Aims To determine whether substituting Seeking Safety (SS), a manualized therapy for comorbid substance use disorders (SUD) and post-traumatic stress disorder (PTSD) for part of treatment-as-usual (TAU) improves substance use outcomes.
Design Randomized controlled effectiveness trial.
Settings Out-patient Veterans Administration Health Care System SUD clinic.
Participants Ninety-eight male military Veterans with a SUD and co-occurring PTSD symptomatology.
Measurements Drug and alcohol use and PTSD severity, measured on the first day of treatment, and 3 (i.e. the planned end of SS sessions) and 6 months following the baseline assessment. Treatment attendance and patient satisfaction were measured following treatment (3-month follow-up). Active coping was measured at treatment intake and following treatment.
Findings SS compared to TAU was associated with better drug use outcomes (P < 0.05), but alcohol use and PTSD severity decreased equally under both treatments (P's < 0.01). SS versus TAU was associated with increased treatment attendance, client satisfaction and active coping (all P's < 0.01). However, neither these factors nor decreases in PTSD severity mediated the effect of treatment on drug use.
Conclusions The manualized treatment approach for substance use disorder, Seeking Safety, is well received and associated with better drug use outcomes than ‘treatment as usual’ in male veterans with post-traumatic stress disorder. However, the mechanism of its effect is unclear.