The prevalence of current posttraumatic stress disorder (PTSD) is many-fold higher in individuals with opioid use disorder (OUD) than in the general population. This study demonstrates that participants receiving MOUD who receive Prolonged Exposure (PE) tend to experience improvements in their PTSD symptoms without relapsing to substance use when they receive a sufficient “dose” of PE.
Kelly Peck, PhD
The prevalence of current posttraumatic stress disorder (PTSD) is many-fold higher in individuals with opioid use disorder (OUD) than in the general population. Prolonged exposure (PE) therapy is highly efficacious for improving PTSD symptoms. However, few studies have evaluated PE in individuals receiving medications for OUD (MOUD). Furthermore, the efficacy of PE has been limited by poor attendance, particularly among individuals receiving treatment for OUD and other substance use disorders.
The results of a trial recently published in Drug and Alcohol Dependence indicated that the combination of PE with financial incentives for attendance to therapy sessions increased therapy attendance and improved PTSD symptoms among individuals receiving MOUD treatment.
Kelly Peck, Ph.D led a randomized trial in collaboration with Jillian Giannini, M.A., Gary Badger, M.S., Rebecca Cole, B.A., and Stacey Sigmon, Ph.D. that sought to evaluate the initial efficacy of a novel protocol for improving PE attendance and PTSD symptoms among people receiving buprenorphine or methadone treatment. The trial was conducted at UVM between March 2021 and April 2023.
A total of 52 adults with PTSD who were receiving buprenorphine or methadone treatment were enrolled. Participants were randomly assigned to receive one of three 12-week experimental conditions: continued MOUD treatment as usual (TAU), (b) MOUD + Prolonged Exposure Therapy (PE), or (c) MOUD + PE with financial incentives contingent upon PE session attendance (PE+). PE+ participants attended more therapy sessions (88%) than PE participants (33%). Although participants in all three groups reported significant improvements in clinician-assessed PTSD symptoms, PE+ participants reported greater improvements in PTSD symptoms than TAU participants and achieved higher rates of diagnostic remission than TAU and PE participants. Importantly, participants who received PE did not exhibit an increase in substance use during treatment.
This study demonstrates that participants receiving MOUD who receive PE tend to experience improvements in their PTSD symptoms without relapsing to substance use when they receive a sufficient “dose” of PE. Financial incentives and other methods for increasing PE attendance are critical for alleviating the distress and reducing personal and societal costs associated with PTSD among individuals receiving MOUD.
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