Aug 2026· Drug and Alcohol Review· Vol 45· 0 citations· 46 references
Medicine
TL;DR
It is suggested that staff generally viewed M‐PE favourably but emphasised the importance of ensuring client readiness and organisational support, and the feasibility and acceptability of integrating M‐PE into a community‐based SUD program.
Abstract
ABSTRACT Introduction Post‐traumatic stress disorder (PTSD) commonly co‐occurs with substance use disorders (SUD), yet few community‐based SUD programs incorporate evidence‐based trauma‐focused. Prolonged exposure (PE), including its massed format (M‐PE) with session frequency of 3–4 times per week, is a gold standard intervention for PTSD; however, concerns about client readiness, logistical demands and relapse risk have limited its adoption within SUD settings. This study examined staff perspectives on the feasibility and acceptability of integrating M‐PE into a community‐based SUD program. Methods Prior to launching a Hybrid Type 1 effectiveness–implementation trial (Project COMET), we conducted semi‐structured virtual interviews with 15 community clinic staff: providers (n = 8), administrators (n = 2) and peer specialists (n = 5). Interviews were recorded, transcribed and analysed using a rapid qualitative analysis framework with matrix techniques to compare themes across roles. Results Four overarching themes captured staff perspectives on integrating M‐PE: (Theme 1) Prior Knowledge and Experiences: Most staff were familiar with EMDR, while direct knowledge of PE/M‐PE was limited. (Theme 2) Perceptions of M‐PE: M‐PE was widely viewed as a promising, structured intervention that fits the pacing and duration of SUD care. (Theme 3) Symptom Reduction and Client Impact: Staff anticipated improvements in PTSD and SUD symptoms through trauma‐focused treatment. (Theme 4) Barriers and Constraints: Participants identified several potential implementation challenges, including logistical barriers and client readiness. Discussion and Conclusions Findings suggest that staff generally viewed M‐PE favourably but emphasised the importance of ensuring client readiness and organisational support. Enhancing feasibility and long‐term sustainability may require expanded psychoeducation, targeted provider training and flexible delivery models. Trial Registration: ClinicalTrials.gov identifier: NCT06968832.
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.
K. Mills, Natalie Peach, Ivana Kihas et al.· European Journal of Psychotr...· 0 citations
The Integrated Treatment Adherence Program (ITAP) is a novel psychosocial intervention designed to strengthen post-acute care transitions for individuals with co-occurring mood and substance use disorders (Mood-SUD). As an adjunctive treatment, ITAP integrates elements of individual therapy, family support, and case management for six months following an acute care transition. This qualitative study explored stakeholder perspectives on ITAP as part of a larger hybrid effectiveness-implementation trial. Semi-structured interviews with veterans (n = 15) and Veterans Health Administration (VHA) mental health providers (n = 15) were analyzed thematically using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify determinants of feasibility, effectiveness, and sustainability of implementing ITAP within the VHA in the future. Veterans conveyed that ITAP promoted accountability and motivation and emphasized values-based, recovery-oriented goal setting as central to improvements in mood and substance use. Across both groups, relational continuity, flexible delivery (phone, video, in-person), and coordinated care were viewed as essential for engagement, feasibility, and sustainability. Providers highlighted ITAP’s potential fit within existing VHA services and feasibility for delivery by clinicians or peer specialists, while identifying leadership support, dedicated infrastructure, and opportunities for ongoing follow-up contact after ITAP completion as critical to implementation success. Findings underscore ITAP’s recovery-oriented framework and care coordination as key mechanisms supporting transitional care within the VHA system. Future efforts should focus on refining implementation strategies, evaluating scalability, and examining sustainment across diverse healthcare settings.
K. Shirley, Olivia L. Bolts, Lavinia A. Pinto et al.· Psychological services· 0 citations
Key challenges identified included the absence of integrated treatment for comorbid mental health conditions, frequent relapses, lack of culturally adaptive interventions, limited innovation in treatment approaches, minimal family involvement, and absence of individualized treatment planning.
