Skip to main content

Advertisement

SpringerLink
Log in

Response-to-Treatment for Comorbid Post-Traumatic Stress and Substance Use Disorders: the Value of Combining Person- and Variable-Centered Approaches

  • Published:
Journal of Psychopathology and Behavioral Assessment Aims and scope Submit manuscript

Abstract

Optimizing treatment for co-occurring post-traumatic stress disorder and substance use disorder (PTSD+SUD) is critically important. Whereas treatments have been designed that target PTSD+SUD with some success, these treatments do not benefit all. Data-driven approaches that combine person- and variable-centered methods, such as parallel process latent class growth analysis (PP-LCGA) can be used to identify response-to-treatment trajectories across both PTSD symptoms and substance use. The current study employed PP-LCGA separately in two randomized clinical trials (study 1 n = 81, Mean age = 40.4 years, SD = 10.7; study 2 n = 59, Mean age = 44.7 years, SD = 9.4) to examine PTSD symptom response and percentage of days using substances across treatment trials comparing Concurrent Treatment of PTSD and SUD using Prolonged Exposure and Relapse Prevention. Results revealed four PTSD+SUD profiles for study one and three PTSD+SUD profiles for study two. For PTSD symptoms, response trajectories could be broadly classified into treatment responders and non-responders across both studies. For substance use, response trajectories could be broadly classified into declining, moderately stable, and abstaining profiles. When considering PTSD symptoms and substance use trajectories together, profiles emerged that would have been missed had these treatment outcomes been considered separately.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Allan, N. P., Gros, D. F., Myers, U. S., Korte, K. J., & Acierno, R. (2017). Predictors and outcomes of growth mixture modeled trajectories across an exposure-based PTSD intervention with veterans. Journal of Clinical Psychology, 73(9), 1048–1063 https://doi.org/10.1002/jclp.22408.

    PubMed  Google Scholar 

  • S. Back, E. Foa, T. Killeen, K. Mills, & M. Teesson (2014). Concurrent treatment of PTSD and substance use disorders using prolonged exposure (COPE): Therapist guide.

  • Beck, A. T., Steer, R., & Brown, G. K. (1996). Beck depression inventory-II. San Antonio: The Psychological Corporation.

    Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8(1), 75–90 https://doi.org/10.1002/jts.2490080106.

    PubMed  Google Scholar 

  • Blanchard, E. (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy, 34(8), 669–673 https://doi.org/10.1016/0005-7967(96)00033-2.

    PubMed  Google Scholar 

  • Blanco, C., Xu, Y., Brady, K., Pérez-Fuentes, G., Okuda, M., & Wang, S. (2013). Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: Results from national epidemiological survey on alcohol and related conditions. Drug and Alcohol Dependence, 132(3), 630–638 https://doi.org/10.1016/j.drugalcdep.2013.04.016.

    PubMed  PubMed Central  Google Scholar 

  • Bouchery, E., Harwood, H., Sacks, J., & Simon, C. (2011). Economic costs of excessive alcohol consumption in the US, 2006. American Journal of Preventive Medicine, 41(5), 516–524.

    PubMed  Google Scholar 

  • Boulet, J., & Boss, M. (1991). Reliability and validity of the brief symptom inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3(3), 433–437.

    Google Scholar 

  • Cacciola, J., Alterman, A., McLellan, A., & Lin, Y. (2007). Initial evidence for the reliability and validity of a “lite” version of the addiction severity index. Drug and Alcohol, 87, 297–302 Retrieved from http://www.sciencedirect.com/science/article/pii/S0376871606003322.

    Google Scholar 

  • Carroll, K. M. (1998). Treating drug dependence. In Treating addictive behaviors (pp. 217–229). Boston, MA: Springer US https://doi.org/10.1007/978-1-4899-1934-2_16.

    Google Scholar 

  • Clapp, J. D., Kemp, J. J., Cox, K. S., & Tuerk, P. W. (2016). Patterns of change in response to prolonged exposure: Implications for treatment outcome. Depression and Anxiety, 33(9), 807–815 https://doi.org/10.1002/da.22534.

