Tanya C. Saraiya

Polysubstance use is prevalent among individuals who use opioids, many of whom also often concurrently smoke tobacco products. Specifically, 74–97% of people who use opioids or receive treatment fo...

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) often co-occur and present significant treatment challenges. Cognitive Processing Therapy (CPT) is a widely used, efficacious treatment for PTSD, but the application of CPT among individuals with co-occurring PTSD/AUD has been limited. To address this gap, we developed a novel, 12-session trauma-focused treatment that combines CPT with Relapse Prevention (RP) for AUD (CPT+RP). This paper describes CPT+RP and presents preliminary outcomes from the first six participants enrolled in a larger, ongoing multisite clinical trial of CPT+RP. PTSD symptoms were assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). The Timeline Follow-Back (TLFB) assessed frequency (percent days drinking; PDD) and quantity (drinks per drinking day; DDD) of alcohol use, and craving was measured using the Penn Alcohol Craving Scale (PACS). The Client Satisfaction Questionnaire measured acceptability. Pre- to post-treatment reductions were observed in PTSD symptoms (ΔMCAPS-5 = 14.00; ΔMPCL-5 = 20.50), frequency and quantity of alcohol use (ΔMPDD = 38.65; ΔMDDD = 6.24), and craving (ΔPACS = 6.17). Most participants achieved clinically significant improvement in their PTSD symptoms and acceptability was high. Although preliminary, the findings suggest the new CPT+RP intervention is feasible, acceptable, and a promising treatment innovation for co-occurring PTSD and AUD.

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.

Adverse childhood experiences (ACEs), defined as abuse, neglect, and household dysfunction experienced before the age of 18 (Felitti et al., 1998), are widely studied determinants of health. ACEs c...

Opioid use disorder (OUD) and posttraumatic stress disorder (PTSD) frequently co-occur. However, there are no psychotherapy treatments intentionally designed for this comorbidity, nor designed to be augmented with medications for OUD. In this open-label pilot trial, we tested Helping Opioid Use Disorder and PTSD with Exposure (HOPE), a novel integrated, trauma-focused treatment for individuals (N = 6) with OUD/PTSD who were stabilized on medications for OUD. HOPE was delivered weekly for 10–12 sessions, and one follow-up visit was conducted ~1-month post-treatment. Primary outcomes included urine drug screens, the Timeline Followback, Desire for Drugs Questionnaire, Clinician-Administered PTSD Scale-5 (CAPS-5), and PTSD Checklist-5 (PCL-5). Boot-strapped linear mixed effect models and generalized estimating equations showed that PTSD symptoms (CAPS-5: B = −7.16, SE = 1.24, p < 0.01; PCL-5: B = −2.04, SE = 0.26, p < 0.01), desire for opioids (B = −0.56, SE = 0.15, p < 0.01), depression symptoms (B = −0.43, SE = 0.09, p < 0.01), and anxiety symptoms (B = −0.50, SE = 0.08, p < 0.01) decreased significantly over time. Client satisfaction increased throughout the study (B = 0.18, SE = 0.08, p = 0.02), and 83.3% of participants completed the therapy and follow-up visit. There were no significant changes in opioid or other substance use from baseline to follow-up. Although preliminary, results show high acceptability and feasibility of the HOPE therapy and demonstrate significant improvements in PTSD and associated symptoms with an integrated, trauma-focused treatment.

The South Asian diaspora is one of the largest racial/ethnic diasporas in the world. Limited psychological research and practice have focused on the traumatic experiences of South Asian individuals in this diaspora, and even less work has examined how these traumatic experiences are inextricably linked with historical and ongoing colonial context; migration and displacement; and intersectional identity based on religion, race, gender, nationality, and more. Additionally, scant research has focused on tangible solutions to these grave gaps in mental health care—how to best disseminate and implement culturally congruent interventions, enhance policy for trauma‐informed work, and best attend to the culturally informed needs of South Asian mental health trainees. This narrative review examines the current psychological literature on trauma among South Asian individuals in the diaspora from a translational perspective. We review (a) South Asian history using a trauma‐focused lens, (b) the types and prevalence of traumatic experiences, (c) trauma interventions, (d) trauma‐related dissemination and implementation efforts, and (e) trauma‐informed policy initiatives. We note from the outset that due to the limited work on the diaspora, much of this review inadvertently also reviews extant work on trauma among South Asians residing in South Asia, which is distinct but related to diasporic experiences. Recommendations for the traumatic stress field, community members and lay providers, and implications for the training of South Asian students preparing for careers in mental health are discussed.