F. Ahmed, Djamil A Malik· Foundation University Journa...· 0 citations
There is a recognized need for efforts that promote utilization and completion of trauma-focused evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). Patients referred to PTSD specialty clinics are often reluctant to engage in EBPs, especially if they are treatment-naive or had prior negative treatment experiences. To address this reluctance, we implemented PTSD101, a psychoeducation group led by peer specialists offered in a specialty PTSD clinic for veterans considering new PTSD services. This present study aimed to conduct a program evaluation of PTSD101 using pre-post data. The structured group consisted of seven 90-min sessions addressing: (a) civilian readjustment; (b) effects of trauma; (c) trust, safety, and self-care; (d) coping/healing; (e) survival strategies and relationships; (d) substance use and medication; and (f) PTSD treatment. Data were collected from 34 veterans across multiple group cohorts. Following completion of the group, over half of the veterans (n = 18) initiated a new behavioral health treatment service, including trauma-focused EBPs (n = 11). Significant improvements were also noted in measures of PTSD symptoms, depression symptoms, and illness management strategies and recovery outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Dezarie Moskal, Martin J. De Vita, Tangeria Adams et al.· Psychological services· 0 citations
Background Trauma affected youth in northwest Nigeria's humanitarian crisis face trauma exposure and limited mental health care; this study evaluated outcomes of a task-shifted, community delivered intervention. Methods A convergent parallel mixed-methods, quasi-experimental design was employed. Participants (N=412, aged 15–24) were allocated to intervention (n=206) receiving a culturally adapted 10-session group Trauma-Focused Cognitive Behavioural Therapy (CBT) delivered by trained community lay providers, or to the waitlist control (n=206). Primary outcomes were posttraumatic stress disorder (PTSD) symptoms (Child PTSD Symptom Scale [CPSS]) and functional impairment (WHO Disability Assessment Schedule for Children). Assessments occurred at baseline, post-intervention, and 3 month follow up. Analysis used intention to treat three level linear mixed models accounting for clustering within communities. Qualitative methods involved 24 key informant interviews analysed using thematic analysis following COREQ guidelines. Results At post-intervention, the intervention group showed significantly greater reductions in CPSS (mean difference: -8.3, 95% CI: -10.6 to -6.0, p<0.001, d=1.35) and WHODAS-Child scores (mean difference: -8.9, 95% CI: -11.5 to -6.3, p<0.001, d=1.40) compared to controls. Gains were maintained at follow-up. Qualitative themes highlighted the necessity of health system integration and community ownership for sustainability. Conclusion A task-shifted, community-delivered trauma-focused intervention demonstrates promising effectiveness in reducing PTSD symptoms and improving functioning among youth in northwest Nigeria, indicating potential for scale-up pending confirmatory evidence from randomised controlled trials and health system integration.
Yakubu Abdullahi, Bashar Summayyah, A. Audu et al.· Rwanda Journal of Medicine a...· 0 citations
Communities play a crucial role in addressing trauma-related stress. Broadly, community interventions include both evidence-based psychotherapies delivered in community-relevant settings, such as cognitive processing therapy (CPT), prolonged exposure (PE), and cognitive behavioral therapy (CBT), and community-tailored approaches adapted to local resources and service needs, such as Common Elements Treatment Approaches (CETA), community psychoeducation, and care management. Although an increasing number of studies have examined community interventions for posttraumatic stress disorder (PTSD) symptoms, debates persist, and systematic evidence remains limited. This study conducted a network meta-analysis (NMA) to assess and compare the effectiveness of community interventions for PTSD symptoms.
Randomized controlled trials (RCTs) were included if they examined community interventions for PTSD symptoms among trauma-exposed community populations. Studies were identified through Web of Science, Embase, PubMed, PsycINFO, Scopus, Wanfang, and CINAHL. Risk of bias was assessed using the Cochrane Risk of Bias Tool, and data were synthesized using Bayesian NMA with random-effects models.
Thirty-six RCTs involving 5,350 participants and 16 intervention types were included. The primary outcomes were immediate post-treatment and follow-up PTSD symptoms within 6 months; secondary outcomes included immediate depression and anxiety symptoms, and treatment attrition. PE (SMD = 1.69, 95% CrI [1.14, 2.24]) and CPT (SMD = 1.23, 95% CrI [0.81, 1.67]) showed relatively strong immediate effects on PTSD symptoms in community settings. When combined into a single node, community-tailored interventions showed a significant moderate immediate effect (SMD = 0.52, 95% CrI [0.34, 0.71]). When modeled separately, community-tailored psychological interventions, care management, psychoeducation, and CETA also showed significant moderate effects, with SMDs ranging from 0.48 to 0.59.
Trauma-focused interventions, particularly PE and CPT, appeared to show relatively strong effects in reducing PTSD symptoms in community settings, suggesting the potential value of approaches that incorporate cognitive restructuring and structured engagement with trauma-related cues. Community-tailored approaches showed some evidence of immediate benefit and may provide feasible, accessible support for trauma-affected populations, especially where specialist resources are limited. This NMA provides comparative evidence to guide the selection, adaptation, and delivery of PTSD interventions in community settings. PROSPERO registration number: CRD42023396053.
Xuan Wang, Rong Ma, Zhengyi Liu et al.· BMC Psychology· 0 citations
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