    PubMed  Google Scholar 

  • Derogatis, L., & Savitz, K. (2000). The SCL–90–R and brief symptom inventory (BSI) in primary care. In M. Maruish (Ed.), Handbook of psychological assessment in primary care (pp. 297–334). Mahwah, NJ: Lawrence Erlbaum Associates Publishers Retrieved from http://psycnet.apa.org/psycinfo/2000-03632-009.

    Google Scholar 

  • Derogatis, L. R., & Spencer, P. M. (1993). Brief symptom inventory: BSI. Upper Saddle River, NJ: Pearson.

    Google Scholar 

  • Enders, C. K. (2010). Applied missing data analysis. New York, NY: Guilford Press.

    Google Scholar 

  • Falsetti, S. A., Resnick, H. S., Resick, P. A., & Kilpatrick, D. G. (1993). The modified PTSD symptom scale: A brief self-report measure of posttraumatic stress disorder. Behaviour, 16, 161–162.

    Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR Axis I disorders, research version, patient edition with psychotic screen. New York, NY: Biometrics Research, New York State Psychiatric Institute.

    Google Scholar 

  • Gielen, N., Havermans, R. C., Tekelenburg, M., & Jansen, A. (2012). Prevalence of post-traumatic stress disorder among patients with substance use disorder: It is higher than clinicians think it is. European Journal of Psychotraumatology, 3, 17734. https://doi.org/10.3402/ejpt.v3i0.17734.

    Google Scholar 

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54 https://doi.org/10.1023/B:JOBA.0000007455.08539.94.

    Google Scholar 

  • Gueorguieva, R., Wu, R., Donovan, D., Rounsaville, B. J., Couper, D., Krystal, J. H., & O’Malley, S. S. (2010). Naltrexone and combined behavioral intervention effects on trajectories of drinking in the COMBINE study. Drug and Alcohol Dependence, 107(2–3), 221–229 https://doi.org/10.1016/j.drugalcdep.2009.10.017.

    PubMed  Google Scholar 

  • Henson, J. M., Reise, S. P., & Kim, K. H. (2007). Detecting mixtures from structural model differences using latent variable mixture modeling: A comparison of relative model fit statistics. Structural Equation Modeling: A Multidisciplinary Journal, 14(2), 202–226 https://doi.org/10.1080/10705510709336744.

    Google Scholar 

  • Jung, T., & Wickrama, K. A. S. (2008). An introduction to latent class growth analysis and growth mixture modeling. Social and Personality Psychology Compass, 2, 302–317 https://doi.org/10.1111/j.1751-9004.2007.00054.x.

    Google Scholar 

  • Kaczkurkin, A. N., Asnaani, A., Alpert, E., & Foa, E. B. (2016). The impact of treatment condition and the lagged effects of PTSD symptom severity and alcohol use on changes in alcohol craving. Behaviour Research and Therapy, 79, 7–14 https://doi.org/10.1016/j.brat.2016.02.001.

    PubMed  PubMed Central  Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048–1060.

    PubMed  Google Scholar 

  • Korte, K. J., Allan, N. P., Gros, D. F., & Acierno, R. (2016). Differential treatment response trajectories in individuals with subclinical and clinical PTSD. Journal of Anxiety Disorders, 38, 95–101 https://doi.org/10.1016/j.janxdis.2016.01.006.

    PubMed  PubMed Central  Google Scholar 

  • Li, F., Cohen, A., Kim, S., & Cho, S. (2009). Model selection methods for mixture dichotomous IRT models. Applied Psychological Measurement, 33, 353–373 Retrieved from http://apm.sagepub.com/content/early/2009/03/02/0146621608326422.short.

