Treatment for co-occurring posttraumatic stress disorder and substance use disorders among veterans and civilians: A test of causally moderated comparative effectiveness.
Shannon M Blakey, Antonio A Morgan-López, Alexander C Kline et al.
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In 30 seconds
This meta-analysis used secondary analyses of psychotherapy-arm data from 26 randomised controlled trials involving 3,228 veterans and civilians with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD). It examined whether veteran status moderated treatment outcomes. Trauma-focused psychotherapy for PTSD and integrated trauma-focused psychotherapy for PTSD and SUD were each superior to treatment as usual for alcohol-use severity, with stronger effects among veterans than civilians. Veteran status did not appear to modify comparative effects on PTSD or drug-use severity.
Key findings
- Both trauma-focused psychotherapy and integrated trauma-focused psychotherapy outperformed treatment as usual for alcohol-use severity; the effect was stronger among veterans.
- There was no evidence that veteran status modified treatment effects on PTSD severity relative to treatment as usual.
- There was no evidence that veteran status modified treatment effects on drug-use severity relative to treatment as usual.
Why it matters
The findings suggest that veteran status may help explain variation in alcohol-use outcomes when treating people with co-occurring PTSD and SUD. They also distinguish this outcome from PTSD and drug-use severity, for which differential response by veteran status was not supported. This may inform future research on matching patients to treatments while underscoring that subgroup effects should be interpreted in light of the evidence.
What to keep in mind
The analyses were secondary and limited to psychotherapy-arm data from the included trials; the abstract reports no quantitative effect estimates.