How changes in post‐traumatic stress disorder (PTSD) severity mediate substance use disorder (SUD) severity during and after treatment for co‐occurring PTSD and SUD: Results from Project Harmony.
Background and Aims: Post‐traumatic stress disorder (PTSD) commonly co‐occurs with substance use disorders (SUD). Comorbid PTSD and SUD (PTSD+SUD) is associated with greater severity and impairment and poorer treatment outcomes. Several interventions exist to treat PTSD, SUD and PTSD+SUD; however, r...
| Publicado en: | Addiction Vol. 120; no. 11; pp. 2245 - 2258 |
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| Autores principales: | , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Nov2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=188720898&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 188720898 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09652140 AIO jtl: Addiction issn: 09652140 maglogo: Y pubinfo: dt: Nov2025 vid: 120 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 188720898 186488072 188720898 188720898 10.1111/add.70126 188720898 ppf: 2245 ppct: 13 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: How changes in post‐traumatic stress disorder (PTSD) severity mediate substance use disorder (SUD) severity during and after treatment for co‐occurring PTSD and SUD: Results from Project Harmony. aug: au: Hien, Denise A. Gette, Jordan A. Blakey, Shannon M. Piccirillo, Marilyn L. Back, Sudie E. Bauer, Alexandria G. Ebrahimi, Chantel T. Ellis, Robyn A. Killeen, Therese K. Lehinger, Elizabeth A. López‐Castro, Teresa Norman, Sonya B. Ruglass, Lesia M. Saraiya, Tanya C. Saavedra, Lissette M. Morgan‐López, Antonio A. affil: Center of Alcohol and Substance Use Studies, Rutgers University–New Brunswick, Piscataway NJ,, USA sug: subj: Stress Disorders, Post-Traumatic Physiopathology Severity of Illness Substance Use Disorders Physiopathology Substance Use Disorders Therapy Stress Disorders, Post-Traumatic Therapy Comorbidity Treatment Outcomes Human Male Female Adult Nonexperimental Studies Models, Statistical Alcohol Abuse Complications Psychotherapy Mediation Analysis Secondary Analysis Factor Analysis DSM Age Factors Sex Factors Race Factors Educational Status Dose-Response Relationship, Drug Depression Psychosocial Factors Marital Status Confidence Intervals Harm Reduction Funding Source Antipsychotic Agents Therapeutic Use Antipsychotic Agents Administration and Dosage Descriptive Statistics Data Analysis Software Adult: 19-44 years Male Female ab: Background and Aims: Post‐traumatic stress disorder (PTSD) commonly co‐occurs with substance use disorders (SUD). Comorbid PTSD and SUD (PTSD+SUD) is associated with greater severity and impairment and poorer treatment outcomes. Several interventions exist to treat PTSD, SUD and PTSD+SUD; however, research has yet to elucidate the indirect pathways underlying treatment for PTSD+SUD. The present study examined how changes in PTSD severity relate to changes in SUD severity across treatment types during and post‐treatment. Methods: Observational study using data collected as part of Project Harmony, a virtual clinical trial employing integrative data analysis to compare treatment effectiveness of PTSD+SUD interventions from 36 randomized controlled trials for PTSD+SUD (n = 4046). Multilevel mediated linear growth modeling was used to examine potential outcomes mediation. Each of the eight active treatments was compared to treatment as usual (TAU) for both alcohol and drug use outcomes. Results: Alcohol use severity outcomes were fully or partially mediated by changes in PTSD severity for trauma‐focused psychotherapy + AUD medication [ab = −0.16 (95% confidence interval = −0.30 to −0.04)]; other treatments with mediation effects included trauma‐focused integrated psychotherapy, AUD medications and PTSD medications. Drug use severity outcomes were fully or partially mediated by changes in PTSD severity for trauma‐focused psychotherapy + AUD medication [ab = −0.08 (−0.18 to −0.001)]; other treatments with mediation effects on drug use severity included trauma‐focused integrated psychotherapy, AUD medications, PTSD medications and placebo medications. Conclusions: Among people with co‐occurring post‐traumatic stress disorder (PTSD) and substance use disorders (SUD), reductions in alcohol and drug use severity appear to be mediated by reductions in PTSD during treatment. For those with drug use disorders, PTSD reductions appear to mediate further SUD reductions after treatment. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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