Six-Month Treatment Outcomes of Cocaine-Dependent Patients with and Without PTSD in a Multisite National Trial * (Post-Traumatic Stress Disorder) (Report‪)‬

AN ASSOCIATION BETWEEN SUBSTANCE USE disorder (SUD) and posttraumatic stress disorder (PTSD) is by now well established. For example, epidemiological data document that, among men who experience PTSD in their lifetime, 52% develop alcohol-use disorder and 35% develop drug-use disorder. Among women, the rates are 28% and 27%, respectively (Kessler et al., 1995). In clinical settings, the rate of co-occurring PTSD and SUD is higher, with 11%-34% in substance-use treatment estimated to have current PTSD and, for women in particular, 30%-59% (Najavits et al., 1997, 2003). Studies also have consistently shown greater impairment on a wide variety of variables in those with the dual diagnosis compared with those with either disorder alone (Brady et al., 1994; Hien et al., 2000; Najavits et al., 1997, 1998a; Ouimette et al., 1999). Few studies, however, have examined treatment outcome in this dual-diagnosis population. Those that do fall into two types. The first type tests a specific therapy for the dual diagnosis, which thus far have usually been uncontrolled pilot studies with relatively small samples (Brady et al., 2001; Donovan et al., 2001; Najavits et al., 1998b, 2005; Zlotnick et al., 2003) and, even in recent controlled trials, include only patients who have the dual diagnosis (no comparison to a SUD- or PTSD-only sample) (e.g., Hien et al., 2004; Cohen and Hien, 2006; Najavits et al., 2006; Triffieman, 2000). The second type are naturalistic studies, sometimes with larger samples, but typically with unstandardized diagnostic assessment, few assessment points, lack of rigorous inclusion criteria, and diverse treatments not designed for the dual diagnosis, often unspecified and/or uncontrolled in amount and type (e.g., Morrissey et al., 2005; Ouimette et al., 1998, 1999, 2003). The first type of study generally has shown improvements in PTSD and/or trauma-related symptoms, SUD symptoms, and other areas of functioning and pathology (Brady, 2001; Donovan et al., 2001; Hien et al., 2004; Najavits et al., 1998b, 2005, 2006; Triffieman, 2000; Zlotnick et al., 2003). In the second type of study, results indicate that the dual-diagnosis patients typically have worse outcomes on a variety of measures than those with SUD alone (Hien et al., 2000; Ouimette et al., 1999) or PTSD alone (Dansky et al., 1998). However, improvements over time are nonetheless found for the dual diagnosis patients (Dansky et al., 1998), particularly when they receive more PTSD-focused treatment and more psychosocial treatment generally (Ouimette et al., 2000, 2003).