    Google Scholar 

  • López-Castro, T., Hu, M. C., Papini, S., Ruglass, L. M., & Hien, D. A. (2015). Pathways to change: Use trajectories following trauma-informed treatment of women with co-occurring post-traumatic stress disorder and substance use disorders. Drug and Alcohol Review, 34(3), 242–251 https://doi.org/10.1111/dar.12230.

    PubMed  Google Scholar 

  • Lubke, G., & Muthén, B. O. (2007). Performance of factor mixture models as a function of model size, covariate effects, and class-specific parameters. Structural Equation Modeling: A Multidisciplinary Journal, 14(1), 26–47 https://doi.org/10.1080/10705510709336735.

    Google Scholar 

  • McCauley, J. L., Killeen, T., Gros, D. F., Brady, K. T., & Back, S. E. (2012). Posttraumatic stress disorder and co-occurring substance use disorders: Advances in assessment and treatment. Clinical Psychology: Science and Practice, 19(3), 283–304 https://doi.org/10.1111/cpsp.12006.

    Google Scholar 

  • McLellan, A., Cacciola, J., Carise, D., & Coyne, T. (1999). Addiction severity index lite—Clinical/training version. Philadelphia, PA: Treatment Research.

    Google Scholar 

  • Medicine, I. of. (2008). Treatment of posttraumatic stress disorder: An assessment of the evidence. Washington, DC: National Academic Press.

    Google Scholar 

  • Mills, K. L., Teesson, M., Ross, J., & Peters, L. (2006). Trauma, PTSD, and substance use disorders: Findings from the Australian National Survey of mental health and well-being. American Journal of Psychiatry, 163(4), 652–658 https://doi.org/10.1176/ajp.2006.163.4.652.

    PubMed  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998-2012). Mplus User’s Guide (eighth). Los Angeles, CA: Muthén & Muthén.

    Google Scholar 

  • Muthen, B., & Muthen, L. K. (2000). Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes. Alcoholism: Clinical and Experimental Research, 24(6), 882–891 https://doi.org/10.1111/j.1530-0277.2000.tb02070.x.

    Google Scholar 

  • Nagin, D. S. (1999). Analyzing developmental trajectories: A semiparametric, group-based approach. Psychological Methods, 4, 139–157.

    Google Scholar 

  • Nagin, D. S., & Tremblay, R. E. (2001). Analyzing developmental trajectories of distinct but related behaviors: A group-based method. Psychological Methods, 6(1), 18–34 https://doi.org/10.1037/1082-989X.6.1.18.

    PubMed  Google Scholar 

  • Najavits, L. M., & Hien, D. (2013). Helping vulnerable populations: A comprehensive review of the treatment outcome literature on substance use disorder and PTSD. Journal of Clinical Psychology, 69, 433–479. https://doi.org/10.1002/jclp.21980.

    Article  PubMed  Google Scholar 

  • Najavits, L. M., Harned, M. S., Gallop, R. J., Butler, S. F., Barber, J. P., Thase, M. E., & Crits-Cristoph, P. (2007). Six-month treatment outcomes of cocaine-dependent patients with and without PTSD in a multisite national trial. Journal of Studies on Alcohol and Drugs, 68, 353–361.

    PubMed  Google Scholar 

  • Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal, 14(4), 535–569 https://doi.org/10.1080/10705510701575396.

    Google Scholar 

  • Ouimette, P. C., Brown, P. J., & Najavits, L. M. (1998). Course and treatment of patients with both substance use and posttraumatic stress disorders. Addictive Behaviors, 23(6), 785–795 https://doi.org/10.1016/S0306-4603(98)00064-1.

    PubMed  Google Scholar 

  • Ouimette, P., Coolhart, D., Funderburk, J. S., Wade, M., & Brown, P. J. (2007). Precipitants of first substance use in recently abstinent substance use disorder patients with PTSD. Addictive Behaviors, 32(8), 1719–1727 https://doi.org/10.1016/j.addbeh.2006.11.020.

    PubMed  Google Scholar 

  • Petras, H., & Masyn, K. (2010). General growth mixture analysis with antecedents and consequences of change. In Handbook of quantitative criminology (pp. 69–100). New York, NY: Springer New York https://doi.org/10.1007/978-0-387-77650-7_5.

