A Systematic Review of Integrative Treatments for Posttraumatic Stress Disorder and Substance Use Disorders

Background and Purpose: In the United States, an estimated 10 million individuals experienced post-traumatic stress disorder (PTSD) and 18 million experienced a diagnosable substance use disorder (SUD) within the past year, with treatment costs often exceeding $21 billion annually. Furthermore, recent evidence suggests a 30-60% co-occurrence rate between PTSD and SUDs. While integrative approaches treating co-occurring PTSD and SUD have an evidence base, it remains unclear whether this base supports efficacy for all client populations, including those from armed services backgrounds. This systematic review examines current evidence for integrative treatments of PTSD and SUD. The goal of this review is to provide practitioners evaluations of the evidence base in order to provide timely, effective and cost efficient treatment.

Methods: Databases including Pubmed/MEDLINE, Psychinfo, social work abstracts, Education Resources Information Center, social service abstracts, sociological abstracts, and the Cochrane Central Register of Controlled Trials were searched for 20 years’ worth of publications. A refined examination of publication titles and abstracts based on specific criteria yielded 16 publications. Criteria outlined were that each publication must 1) have quantitative results, 2) measure outcomes associated with substance use, 3) be presented in a peer-reviewed journal, 4) examined non-nicotine/non-cannabis related substance use disorder and 5) be in English. Only 2 of the 16 publications identified employed an experimental design. Thus, all publications were assessed using guidelines outlined by the U.S. Preventive Services Task Force Group (Harris et al., 2001), which offers a quality rating of Good (RCT design, delineated intervention, adequate sample size & diversity, low attrition), Fair (no control group or criteria for Good unmet), or Poor (no control design, confounders not controlled, high attrition or small sample size).

Results: Of the 16 publications reviewed, 4 were classified as Good, 2 as Fair, and 6 as Poor. While treatment approaches and included samples were diverse, the review identified 5 types of treatment approaches ; Treatments for combined gender outpatient settings, treatments for men with no armed services experience, treatments for outpatient men and women, treatments for men with armed services experience, and peer-led treatment approaches. Treatments for outpatient men and women and treatments for all female groups offered the most evidence for effective interventions, while peer-led treatment and treatments for men with armed services experience. Treatments for men in with no armed services experience and treatments for all female groups offered moderate evidence for efficacy.

Conclusions and Implications: For social work practitioners looking to establish evidence-based interventions or engage in effective referral practices for integrative treatments for PTSD and SUDs, treatments for all-female groups and combined gender outpatient settings offer the most compelling evidence based on available literature and methodology used. However, for some clients, including those who may prefer peer-led models of treatment or men currently or formerly in the armed services, there are large gaps in the available literature, leaving doubt about integrative treatment efficacy for all clients. Future social work practice may assist in closing this gap through increased emphasis on the alignment between client conditions, selected intervention and intended outcomes.