 6 months
• If on psychiatric medication, are on a stable regimen for at least 4 weeks prior to participation in the study
• Have a stable mailing address and live nearby enough to come to VA Boston for treatment
• Able to sign informed consent
• Willing to participate in all assessments and urine testing
• Willing to provide a release of information for study staff to contact treaters as needed for clinical concerns

Exclusion Criteria:

• Any current acute medical condition that would either interfere with the patient's ability to attend treatment, or would be of such severity as to affect the patient's psychological functioning
• Current bipolar I disorder, schizophrenia or other psychotic disorders, mental retardation, or organic mental disorder
• Any obvious clinical sign that the patient is not sufficiently stable to participate in the treatment, or notification by the patient's primary providers that participation would be contraindicated
• Dangerousness that would present a threat to staff or patients (e.g., history of assault within the past 6 months)
• The patient is mandated to treatment