Adolescent exposure-based treatment safe, feasible for co-occurring substance abuse, PTSD symptoms

Carla Kmett Danielson

Risk reduction through family therapy, or RRFT, among adolescents resulted in within-group improvements in substance use problems and PTSD symptoms compared with treatment as usual, according to results of a randomized clinical trial published in JAMA Psychiatry.

“RRFT incorporates exposure therapy, which is a gold standard treatment approach for PTSD that involves direct discussion of the traumatic events experienced by these youth,” Carla Kmett Danielson, PhD, of the department of psychiatry and behavioral sciences at Medical University of South Carolina, told Healio Psychiatry. "To date, clinical lore suggested that it may be unsafe to engage in exposure therapy adolescents who have PTSD symptoms and are using substances, as the discussion of the trauma memories may lead to distress-related increases in substance use behaviors. This study indicates that exposure therapy, in conjunction with substance use interventions, is not only safe but also helpful."

According to Danielson and colleagues, RRFT was developed to address intervention needs for adolescents with co-occurring substance use problems and PTSD symptoms. To test its effectiveness, they enrolled 124 participants aged 13 to 18 years who engaged in nontobacco substance use once or more during the past 90 days, reported five or more PTSD symptoms and experienced at least one interpersonal traumatic event. Participants were recruited from and treatment was administered at community-based child advocacy centers in the Southeastern United States. The researchers collected blinded assessments at baseline and at 3, 6, 12 and 18 months after baseline. A total of 61 participants were randomly assigned to RRFT and 63 to treatment as usual.

Danielson and colleagues found that RRFT resulted in significantly greater reductions in substance-using days from baseline to 12 months (event rate [ER] = 0.29; 95% CI, 0.12-0.65) and 18 months (ER = 0.1; 95% CI, 0.04-0.24) compared with treatment as usual. Further, those in RRFT groups experienced significant within-group reductions in PTSD symptoms from baseline to 3 months (beta = –9.25; 95% CI, –12.95 to –5.55), 6 months (beta = –16.63; 95% CI, –20.4 to –12.87), 12 months (beta = –17.51; 95% CI, –21.62 to –13.4) and 18 months (beta = –19.02; 95% CI, –23.07 to –14.96). The researchers did not observe between-group differences, they noted.

“We should be taking an integrative approach to the treatment of substance use problems and PTSD symptoms among adolescents, including those who have experienced interpersonal traumatic events," Danielson said. "My hope is that these findings will transform practice such that mental health treatment centers and substance abuse treatment centers alike will embrace the notion of integrative treatment." – by Joe Gramigna

Disclosures: Danielson reports receiving grants from the National Institute on Drug Abuse. Please see the study for all other authors’ relevant financial disclosures.