Written exposure therapy for post-traumatic stress disorder in residential treatment for substance use disorders: A randomized feasibility trial.

BACKGROUND

PTSD often co-occurs with and may exacerbate substance use disorders (SUD), but PTSD treatment is rarely available in residential/inpatient SUD care. We conducted a pilot feasibility randomized controlled trial of treatment as usual plus Written Exposure Therapy (TAU+WET) vs. TAU in residential SUD care.

METHODS

N = 42 participants were randomly assigned to TAU + WET or TAU (60% men, 42% women; 39% Black, 37% white, 24% multiracial or another race; mean age = 37.43 years ± 10.79). PTSD symptoms were measured via the Posttraumatic Stress Disorder Checklist for DSM 5. Secondary outcomes were WET feasibility (completion rates) and acceptability (patient attitudes). Exploratory outcomes were depressive symptoms, trauma coping self-efficacy, emotion regulation difficulties, and substance use recovery capital.

RESULTS

PTSD symptoms in both groups significantly improved from pre- to post-WET, with larger reductions among TAU + WET vs. TAU participants (F[1,40] = 55.33, p < 0.001, np2 = 0.58; Mdiff = -24.67, SE = 3.63, p < 0.001, 95% CI [-32.00, -17.35] vs. Mdiff = -15.43, SE = 3.99, p < 0.001, 95% CI [-23.50, -7.37]. TAU + WET participants were more likely than TAU participants to achieve PTSD remission (52% vs. 21%; χ2 [1] = 4.42, p = 0.044, OR = 0.244, 95% CI [.062, 0.965]) and showed significantly greater improvement than TAU participants across all exploratory outcomes.

CONCLUSIONS

WET is effective, well tolerated, and may enhance TAU in residential substance use treatment. A larger RCT with a longer follow-up period is needed to assess post-residential SUD outcomes and whether improvements are maintained.