Substance use disorders and PTSD: Examining substance use, PTSD symptoms, and dropout following imaginal exposure

Amber M. Jarnecke, Nicholas P. Allan, Christal L. Badour, Julianne C. Flanagan, Therese K. Killeen, Sudie E. Back

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Integrated exposure-based interventions to treat substance use disorders (SUD) and posttraumatic stress disorder (PTSD) may not be widely utilized, in part, because of clinician concerns that such interventions will worsen symptomatology and lead to treatment dropout. In order to address this question, the current pilot study examined whether participants' ratings of craving and distress following imaginal exposure predicted increased substance use, PTSD severity, and treatment dropout. Participants (N = 46) were U.S. military Veterans who met criteria for current SUD and PTSD. Subjective ratings of craving and distress, and past-week substance use and PTSD symptom severity were assessed at each treatment session. Multilevel modeling tested whether lagged ratings of craving and distress predicted the following week's frequency of substance use and PTSD severity. Discrete time survival analysis, using proportional odds Cox ratio, examined whether craving and distress ratings predicted treatment dropout. The findings revealed that neither craving nor distress following imaginal exposure were associated with the following week's substance use or PTSD severity. However, participants with higher craving and distress were more likely to drop out before completing treatment. Future research is needed to develop strategies to increase treatment retention for individuals at-risk for treatment dropout and identify mechanisms that account for the association between in-session ratings of craving and distress and dropout.

Original languageEnglish
Pages (from-to)35-39
Number of pages5
JournalAddictive Behaviors
StatePublished - Mar 2019

Bibliographical note

Funding Information:
This manuscript is the result of work supported, in part, by the National Institute on Alcohol Abuse and Alcoholism ( T32AA747430 and K23AA023845 ), the National Institute on Drug Abuse ( R01DA030143 and K02DA039229 ), and the Office of Research on Women’s Health ( K12DA035150 ). NIAAA, NIDA, and ORWH had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Publisher Copyright:
© 2018


  • Addiction
  • Imaginal exposure
  • Posttraumatic stress disorder
  • Substance use
  • Treatment retention

ASJC Scopus subject areas

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


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