Trauma Affect Regulation: Guide for Education and Therapy (TARGET): An Evidence- Based Approach to the “BI and Ts” in T-SBIRT

Background and Purpose:  Youth and adults at risk for substance use disorders often are poly-victims, having suffered numerous types of traumatic events including child abuse and neglect, community victimization, sudden or violent loss of a loved one, and accidental injuries.  When identified by screening protocols, these individuals may benefit from a trauma-related brief intervention such as the T-SBIRT model developed by Topitzes and colleagues.  Critical skills to which T-SBIRT introduces clients are those that address the two focal impairments driving both traumatic stress and addiction: emotion dysregulation and executive dysfunction.  When these problems are clinically significant, referral to treatments that target these impairments is essential.  This paper provides a structured review of a well-validated, trauma-focused intervention to which trauma-affected youth and adults can be referred for comorbid traumatic stress and substance use disorders.  

 

Methods: Trauma Affect Regulation: Guide for Education and Therapy (TARGET) is a manualized but flexibly adaptable therapeutic intervention for youth and adults who are experiencing co-occurring post-traumatic stress disorder (PTSD) or other complex traumatic stress disorders (Ford, 2017, Complex trauma and complex PTSD, in Handbook of Trauma Psychology) and substance use or other behavioral health disorders.  Six randomized clinical trial efficacy studies and two quasi-experimental field trial effectiveness studies have been conducted to evaluate different variants of TARGET with high-risk traumatized youth and adults.

 

Results: Clinical and field trial studies (N > 500 youth/young adults and 400 adults) have demonstrated that TARGET is associated with clinically significant reductions in PTSD, depression, anxiety, dissociation, and substance use risk or disorders, as well as improvements in emotion regulation and substance-refusal self-efficacy.  Results from a recent pilot study evaluating TARGET in combination with internet-based cognitive behavior therapy for college student problem drinkers provided additional empirical support for TARGET as a brief and intensive therapeutic treatment for young adults.  In a trial comparing TARGET to exposure therapy, TARGET was shown to improve clinical outcomes for young adult and mid-life adults, i.e., male military veterans with PTSD and co-occurring anger and substance use problems.

 

Conclusions and Implications: TARGET appears to be applicable as a framework for both brief intervention and ongoing treatment within the T-SBIRT paradigm.  That is, when referral to treatment is indicated for recipients of T-SBIRT services, TARGET represents an optimal referral destination considering: a) the model focus on complex trauma symptoms; b) wide-ranging ages and client profiles served by the model; c) accommodations for co-morbid presentations within the model; d) flexible duration and dosage including brief and extended treatment courses; and e) a strong evidence-base.  In sum, taken together with T-SBIRT, TARGET provides a model for continuity of care across the continuum from prevention, early intervention, and intensive therapeutic intervention.