    Google Scholar 

  • Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2011). Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: Results from wave 2 of the National Epidemiologic Survey on alcohol and related conditions. Journal of Anxiety Disorders, 25(3), 456–465 https://doi.org/10.1016/j.janxdis.2010.11.010.

    PubMed  Google Scholar 

  • Pineau, J., Bellemare, M. G., Rush, A. J., Ghizaru, A., & Murphy, S. A. (2007). Constructing evidence-based treatment strategies using methods from computer science. Drug and Alcohol Dependence, 88, S52–S60. https://doi.org/10.1016/j.drugalcdep.2007.01.005.

    Article  PubMed  PubMed Central  Google Scholar 

  • Possemato, K., Maisto, S. A., Wade, M., Barrie, K., McKenzie, S., Lantinga, L. J., & Ouimette, P. (2015). Ecological momentary assessment of PTSD symptoms and alcohol use in combat veterans. Psychology of Addictive Behaviors : Journal of the Society of Psychologists in Addictive Behaviors, 29(4), 894–905 https://doi.org/10.1037/adb0000129.

    Google Scholar 

  • Reynolds, M., Mezey, G., Chapman, M., Wheeler, M., Drummond, C., & Baldacchino, A. (2005). Co-morbid post-traumatic stress disorder in a substance misusing clinical population. Drug and Alcohol Dependence, 77(3), 251–258 https://doi.org/10.1016/j.drugalcdep.2004.08.017.

    PubMed  Google Scholar 

  • Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. I. (2015). Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: A systematic review and meta-analysis. Clinical Psychology Review, 38, 25–38 https://doi.org/10.1016/j.cpr.2015.02.007.

    PubMed  Google Scholar 

  • Ruglass, L. M., Papini, S., Trub, L., & Hien, D. A. (2014). Psychometric properties of the modified posttraumatic stress disorder symptom scale among women with posttraumatic stress disorder and substance use disorders receiving outpatient group treatments. Journal of Traumatic Stress Disorders & Treatment, 4(1) https://doi.org/10.4172/2324-8947.1000139.

  • Ruglass, L. M., Lopez-Castro, T., Papini, S., Killeen, T., Back, S., & Hien, D. A. (2017). Concurrent treatment with prolonged exposure for co-occurring full or subthreshold posttraumatic stress disorder and substance use disorders: A randomized clinical trial. Psychotherapy and Psychosomatics, 86(3), 150–161. https://doi.org/10.1159/000462977.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schumm, J. A., Walter, K. H., & Chard, K. M. (2013). Latent class differences explain variability in PTSD symptom changes during cognitive processing therapy for veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 5(6), 536–544. https://doi.org/10.1037/a0030359 (supplemental).

  • Sheehan, D. V., Janavs, J., Baker, R., Harnett-Sheehan, K., Knapp, E., Sheehan, M., Lecrubier, Y., Weiller, E., Hergueta, T., Amorim, P., Bonora, L. I., & Lepine, J. P. (1998). MINI-Mini international neuropsychiatric interview-English version 5.0.0-DSM-IV. Journal of Clinical Psychiatry, 59, 34–57.

    Google Scholar 

  • Sloan, D. M., & Kring, A. M. (2007). Measuring changes in emotion during psychotherapy: Conceptual and methodological issues. Clinical Psychology: Science and Practice, 14(4), 307–322 https://doi.org/10.1111/j.1468-2850.2007.00092.x.

    Google Scholar 

  • Sobell, L. C., & Sobell, M. B. (1992). Timeline follow-Back. In Measuring alcohol consumption (pp. 41–72). Totowa, NJ: Humana Press https://doi.org/10.1007/978-1-4612-0357-5_3.

