Cognitive processing therapy (CPT) versus individual drug counseling (IDC) for PTSD for veterans with opioid use disorder maintained on buprenorphine

IF 2.5 4区 医学 Q2 SUBSTANCE ABUSE
Ismene L. Petrakis MD, Sarah Meshberg-Cohen PhD, Charla Nich MS, Megan M. Kelly PhD, Tracy Claudio AA, Jane Serrita Jane PhD, Emily Pisani BA, Elizabeth Ralevski PhD
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引用次数: 0

Abstract

Background and Objectives

There are high rates of comorbidity between posttraumatic stress disorder (PTSD) and opioid use disorder (OUD). Evidence-based trauma-focused psychotherapies such as Cognitive Processing Therapy (CPT) are a first-line treatment for PTSD. Veterans with OUD are treated primarily in substance use disorder (SUD) clinics where the standard of care is drug counseling; they often do not have access to first-line PTSD treatments. This study tested whether CPT can be conducted safely and effectively in veterans with comorbid OUD treated with buprenorphine.

Methods

This 12-week, 2-site, randomized clinical trial (RCT) included open-label randomization to two groups: (a) CPT versus (b) Individual Drug Counselling (IDC) in veterans with PTSD and comorbid OUD who were maintained on buprenorphine (N = 38).

Results

Veterans randomized to either IDC (n = 18) or CPT (n = 20) showed a significant reduction in self-reported PTSD symptoms over time as measured by the PTSD checklist (PCL-5) but there were no treatment group differences; there was some indication that reduction in PTSD symptoms in the CPT group were sustained in contrast to the IDC group. Recruitment was significantly impacted by COVID-19 pandemic, so this study serves as a proof-of-concept pilot study.

Discussion and Conclusions

Veterans with OUD and PTSD can safely and effectively participate in evidence-based therapy for PTSD; further work should confirm that trauma-focused treatment may be more effective in leading to sustained remission of PTSD symptoms than drug counseling.

Scientific Significance

This is the first study to evaluate CPT for PTSD in the context of buprenorphine treatment for OUD.

认知处理疗法(CPT)与个体药物咨询(IDC)对使用丁丙诺啡维持治疗的阿片类药物使用障碍退伍军人的创伤后应激障碍的治疗效果对比。
背景和目标创伤后应激障碍(PTSD)和阿片类药物使用障碍(OUD)的合并率很高。认知处理疗法(CPT)等以创伤为重点的循证心理疗法是治疗创伤后应激障碍的一线疗法。患有 OUD 的退伍军人主要在药物使用障碍(SUD)诊所接受治疗,那里的标准治疗方法是药物咨询;他们通常无法获得创伤后应激障碍的一线治疗。这项研究测试了 CPT 是否能安全有效地应用于接受丁丙诺啡治疗的合并 OUD 退伍军人。方法这项为期 12 周的随机临床试验(RCT)包括开放标签随机分配两组:(a) CPT 对 (b) 个别药物咨询 (IDC),对象是患有创伤后应激障碍并合并 OUD 且持续服用丁丙诺啡的退伍军人(N = 38)。结果随机接受 IDC(18 人)或 CPT(20 人)治疗的退伍军人的自我报告的创伤后应激障碍症状随着时间的推移显著减少,以创伤后应激障碍核对表(PCL-5)来衡量,但治疗组之间没有差异;有迹象表明,与 IDC 组相比,CPT 组的创伤后应激障碍症状减少是持续性的。讨论与结论患有 OUD 和创伤后应激障碍的退伍军人可以安全、有效地参与以证据为基础的创伤后应激障碍治疗;进一步的工作应证实,与药物咨询相比,以创伤为重点的治疗可能更有效地导致创伤后应激障碍症状的持续缓解。科学意义这是第一项在丁丙诺啡治疗 OUD 的背景下评估创伤后应激障碍 CPT 的研究。
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来源期刊
CiteScore
5.00
自引率
0.00%
发文量
118
期刊介绍: The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.
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