Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans

Sudie E. Back, Therese Killeen, Christal L. Badour, Julianne C. Flanagan, Nicholas P. Allan, Elizabeth Santa Ana, Brian Lozano, Kristina J. Korte, Edna B. Foa, Kathleen T. Brady

Research output: Contribution to journalArticlepeer-review

117 Scopus citations


Objective: A substantial amount of individuals with substance use disorders (SUD) also meet criteria for posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) is an effective, evidence-based treatment for PTSD, but there is limited data on its use among individuals with current alcohol or drug use disorders. This study evaluated the efficacy of an integrated treatment that incorporates PE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure or COPE) among veterans. Method: Military veterans (N = 81, 90.1% male) with current SUD and PTSD were randomized to 12 sessions of COPE or Relapse Prevention (RP). Primary outcomes included the Clinician Administered PTSD Scale (CAPS), PTSD Checklist-Military version (PCL-M), and the Timeline Follow-back (TLFB). Results: On average, participants attended 8 out of 12 sessions and there were no group differences in retention. Intent-to-treat analyses revealed that COPE, in comparison to RP, resulted in significantly greater reductions in CAPS (d = 1.4, p <.001) and PCL-M scores (d = 1.3, p =.01), as well as higher rates of PTSD diagnostic remission (OR = 5.3, p <.01). Both groups evidenced significant and comparable reductions in SUD severity during treatment. At 6-months follow-up, participants in COPE evidenced significantly fewer drinks per drinking day than participants in RP (p =.05). Conclusions: This study is the first to report on the use of an integrated, exposure-based treatment for co-occurring SUD and PTSD in a veteran sample. The findings demonstrate that integrated, exposure-based treatments are feasible and effective for military veterans with SUD and PTSD. Implications for clinical practice are discussed.

Original languageEnglish
Pages (from-to)369-377
Number of pages9
JournalAddictive Behaviors
StatePublished - Mar 2019

Bibliographical note

Publisher Copyright:
© 2018 Elsevier Ltd


  • Addiction
  • PTSD
  • Posttraumatic stress disorder
  • Prolonged exposure
  • Substance use disorder
  • Veterans

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Toxicology
  • Psychiatry and Mental health


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