    Google Scholar 

  • Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1983). STAI manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Stein, N. R., Dickstein, B. D., Schuster, J., Litz, B. T., & Resick, P. A. (2012). Trajectories of response to treatment for posttraumatic stress disorder. Behavior Therapy, 43(4), 790–800 https://doi.org/10.1016/j.beth.2012.04.003.

    PubMed  PubMed Central  Google Scholar 

  • van Dam, D., Vedel, E., Ehring, T., & Emmelkamp, P. M. G. (2012). Psychological treatments for concurrent posttraumatic stress disorder and substance use disorder: A systematic review. Clinical Psychology Review, 32(3), 202–214 https://doi.org/10.1016/j.cpr.2012.01.004.

    PubMed  Google Scholar 

  • Wang, P., Lane, M., Olfson, M., & Pincus, H. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629–640.

    PubMed  Google Scholar 

  • Weathers, F., Huska, J., & Keane, T. (1991). The PTSD checklist military version (PCL-M). Boston, MA: National Center for PTSD.

    Google Scholar 

  • Weathers, F. W., Keane, T. M., & Davidson, J. R. T. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13(3), 132–156 https://doi.org/10.1002/da.1029.

    PubMed  Google Scholar 

  • Weiss, R., Hufford, C., Najavits, L., & Shaw, S. (1995). Weekly substance use inventory, Unpublished measure, Harvard University medical school. Boston: MA Retrieved from https://scholar.google.com/scholar?q=Weiss%2C+Hufford%2C+%26+Najavits%2C+1995+substance+use+inventory&btnG=&hl=en&as_sdt=0%2C36.

    Google Scholar 

  • Witkiewitz, K., van der Maas, H. L. J., Hufford, M. R., & Marlatt, G. A. (2007). Nonnormality and divergence in posttreatment alcohol use: Reexamining the Project MATCH data “another way.”. Journal of Abnormal Psychology, 116(2), 378–394 https://doi.org/10.1037/0021-843X.116.2.378.

    PubMed  PubMed Central  Google Scholar 

  • Zandberg, L. J., Rosenfield, D., Alpert, E., McLean, C. P., & Foa, E. B. (2016). Predictors of dropout in concurrent treatment of posttraumatic stress disorder and alcohol dependence: Rate of improvement matters. Behaviour Research and Therapy, 80, 1–9 https://doi.org/10.1016/j.brat.2016.02.005.

    PubMed  PubMed Central  Google Scholar 

Download references

Disclosures and Acknowledgements

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of NIH, the VA, or the United States government.

Author information

Authors and Affiliations

  1. Department of Psychology, Ohio University, Athens, OH, United States

    Nicholas P. Allan

  2. Department of Psychology, The City College of New York, New York, NY, United States

    Teresa López-Castro & Lesia M. Ruglass

  3. Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi, Garden City, NY, United States

    Denise A. Hien

  4. Department of Psychology, University of Texas, Austin, TX, United States

    Santiago Papini

  5. Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States

    Therese K. Killeen, Daniel F. Gros, Emma Barrett & Sudie E. Back

  6. Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States

    Daniel F. Gros & Sudie E. Back

Authors
  1. Nicholas P. Allan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Teresa López-Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Denise A. Hien
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Santiago Papini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Therese K. Killeen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel F. Gros
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lesia M. Ruglass
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Emma Barrett
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sudie E. Back
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicholas P. Allan.

Ethics declarations

Funding

The authors would like to acknowledge support from the National Institute on Drug Abuse grants R01 DA030143 (Back, S.E.), K02 DA039229 (Back, S.E.), and R01 DA10843 (Hien, D. A.).

Conflict of Interest

Several authors (SB and TK) are authors of the COPE therapy manuals.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Allan, N.P., López-Castro, T., Hien, D.A. et al. Response-to-Treatment for Comorbid Post-Traumatic Stress and Substance Use Disorders: the Value of Combining Person- and Variable-Centered Approaches. J Psychopathol Behav Assess 42, 725–738 (2020). https://doi.org/10.1007/s10862-020-09803-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10862-020-09803-w

Keywords

Search

Navigation