Integrated exposure-based therapy for co-occurring post-traumatic stress and substance use among young people: a randomized controlled trial.

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.