Integrated exposure-based therapy for co-occurring post-traumatic stress and substance use among young people: a randomized controlled trial
ABSTRACT Background: Despite well-documented evidence demonstrating the efficacy and safety of integrated treatments for post-traumatic stress disorder (PTSD) and substance use disorder (SUD) in adults, few studies have been conducted among adolescents and young adults, developmental periods when these disorders typically have their onset. Objective: This randomized controlled trial compared the efficacy of an integrated exposure-based treatment for PTSD and SUD among young people [Concurrent Treatment of PTSD and SUD Using Prolonged Exposure for Adolescents (COPE-A)] to a supportive counselling control condition [person-centred therapy (PCT)]. COPE-A represents an adaption of the evidence-based COPE treatment for adults, modified to meet the development needs of the target age group (12–25 years). Method: Participants (n = 55; 69% female) were recruited in Sydney, Australia, between 2018 and 2022, and randomized to receive COPE-A or PCT. PTSD and substance use were assessed at study entry, and outcomes at 4 months (primary end-point) and 12 months post-baseline. Between-group differences in PTSD symptom severity (primary outcome), PTSD diagnosis, substance use, client satisfaction, and adverse events were examined. Results: COPE-A showed significantly greater reductions in PTSD symptom severity [mean difference −9.82, 95% confidence interval (CI) −16.11 to −3.53] and PTSD diagnosis (odds ratio = 0.06, 95% CI 0.01 to 0.46) between baseline and 4 months, which were maintained through to 12 months. PCT demonstrated reductions in PTSD symptom severity, but these did not reach significance until 12 months (mean difference −8.92, 95% CI −13.41 to −4.43). Significant reductions in the frequency of substance use and severity of SUD were found between baseline and 12 months, but there were no between-group differences. Client satisfaction scores were significantly higher in COPE-A compared to PCT. There were no study-related adverse events. Conclusion: The results provide evidence of the safety and efficacy of COPE-A in producing significantly greater improvements in PTSD symptom severity in a shorter time compared to PCT. Trial registration: ACTRN12618000785202.