Disclosures: Healio Psychiatry was unable to confirm relevant financial disclosures at time of reporting.
July 24, 2020
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PTSD exposure therapy does not cause drug relapse, psychiatric symptoms

Disclosures: Healio Psychiatry was unable to confirm relevant financial disclosures at time of reporting.
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Exposure therapy did not appear to increase substance use or other psychiatric symptoms among individuals with PTSD and comorbid substance use disorder, according to study results published in Journal of Traumatic Stress.

Jessica Peirce

“Providers have not offered PTSD treatment to people with opioid and other addictions because they wanted to avoid harming them,” Jessica Peirce, PhD, associate director of Addiction Treatment Services and Center for Addiction and Pregnancy at Johns Hopkins Bayview Medical Campus, told Healio Psychiatry. “Our evidence counters that belief and now we need to understand that withholding effective treatment is more harmful. People with addiction should receive evidence-based effective treatment for PTSD, regardless of their drug use.”

Results of prior studies suggested approximately 25% of individuals with substance use disorders may have comorbid PTSD. Although prolonged exposure (PE) therapy has been shown to be one of the most effective PTSD treatments among populations without substance use disorders, an oft-cited clinical concern is its mechanism of the induction of anxiety within the context of therapy. Thus, some clinicians worry this anxiety may potentially trigger substance use.

Peirce and colleagues aimed to determine whether this common belief among mental health professionals was backed by evidence. Among a sample of 44 individuals with substance use disorder who received PE therapy for PTSD, the researchers evaluated within-session and session-to-session changes in craving and use of substances for multiple drug classes, as well as in PSTD and other psychiatric distress symptoms, across 12 sessions.

Results of visual analog scales showed no within-session craving increases, except for cocaine. Craving scores decreased across sessions for cocaine, benzodiazepines, heroin and methadone, and the researchers observed no craving increases. At each session, reported past-week substance use did not change. From session one to subsequent sessions, the severity of PTSD symptoms and self-reported emotional problems decreased, and no increases in other medical, social or psychiatric problems occurred.

Peirce and colleagues also found PTSD severity to be unrelated to substance use reported 1 or 2 weeks later. Moreover, past-week substance use was linked to higher PTSD severity scores at the next sessions; however, this association was not present 2 weeks later.

“There is no evidence of worsening of drug use or psychiatric distress when people with opioid and other drug use and PTSD participate in PE — a challenging but very effective treatment for PTSD. To the contrary, patients reported much less emotional distress and PTSD and some reduction in drug use and craving.”